BACKGROUND: This study investigates the association between frailty and mortality in Eastern European populations, which remains largely unexplored compared with Western Europe. The aim is to assess the risk of all-cause and cardiovascular mortality associated with varying levels of frailty. METHODS: A prospective multicentre cohort study was conducted, involving random population samples from the Czech Republic, Poland and Lithuania. The baseline survey (2002-2005) included 26 746 individuals aged 45-69 years, with an average follow-up of 13 years. Frailty was measured using a Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI), calculating the number of deficits in each domain. Cox proportional regression models and inverse probability weighting (IPW) were employed to account for risk factor differences among the frailty groups: robust, prefrail, mild, moderate and severe. RESULTS: The study included 14 287 people, among whom 891 were frail, with a total of 2402 deaths.Compared with non-frail persons, those with mild (IPW HR 2.06, 95% CI 1.60 to 2.66) and severe (IPW HR 2.71, 95% CI 1.45 to 5.07) frailty had more than twofold elevated risk of all-cause mortality. For cardiovascular mortality, the corresponding HRs were (IPW HR 3.05, 95% CI 2.14 to 4.35) and (IPW HR 3.88, 95% CI 1.95 to 7.74). Men exhibited a higher mortality risk at all frailty levels only in unweighted analysis. Country-specific differences were not significant. CONCLUSIONS: A CGA-based FI is an independent predictor of all-cause and cardiovascular mortality, with even mild frailty increasing the risk. Implementing frailty assessments can improve health risk prediction in older adults from Eastern Europe.

• Keywords
• AGING, COHORT STUDIES, MORTALITY,
• MeSH
• Geriatric Assessment * MeSH
• Cardiovascular Diseases * mortality   MeSH
• Frailty * mortality   MeSH
• Frail Elderly * statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Cause of Death MeSH
• Proportional Hazards Models MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Lithuania epidemiology   MeSH
• Poland epidemiology   MeSH
• Europe, Eastern epidemiology   MeSH

AIMS: Impaired lung function has been strongly associated with cardiovascular disease (CVD) events. We aimed to assess the additive prognostic value of spirometry indices to the risk estimation of CVD events in Eastern European populations in this study. METHODS: We randomly selected 14,061 individuals with a mean age of 59 ± 7.3 years without a previous history of cardiovascular and pulmonary diseases from population registers in the Czechia, Poland, and Lithuania. Predictive values of standardised Z-scores of forced expiratory volume measured in 1 s (FEV1), forced vital capacity (FVC), and FEV1 divided by height cubed (FEV1/ht3) were tested. Cox proportional hazards models were used to estimate hazard ratios (HRs) of CVD events of various spirometry indices over the Framingham Risk Score (FRS) model. The model performance was evaluated using Harrell's C-statistics, likelihood ratio tests, and Bayesian information criterion. RESULTS: All spirometry indices had a strong linear relation with the incidence of CVD events (HR ranged from 1.10 to 1.12 between indices). The model stratified by FEV1/ht3 tertiles had a stronger link with CVD events than FEV1 and FVC. The risk of CVD event for the lowest vs. highest FEV1/ht3 tertile among people with low FRS was higher (HR: 2.35; 95% confidence interval: 1.96-2.81) than among those with high FRS. The addition of spirometry indices showed a small but statistically significant improvement of the FRS model. CONCLUSIONS: The addition of spirometry indices might improve the prediction of incident CVD events particularly in the low-risk group. FEV1/ht3 is a more sensitive predictor compared to other spirometry indices.

• Keywords
• cardiovascular disease, cohort studies, mortality, pulmonary function test, risk prediction model,
• Publication type
• Journal Article MeSH

BACKGROUND: Social differences in lung functioning have been reported, but the role of socioeconomic position (SEP) at different stages of life is less well understood, particularly in Central and Eastern Europe. This study addressed this question. METHODS: The analysis included 10 160 individuals aged 45-70 years from the Czech Republic, Poland and Lithuania. Lung function was either normal if values of forced expiratory volume in the first second divided by forced vital capacity (FEV1/FVC) and FVC were higher than the lower limit of normality or impaired if otherwise. SEP at three stages of life was assessed using maternal education (childhood), participant's education (young adulthood), and current ability to pay for food, clothes and bills (late adulthood). SEP measures were dichotomised as advantaged versus disadvantaged. The associations between impaired lung function and life-course SEP were estimated by logistic regression. RESULTS: Disadvantaged SEP in young and late adulthood had higher odds of impaired lung function. In young adulthood, age-adjusted ORs were 1.26 (95% CI 1.06 to 1.49) in men and 1.56 (95% CI 1.29 to 1.88) in women, while in late adulthood, the ORs were 1.15 (95% CI 0.99 to 1.34) in men and 1.26 (95% CI 1.09 to 1.46) in women. Men and women disadvantaged at all three stages of life had ORs of 1.42 (95% CI 1.06 to 1.91) and 1.83 (95% CI 1.32 to 2.52), respectively, compared with those always advantaged. Smoking substantially attenuated the ORs in men but not in women. CONCLUSION: Reducing socioeconomic inequalities in young and late adulthood may contribute to reducing the risk of impaired lung function in late adulthood.

• Keywords
• epidemiology, health impact assessment, health inequalities, life course epidemiology, social class,
• Publication type
• Journal Article MeSH

It is unclear whether the dose-response relationship between lung function and all-cause and cardiovascular mortality in the Central and Eastern European populations differ from that reported in the Western European and American populations. We used the prospective population-based HAPIEE cohort that includes randomly selected people with a mean age of 59 ± 7.3 years from population registers in Czech, Polish, Russian and Lithuanian urban centres. The baseline survey in 2002-2005 included 36,106 persons of whom 24,944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose-response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11-16 years of follow-up. Mortality rate increased in a dose-response manner from highest to lower FEV1/height3 deciles. Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI 1.08‒1.49), 1.37 (1.18-1.60) and 2.15 (1.86‒2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29-2.63), 2.35 (1.67-3.28) and 3.46 (2.50‒4.78). Patterns were similar across countries, with some statistically insignificant variation. FEV1/height3 is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function.

• MeSH
• Cardiovascular Diseases * epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Lung MeSH
• Proportional Hazards Models MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

BACKGROUND: The association between impaired lung function and mortality has been well documented in the general population of Western European countries. We assessed the risk of death associated with reduced spirometry indices among people from four Central and Eastern European countries. METHODS: This prospective population-based cohort includes men and women aged 45-69 years, residents in urban settlements in Czech Republic, Poland, Russia and Lithuania, randomly selected from population registers. The baseline survey in 2002-2005 included 36,106 persons of whom 24,993 met the inclusion criteria. Cox proportional hazards models were used to estimate the hazard ratios of mortality over 11-16 years of follow-up for mild, moderate, moderate-severe and very severe lung function impairment categories. RESULTS: After adjusting for covariates, mild (hazard ratio (HR): 1.25; 95% CI 1.15‒1.37) to severe (HR: 3.35; 95% CI 2.62‒4.27) reduction in FEV1 was associated with an increased risk of death according to degree of lung impairment, compared to people with normal lung function. The association was only slightly attenuated but remained significant after exclusion of smokers and participants with previous history of respiratory diseases. The HRs varied between countries but not statistically significant; the highest excess risk among persons with more severe impairment was seen in Poland (HR: 4.28, 95% CI 2.14‒8.56) and Lithuania (HR: 4.07, 95% CI 2.21‒7.50). CONCLUSIONS: Reduced FEV1 is an independent predictor of all-cause mortality, with risk increasing with the degree of lung function impairment and some country-specific variation between the cohorts.

• Keywords
• Cohort study, Forced expiratory volume in one second, Mortality, Pulmonary function test,
• MeSH
• Cardiovascular Diseases * epidemiology   MeSH
• Cohort Studies MeSH
• Humans MeSH
• Lung MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Poland epidemiology   MeSH

OBJECTIVES: The paper aims to identify the priorities for cardiovascular health promotion research in Central and Eastern Europe (CEE), the region with the highest cardiovascular diseases (CVD) burden in the world. METHODS: This narrative review covered peer-reviewed publications and online databases using a nonsystematic purposive approach. RESULTS: In despite of a steady decrease in CVD burden in the region, the East-West disparities are still significant. There is minimal continuity in the past and current CVD prevention efforts in the region. Many challenges still exist, including an opportunity gap in research funding, surveillance and population-based preventive interventions. A comprehensive approach focusing on multisectoral cooperation, quality and accessibility of healthcare and equity-oriented public policies and supported by well-designed epidemiologic studies is needed to overcome these challenges. CONCLUSION: The current level of effort is not adequate to address the magnitude of the CVD epidemic in CEE. It is imperative to strengthen the epidemiological base concerning cardiovascular health in the region, to foster surveillance and progress in implementation of CVD preventive strategies in the most affected populations of Europe.

• MeSH
• Diet statistics & numerical data   MeSH
• Health Services Accessibility * MeSH
• Epidemiological Monitoring * MeSH
• Hypertension epidemiology   MeSH
• Cardiovascular Diseases epidemiology   mortality   prevention & control   MeSH
• Smoking epidemiology   MeSH
• Quality of Health Care MeSH
• Evidence-Based Practice MeSH
• Humans MeSH
• Obesity epidemiology   MeSH
• Health Promotion * MeSH
• Heart Disease Risk Factors MeSH
• Health Equity MeSH
• Sedentary Behavior MeSH
• Commonwealth of Independent States epidemiology   MeSH
• Health Policy * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Geographicals
• Europe epidemiology   MeSH
• Commonwealth of Independent States epidemiology   MeSH
• Europe, Eastern epidemiology   MeSH

OBJECTIVES: Large socioeconomic inequalities in health are still present in the Central Europe. The aim was to explore socioeconomic inequalities in mortality in Visegrad countries-the Czech Republic, Hungary, Poland and Slovakia (V4), by three different socioeconomic indicators (unemployment, risk of poverty/social exclusion, education). The study was conducted within the H2020 Euro-Healthy project. METHODS: The associations between selected socioeconomic indicators and the standardised mortality rates by four main causes (mortality related to cancer, circulatory, respiratory and digestive system) in the economically active population aged 20-64 years in the 35 NUTS 2 level regions of the V4 in the period 2011-2013 were explored, using linear regression models. RESULTS: Lower education level was the most significant predictor of mortality in the V4. The lowest mortality rates by all causes of death were found in the regions of the Czech Republic, the highest in regions of Hungary. CONCLUSIONS: Despite the common origin, the pathways of the V4 countries in employment, poverty and education seem to be different, also having impact on health equity. Therefore, where you live in the V4 can significantly influence your health.

• Keywords
• Ecological design, Health equity, Measurement, Mortality, Regional differences, Socioeconomic inequalities,
• MeSH
• Poverty statistics & numerical data   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Linear Models MeSH
• Young Adult MeSH
• Mortality trends   MeSH
• Unemployment statistics & numerical data   MeSH
• Forecasting MeSH
• Cause of Death * MeSH
• Social Discrimination * MeSH
• Socioeconomic Factors * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Hungary epidemiology   MeSH
• Poland epidemiology   MeSH
• Slovakia epidemiology   MeSH

BACKGROUND: Eastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations. METHODS: Participants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43-74 years and free of CVD at baseline examination during 2002-2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years. RESULTS: During the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios [HRs] for these six factors ranged between 1.26 [95% confidence interval 1.14-1.40] and 1.81 [95% confidence interval 1.24-2.64], fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% [4%-13%] to 22% [11%-31%] for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature. CONCLUSIONS: Six psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained.

• MeSH
• Demography MeSH
• Depression * epidemiology   physiopathology   MeSH
• Adult MeSH
• Cardiovascular Diseases * epidemiology   mortality   psychology   MeSH
• Comorbidity MeSH
• Middle Aged MeSH
• Humans MeSH
• Loneliness * MeSH
• Prospective Studies MeSH
• Psychology * MeSH
• Risk Factors MeSH
• Aged MeSH
• Socioeconomic Factors * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Poland epidemiology   MeSH
• Russia epidemiology   MeSH

After several decades of stagnation, mortality in most Central European countries started to decrease after 1989. The Czech Republic and Poland were the first former Communist countries in this region to experience a rapid and sustained increase in life expectancy. This study focuses on the trends in cause-of-death mortality that have contributed to the recent progress in these two countries. The analysis is based on the cause-of-death time series (1968-2013) reconstructed in accordance with the 10th ICD revision, which makes the data fully comparable over the full period under study. Actual trends in cause-specific mortality are presented, and age, sex and causes of death components of life expectancy changes are disentangled. In both countries, the reduction in cardiovascular mortality at adult and old ages was crucial for the increase in life expectancy after 1991. Results are discussed in the context of institutional changes that occurred after the fall of Communism, such as the reorientation of health policies and the emergence of non-governmental organizations. Changes in health-related attitudes and behaviours as well as structural changes in societies, notably the rising share of persons with tertiary education, are also discussed.

• Keywords
• Causes of death, Life expectancy, Mortality, Poland, The Czech Republic,
• Publication type
• Journal Article MeSH

PURPOSE: The aim of the study was to assess the relationships between individual-level dietary intakes of antioxidant vitamins C, E and beta-carotene with all-cause and cause-specific mortality in three Central and Eastern European (CEE) populations. METHODS: Data from the Health, Alcohol and Psychosocial factors in Eastern Europe cohort study were used. At the baseline survey, between 2002 and 2005, 28,945 men and women aged 45-69 years were examined in Novosibirsk (Russia), Krakow (Poland) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Cox regression was used to estimate the association between vitamin consumption and all-cause, cardiovascular (CVD) disease and cancer mortality. RESULTS: In multivariable-adjusted analyses, there were no clear inverse associations between antioxidant vitamin intakes and mortality, although in some groups, several hazard ratios (HRs) were significant. For example, in men, compared with the lowest quintile of vitamin C intake, all-cause mortality in the third and fourth quintiles was lower by 28 % (HR 0.72; 95 % CI 0.61-0.85) and by 20 % (HR 0.80; 95 % CI 0.68-0.95), respectively. CVD mortality was lower by 35 % (HR 0.65; 95 % CI 0.50-0.84) and by 23 % (HR 0.77; 95 % CI 0.59-0.99) in third and fourth quintile of vitamin C intake, respectively. In women, the third and fourth quintiles of dietary intake of vitamin E were associated with reduced risk of all-cause death by 33 % (HR 0.67; 95 % CI 0.53-0.84) and by 23 % (HR 0.77; 95 % CI 0.61-0.97), respectively. Consumption of vitamin C, vitamin E and beta-carotene was not related to CVD mortality in women and to cancer mortality in either gender. CONCLUSION: This large prospective cohort study in CEE populations with low prevalence of vitamin supplementation did not find a strong, dose-response evidence for protective effects of antioxidant vitamin intake.

• Keywords
• Antioxidant vitamin, Cardiovascular, Central and Eastern Europe, Mortality,
• MeSH
• Antioxidants administration & dosage   MeSH
• beta Carotene administration & dosage   MeSH
• Cardiovascular Diseases mortality   MeSH
• Ascorbic Acid administration & dosage   MeSH
• Middle Aged MeSH
• Humans MeSH
• Urban Population * MeSH
• Neoplasms mortality   MeSH
• Follow-Up Studies MeSH
• Dietary Supplements MeSH
• Cause of Death MeSH
• Proportional Hazards Models MeSH
• Prospective Studies MeSH
• Surveys and Questionnaires MeSH
• Risk Factors MeSH
• Aged MeSH
• Socioeconomic Factors MeSH
• Vitamin E administration & dosage   MeSH
• Vitamins administration & dosage   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Poland epidemiology   MeSH
• Russia epidemiology   MeSH
• Names of Substances
• Antioxidants MeSH
• beta Carotene MeSH
• Ascorbic Acid MeSH
• Vitamin E MeSH
• Vitamins MeSH