Associations of socioeconomic status with infectious diseases mediated by lifestyle, environmental pollution and chronic comorbidities: a comprehensive evaluation based on UK Biobank | Infectious Diseases of Poverty

Study population

UKB is a repository of research data sourced from ~ 500,000 UK-wide participants aged around 40–70 years old, recruited from 22 assessment centers during 2006–2010 [28]. We used data collected for each participant from enrollment to March 26, 2021. In brief, data in the UKB repository was grouped into 277 categories, and we retrieved those related to (i) socioeconomic factors (categories 100,066, 100,063, and 100,064); (ii) lifestyle factors (categories 100,058, 100,054, 100,052, 100,051, 100,057, and 143); (iii) environmental pollution factors (categories 114 and 115); (iv) health outcome factors (categories 2002, 100,074, 100,060, 137, and 100,092) (Additional file 1: Table S1) [29]. Note that although an individual’s SES and lifestyle may change over time, we used the baseline survey data to define the socioeconomic and lifestyle status of each participant. A research protocol for our study has obtained all necessary approvals from the UKB’s review committees. We accessed to the UKB cohort consisting of 502,462 individuals. Following Yang and Zhou [30, 31], we removed individuals: (i) who have sex mismatched; (ii) who are redacted and thus do not have a corresponding ID; (iii) who have missing information on socioeconomic factors or other covariates. Finally, we retained 412,258 participants in UKB for subsequent analysis (Fig. 1a).

Fig. 1

Flowchart of the participants selection in the UK Biobank (a) and US NHANES (b). SES socioeconomic status

In US NHANES, we included 101,316 participants surveyed from 1999 to 2018, and followed Zhang et al. to remove individuals: (i) who were less than 20 years old; (ii) who were pregnant; (iii) who had missing information on socioeconomic factors or other covariates; (iv) who had non-positive sample weights for an interview or health examination in the datasets [32]. Finally, we retained 45,671 participants in US NHANES for subsequent analysis (Fig. 

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Association between healthy lifestyle and memory decline in older adults: 10 year, population based, prospective cohort study


Objective To identify an optimal lifestyle profile to protect against memory loss in older individuals.

Design Population based, prospective cohort study.

Setting Participants from areas representative of the north, south, and west of China.

Participants Individuals aged 60 years or older who had normal cognition and underwent apolipoprotein E (APOE) genotyping at baseline in 2009.

Main outcome measures Participants were followed up until death, discontinuation, or 26 December 2019. Six healthy lifestyle factors were assessed: a healthy diet (adherence to the recommended intake of at least 7 of 12 eligible food items), regular physical exercise (≥150 min of moderate intensity or ≥75 min of vigorous intensity, per week), active social contact (≥twice per week), active cognitive activity (≥twice per week), never or previously smoked, and never drinking alcohol. Participants were categorised into the favourable group if they had four to six healthy lifestyle factors, into the average group for two to three factors, and into the unfavourable group for zero to one factor. Memory function was assessed using the World Health Organization/University of California-Los Angeles Auditory Verbal Learning Test, and global cognition was assessed via the Mini-Mental State Examination. Linear mixed models were used to explore the impact of lifestyle factors on memory in the study sample.

Results 29 072 participants were included (mean age of 72.23 years; 48.54% (n=14 113) were women; and 20.43% (n=5939) were APOE ε4 carriers). Over the 10 year follow-up period (2009-19), participants in the favourable group had slower memory decline than those in the unfavourable group (by 0.028 points/year, 95% confidence interval 0.023 to 0.032, P<0.001). APOE ε4 carriers with favourable (0.027, 95% confidence interval 0.023 to 0.031) and average (0.014, 0.010 to 0.019) lifestyles exhibited a slower memory decline than those with unfavourable lifestyles. Among people who were not carriers of APOE

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Healthy lifestyle and life expectancy with and without Alzheimer’s dementia: population based cohort study


Objective To determine the impact of lifestyle factors on life expectancy lived with and without Alzheimer’s dementia.

Design Prospective cohort study.

Setting The Chicago Health and Aging Project, a population based cohort study in the United States.

Participants 2449 men and women aged 65 years and older.

Main exposure A healthy lifestyle score was developed based on five modifiable lifestyle factors: a diet for brain health (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay—MIND diet score in upper 40% of cohort distribution), late life cognitive activities (composite score in upper 40%), moderate or vigorous physical activity (≥150 min/week), no smoking, and light to moderate alcohol consumption (women 1-15 g/day; men 1-30 g/day).

Main outcome Life expectancy with and without Alzheimer’s dementia in women and men.

Results Women aged 65 with four or five healthy factors had a life expectancy of 24.2 years (95% confidence interval 22.8 to 25.5) and lived 3.1 years longer than women aged 65 with zero or one healthy factor (life expectancy 21.1 years, 19.5 to 22.4). Of the total life expectancy at age 65, women with four or five healthy factors spent 10.8% (2.6 years, 2.0 to 3.3) of their remaining years with Alzheimer’s dementia, whereas women with zero or one healthy factor spent 19.3% (4.1 years, 3.2 to 5.1) with the disease. Life expectancy for women aged 65 without Alzheimer’s dementia and four or five healthy factors was 21.5 years (20.0 to 22.7), and for those with zero or one healthy factor it was 17.0 years (15.5 to 18.3). Men aged 65 with four or five healthy factors had a total life expectancy of 23.1 years (21.4 to 25.6), which is 5.7 years longer than men aged 65 with zero or one healthy factor (life expectancy 17.4 years, 15.8 to 20.1). Of the total life expectancy

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