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Original Articles
Impaired pulmonary function mediates the impact of preterm birth on later-life stroke: a 2-step, multivariable Mendelian randomization study
Xingzhi Guo, Peng Tang, Chen Hou, Yue Liu, Rui Li
Epidemiol Health. 2023;45:e2023031.   Published online March 3, 2023
DOI: https://doi.org/10.4178/epih.e2023031
  • 9,350 View
  • 200 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Observational studies have suggested an association between preterm birth and stroke in late adulthood, but it remains unclear whether the association is causal. The purpose of this study was to evaluate the causal effects of gestational age on stroke and to determine the pathophysiological mechanisms underlying the causal associations.
METHODS
Two-sample Mendelian randomization (MR) was performed to assess the causal effects of fetal gestational duration, early preterm birth (EPB), preterm birth, or postterm birth on stroke and its subtypes. Two-step Mendelian randomization (TSMR) and multivariable Mendelian randomization (MVMR) were additionally used to determine the role of common stroke risk factors, including cardiovascular diseases, hypertension, pulmonary impairment, inflammation, and metabolic diseases, in mediating the causal associations between gestational age and stroke and its subtypes.
RESULTS
Genetically predicted EPB increased the risk of cardioembolic stroke (CES; odds ratio [OR], 1.115; 95% confidence interval [CI], 1.036 to 1.200; p=0.004) and large artery stroke (LAS; OR, 1.131; 95% CI, 1.031 to 1.241; p=0.009). The TSMR results showed that EPB was associated with a lower forced expiratory volume in the first second and forced vital capacity ratio (FEV1/FVC) (β=-0.020; 95% CI, -0.035 to -0.005; p=0.009), which increased the risk of CES and LAS. Further MVMR analysis showed that the associations between EPB and stroke disappeared after adjustment for FEV1/FVC.
CONCLUSIONS
Our data demonstrate that EPB is causally associated with an elevated risk of CES and LAS, and that pulmonary dysfunction mediates the causal impact of EPB on CES and LAS.
Summary
Key Message
Genetically predicted early preterm birth (EPB) is significantly associated with an increased risk of cardioembolic stroke (CES) and large artery stroke (LAS). Further multivariable Mendelian randomization analysis demonstrates that pulmonary impairment mediates the causal impact of EPB on CES and LAS in adulthood.

Citations

Citations to this article as recorded by  
  • Methodological approaches, challenges, and opportunities in the application of Mendelian randomisation to lifecourse epidemiology: A systematic literature review
    Grace M. Power, Eleanor Sanderson, Panagiota Pagoni, Abigail Fraser, Tim Morris, Claire Prince, Timothy M. Frayling, Jon Heron, Tom G. Richardson, Rebecca Richmond, Jessica Tyrrell, Nicole Warrington, George Davey Smith, Laura D. Howe, Kate M. Tilling
    European Journal of Epidemiology.2024; 39(5): 501.     CrossRef
  • Tumor necrosis factor mediates the impact of PM2.5 on bone mineral density: Inflammatory proteome Mendelian randomization and colocalization analyses
    Mingzheng Li, Peng Shi, Huajie Yang, Suyuan Tong, Nianfeng Qiu, Fan Yao, Yuan Du, Shuhua Xi, Fei Wang
    Ecotoxicology and Environmental Safety.2024; 270: 115896.     CrossRef
  • Causal associations of circulating Helicobacter pylori antibodies with stroke and the mediating role of inflammation
    Xingzhi Guo, Peng Tang, Xin Zhang, Rui Li
    Inflammation Research.2023; 72(6): 1193.     CrossRef
  • Causal relationship between Helicobacter pylori antibodies and gastroesophageal reflux disease (GERD): A mendelian study
    Jiaqin Chen, Junning Zhang, Xiaolu Ma, Yuehan Ren, Yi Tang, Zhongmian Zhang, Wangyu Ye, Xiyan Zhang, Zili Lin, Lan Wang, Zhihong Li, Yasin Sahin
    PLOS ONE.2023; 18(12): e0294771.     CrossRef
Associations of racial and ethnic discrimination with adverse changes in exercise and screen time during the COVID-19 pandemic in the United States
Tong Xia, Gilbert C. Gee, Jian Li, Xinyue Liu, Jin Dai, Lu Shi, Donglan Zhang, Zhuo Chen, Xuesong Han, Yan Li, Hongmei Li, Ming Wen, Dejun Su, Liwei Chen
Epidemiol Health. 2023;45:e2023013.   Published online January 28, 2023
DOI: https://doi.org/10.4178/epih.e2023013
  • 11,131 View
  • 115 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
During the coronavirus disease 2019 (COVID-19) pandemic, a growing prevalence of racial and ethnic discrimination occurred when many Americans struggled to maintain healthy lifestyles. This study investigated the associations of racial and ethnic discrimination with changes in exercise and screen time during the pandemic in the United States.
METHODS
We included 2,613 adults who self-identified as non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, or Hispanic from the Health, Ethnicity, and Pandemic study, a cross-sectional survey conducted among a nationally representative sample of United States adults between October and November 2020. We assessed self-reported racial and ethnic discrimination by measuring COVID-19-related racial and ethnic bias and examined its associations with changes in exercise and screen time using multivariable logistic regression models. We analyzed data between September 2021 and March 2022.
RESULTS
COVID-19-related racial and ethnic bias was associated with decreased exercise time among non-Hispanic Asian (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.13 to 1.89) and Hispanic people (OR, 1.91; 95% CI, 1.32 to 2.77), and with increased screen time among non-Hispanic Black people (OR, 1.94; 95% CI, 1.33 to 2.85), adjusting for age, sex, education, marital status, annual household income, insurance, and employment status.
CONCLUSIONS
Racial and ethnic discrimination may have adversely influenced exercise and screen time changes among racial and ethnic minorities during the COVID-19 pandemic in the United States. Further studies are needed to investigate the mechanisms through which racial and ethnic discrimination can impact lifestyles and to develop potential strategies to address racial and ethnic discrimination as a barrier to healthy lifestyles.
Summary
Key Message
In this study with a nationally representative sample of Americans, we found that racial discrimination during the COVID-19 pandemic was associated with undesired changes in exercise and screen time, particularly among minorities.

Citations

Citations to this article as recorded by  
  • Asian American Women’s Experiences of Discrimination and Health Behaviors during the COVID-19 Pandemic
    Katarina Wang, Alice Guan, Janice Seto, Debora L. Oh, Kathie Lau, Christine Duffy, Esperanza Castillo, Valerie McGuire, Michelle Wadhwa, Clifford G. Tepper, Heather A. Wakelee, Mindy C. DeRouen, Salma Shariff-Marco, Iona Cheng, Scarlett Lin Gomez
    Journal of Immigrant and Minority Health.2024; 26(2): 421.     CrossRef
  • Facilitators, motivations, and barriers to physical activity among Chinese American women
    Jingxi Sheng, Hao Lei, Demetrius A. Abshire, Horng-Shiuann Wu, Michael D. Wirth, Sue P. Heiney
    Discover Social Science and Health.2024;[Epub]     CrossRef
  • Social Determinants of Cardiovascular Health in Asian Americans: A Scientific Statement From the American Heart Association
    Nilay S. Shah, Namratha R. Kandula, Yvonne Commodore-Mensah, Brittany N. Morey, Shivani A. Patel, Sally Wong, Eugene Yang, Stella Yi
    Circulation.2024; 150(16): e296.     CrossRef
The associations of job strain and leisure-time physical activity with the risk of hypertension: the population-based Midlife in the United States cohort study
Xinyue Liu, Timothy A. Matthews, Liwei Chen, Jian Li
Epidemiol Health. 2022;44:e2022073.   Published online September 7, 2022
DOI: https://doi.org/10.4178/epih.e2022073
  • 11,710 View
  • 253 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Job strain is positively associated with incident hypertension, while increasing leisure-time physical activity (LTPA) can reduce incident hypertension. However, the joint associations of job strain and LTPA with incident hypertension among United States workers have yet to be investigated. This study examined the independent and joint associations of job strain and LTPA with incident hypertension.
METHODS
This prospective cohort study (n=1,160) utilized data from the population-based Midlife in the United States study. The associations of job strain and LTPA at baseline with incident hypertension during follow-up were examined using Cox proportional hazards models. High job strain was derived from a combination of high job demands and low job control, and high LTPA was defined as engagement in moderate or vigorous LTPA at least once per week.
RESULTS
During 9,218 person-years of follow-up, the hypertension incidence rate was 30.6 (95% confidence interval [CI], 27.3 to 34.3) per 1,000 person-years. High job strain was associated with a higher risk for hypertension than low job strain (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.00 to 1.67). High LTPA was associated with lower hypertension risk than low LTPA (aHR, 0.77; 95% CI, 0.60 to 0.98). Hypertension risk was higher among workers with high job strain and low LTPA than among those with low job strain and high LTPA (aHR, 1.70; 95% CI, 1.18 to 2.43).
CONCLUSIONS
Job strain and LTPA showed positive and inverse associations, respectively, with incident hypertension. The combination of high job strain and low LTPA was associated with the highest risk for hypertension.
Summary
Key Message
High job strain and low leisure-time physical activity are independent risk factors for hypertension among workers, and those with high job strain and low leisure-time physical activity are at the highest risk, so it is critical that policy interventions target job strain and leisure-time physical activity to reduce hypertension.

Citations

Citations to this article as recorded by  
  • Alternative Formulations of Job Strain and Sleep Disturbances: A Longitudinal Study in the United States
    Yijia Sun, Megan Guardiano, Mayumi Saiki, Jian Li
    American Journal of Industrial Medicine.2025; 68(3): 264.     CrossRef
  • Dose–response relationship between leisure-time physical activity and metabolic syndrome in short sleep US adults: evidence from a nationwide investigation
    Yanwei You, Hao Ding, Meihua Tang, Weizhao Wang, Ning Yan, Leizi Min, Yuquan Chen, Xindong Ma
    Applied Physiology, Nutrition, and Metabolism.2025; 50: 1.     CrossRef
  • Prospective associations of occupational and leisure-time physical activity with risk of diabetes: a cohort study from the United States
    Timothy A Matthews, Xinyue Liu, Liwei Chen, Jian Li
    Annals of Work Exposures and Health.2024; 68(6): 581.     CrossRef
  • The association between leisure‐time physical activity and cardiorespiratory and muscular fitness and job strain—Study with a Northern Finland birth cohort of 1966
    Heli Kiema‐Junes, Aino Saarinen, Raija Korpelainen, Leena Ala‐Mursula, Maisa Niemelä, Vahid Farrahi, Mirka Hintsanen
    Stress and Health.2024;[Epub]     CrossRef
  • 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension
    Giuseppe Mancia, Reinhold Kreutz, Mattias Brunström, Michel Burnier, Guido Grassi, Andrzej Januszewicz, Maria Lorenza Muiesan, Konstantinos Tsioufis, Enrico Agabiti-Rosei, Engi Abd Elhady Algharably, Michel Azizi, Athanase Benetos, Claudio Borghi, Jana Br
    Journal of Hypertension.2023; 41(12): 1874.     CrossRef
  • Adulthood Psychosocial Disadvantages and Risk of Hypertension in U.S. Workers: Effect Modification by Adverse Childhood Experiences
    Timothy A. Matthews, Yifang Zhu, Wendie Robbins, Mary Rezk-Hanna, Paul M. Macey, Yeonsu Song, Jian Li
    Life.2022; 12(10): 1507.     CrossRef
  • Associations of COVID-19 Related Work Stressors with Psychological Distress: Racial and Ethnic Disparities in Californian Workers
    Timothy A. Matthews, Megan Guardiano, Negar Omidakhsh, Lara Cushing, Wendie Robbins, OiSaeng Hong, Jian Li
    International Journal of Environmental Research and Public Health.2022; 20(1): 144.     CrossRef
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