@article{bayes_marin_healthy_2022,
	title = {Healthy aging and late-life depression in {Europe}: {Does} migration matter?},
	volume = {9},
	issn = {2296-858X},
	shorttitle = {Healthy aging and late-life depression in {Europe}},
	url = {https://www.frontiersin.org/articles/10.3389/fmed.2022.866524/full},
	doi = {10.3389/fmed.2022.866524},
	abstract = {Background
              There is limited research examining the impact of risk and protective factors on late-life depression using large population-based datasets, particularly those examining differences among older migrants and non-migrants in Europe countries. Thus, the first aim was to analyze differences between migrants and non-migrants regarding socioeconomic status, depression, multimorbidity, healthy aging, and lifestyle behaviors. The second aim was to examine the impact of healthy aging on late-life depression in older migrants compared to their counterparts without a history of international migration in extensive and harmonized data from different population-based cohort studies.
            
            
              Materials and methods
              We analyzed cross-sectional, predominantly nationally representative, community-based data from European participants in the Aging Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) cohort. The descriptive analyses included sociodemographic variables, somatic comorbidities, multimorbidity, healthy aging, and lifestyle behaviors according to migration status. The effects of these variables on late-life depression were examined in a multivariate logistic regression model, including migration status and years since migration as predictors.
            
            
              Results
              Data of 122,571 individuals aged ≥ 50 years were analyzed, of which 11,799 (9.60\%) were migrants. The descriptive analyses indicated that compared to non-migrants, migrants showed a higher prevalence of diabetes (25.6\%), hypertension (38.0\%), coronary artery disease (49.4\%), stroke (4.9\%), and depression (31.1\%). Healthy aging was also better in non-migrants (51.7; SD = 9.7) than in migrants (39.6; SD = 18.2). The results of the logistic regression showed that migration status [OR = 1.231 (CIs: 0.914–1.547)] and increased number of years since migration in the host country [OR = 0.003 (CIs: 0.001–0.005)] were associated with greater levels of depressive symptoms. Concerning health variables, multimorbidity was associated with higher levels of depressive symptoms [OR = 0.244 (CIs: 0.211–0.278)], whereas better healthy aging was associated with fewer depressive symptoms [OR = -0.100 (CIs: -0.102 to -0.098)]. The interaction between migration and healthy aging status was also significant [OR. = -0.019 (CIs: -0.025 to -0.014)].
            
            
              Conclusion
              Migrants reported higher risks for worse health outcomes compared to non-migrants. Significantly, worse healthy aging was associated with a greater risk of depressive symptoms in migrants than in non-migrants. Shedding light on migration and aging processes is essential for promoting a cross-cultural understanding of late-life depression in Europe.},
	urldate = {2022-11-09},
	journal = {Frontiers in Medicine},
	author = {Bayes Marin, Ivet and Fernández, Daniel and Ayuso-Mateos, Jose Luis and Leonardi, Matilde and Tobiasz-Adamczyk, Beata and Koskinen, Seppo and Sanchez-Niubo, Albert and Cristóbal-Narváez, Paula},
	month = nov,
	year = {2022},
	pmcid = {PMC9680089},
	pages = {866524},
}

Background There is limited research examining the impact of risk and protective factors on late-life depression using large population-based datasets, particularly those examining differences among older migrants and non-migrants in Europe countries. Thus, the first aim was to analyze differences between migrants and non-migrants regarding socioeconomic status, depression, multimorbidity, healthy aging, and lifestyle behaviors. The second aim was to examine the impact of healthy aging on late-life depression in older migrants compared to their counterparts without a history of international migration in extensive and harmonized data from different population-based cohort studies. Materials and methods We analyzed cross-sectional, predominantly nationally representative, community-based data from European participants in the Aging Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) cohort. The descriptive analyses included sociodemographic variables, somatic comorbidities, multimorbidity, healthy aging, and lifestyle behaviors according to migration status. The effects of these variables on late-life depression were examined in a multivariate logistic regression model, including migration status and years since migration as predictors. Results Data of 122,571 individuals aged ≥ 50 years were analyzed, of which 11,799 (9.60%) were migrants. The descriptive analyses indicated that compared to non-migrants, migrants showed a higher prevalence of diabetes (25.6%), hypertension (38.0%), coronary artery disease (49.4%), stroke (4.9%), and depression (31.1%). Healthy aging was also better in non-migrants (51.7; SD = 9.7) than in migrants (39.6; SD = 18.2). The results of the logistic regression showed that migration status [OR = 1.231 (CIs: 0.914–1.547)] and increased number of years since migration in the host country [OR = 0.003 (CIs: 0.001–0.005)] were associated with greater levels of depressive symptoms. Concerning health variables, multimorbidity was associated with higher levels of depressive symptoms [OR = 0.244 (CIs: 0.211–0.278)], whereas better healthy aging was associated with fewer depressive symptoms [OR = -0.100 (CIs: -0.102 to -0.098)]. The interaction between migration and healthy aging status was also significant [OR. = -0.019 (CIs: -0.025 to -0.014)]. Conclusion Migrants reported higher risks for worse health outcomes compared to non-migrants. Significantly, worse healthy aging was associated with a greater risk of depressive symptoms in migrants than in non-migrants. Shedding light on migration and aging processes is essential for promoting a cross-cultural understanding of late-life depression in Europe.

@article{kontto_using_2022,
	title = {Using multiple imputation and intervention-based scenarios to project the mobility of older adults},
	volume = {22},
	issn = {1471-2318},
	url = {https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03008-4},
	doi = {10.1186/s12877-022-03008-4},
	abstract = {Abstract
            
              Background
              Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland.
            
            
              Methods
              
                We applied multiple imputation modelling with bootstrapping to generate projections of stair climbing and walking limitations until 2026. A physical activity intervention producing a beneficial effect on self-reported activities of daily living measures was identified in a comprehensive literature search and incorporated in the scenarios used in the projections. We utilised the harmonised longitudinal survey data from the Ageing Trajectories of Health – Longitudinal Opportunities and Synergies (ATHLOS) project (
                N
                 = 24,982).
              
            
            
              Results
              Based on the scenarios from 2012 to 2026, the prevalence of walking limitations will decrease from 9.4 to 6.4\%. A physical activity intervention would decrease the prevalence of stair climbing limitations compared with no intervention from 28.9 to 18.9\% between 2012 and 2026.
            
            
              Conclusions
              A physical activity intervention implemented on older population seems to have a positive effect on maintaining mobility in the future. Our method provides an interesting option for generating projections by incorporating intervention-based scenarios.},
	language = {en},
	number = {1},
	urldate = {2022-04-11},
	journal = {BMC Geriatrics},
	author = {Kontto, Jukka and Paalanen, Laura and Sund, Reijo and Sainio, Päivi and Koskinen, Seppo and Demakakos, Panayotes and Tolonen, Hanna and Härkänen, Tommi},
	month = dec,
	year = {2022},
	pmcid = {PMC8994920},
	pmid = {35397525},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {311},
}

Abstract Background Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland. Methods We applied multiple imputation modelling with bootstrapping to generate projections of stair climbing and walking limitations until 2026. A physical activity intervention producing a beneficial effect on self-reported activities of daily living measures was identified in a comprehensive literature search and incorporated in the scenarios used in the projections. We utilised the harmonised longitudinal survey data from the Ageing Trajectories of Health – Longitudinal Opportunities and Synergies (ATHLOS) project ( N  = 24,982). Results Based on the scenarios from 2012 to 2026, the prevalence of walking limitations will decrease from 9.4 to 6.4%. A physical activity intervention would decrease the prevalence of stair climbing limitations compared with no intervention from 28.9 to 18.9% between 2012 and 2026. Conclusions A physical activity intervention implemented on older population seems to have a positive effect on maintaining mobility in the future. Our method provides an interesting option for generating projections by incorporating intervention-based scenarios.

@article{stepaniak_relationship_2022,
	title = {Relationship between {Dietary} {Macronutrients} {Intake} and the {ATHLOS} {Healthy} {Ageing} {Scale}: {Results} from the {Polish} {Arm} of the {HAPIEE} {Study}},
	volume = {14},
	issn = {2072-6643},
	shorttitle = {Relationship between {Dietary} {Macronutrients} {Intake} and the {ATHLOS} {Healthy} {Ageing} {Scale}},
	url = {https://www.mdpi.com/2072-6643/14/12/2454},
	doi = {10.3390/nu14122454},
	abstract = {Background: Despite extensive research, our knowledge on the relationship between nutrition and healthy ageing is limited. The aim of this study was to evaluate the associations between the intake of macronutrients and a single measure of healthy ageing (ATHLOS Healthy Ageing Scale). Methods: A cross-sectional analysis was performed using data from 9906 randomly selected citizens of Krakow (Poland) who were 45–69 years of age and participants of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Macronutrient intake was evaluated using a food frequency questionnaire. ATHLOS Health Ageing Scale was estimated from 41 variables in pooled data from 16 cohorts. Standardized beta coefficients were estimated using multivariable linear regression models. Results: In multivariable adjusted models, there were significant positive associations between the ATHLOS Healthy Ageing Scale score and intake of protein (b = 0.030, 95\% CI 0.001; 0.059 in men; b = 0.056, 95\% CI 0.027; 0.085 in women), monounsaturated fatty acids (MUFA) (b = 0.042, 95\% CI 0.013; 0.071 in men; b = 0.035, 95\% CI 0.006; 0.064 in women), polyunsaturated fatty acids (PUFA) (b = 0.053, 95\% CI 0.024; 0.082 in men; b = 0.063, 95\% CI 0.034; 0.092 in women), and omega-3 PUFA (b = 0.031, 95\% CI 0.002;0.060 in men; b = 0.054, 95\% CI 0.026; 0.082 in women). Carbohydrate intake was inversely associated with the ATHLOS Healthy Ageing Scale in women. Total fat intake was positively associated with the ATHLOS Healthy Ageing Scale in men. Conclusions: A number of nutrients were associated with the healthy ageing score, suggesting that dietary habits may play an important role in healthy ageing. Further research in other settings and with a prospective design is strongly warranted.},
	language = {en},
	number = {12},
	urldate = {2022-06-17},
	journal = {Nutrients},
	author = {Stepaniak, Urszula and Polak, Maciej and Stefler, Denes and Kozela, Magdalena and Bobak, Martin and Sanchez-Niubo, Albert and Ayuso-Mateos, José Luis and Haro, Josep Maria and Pająk, Andrzej},
	month = jun,
	year = {2022},
	pmcid = {PMC9229969},
	pmid = {35745184},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {2454},
}

Background: Despite extensive research, our knowledge on the relationship between nutrition and healthy ageing is limited. The aim of this study was to evaluate the associations between the intake of macronutrients and a single measure of healthy ageing (ATHLOS Healthy Ageing Scale). Methods: A cross-sectional analysis was performed using data from 9906 randomly selected citizens of Krakow (Poland) who were 45–69 years of age and participants of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Macronutrient intake was evaluated using a food frequency questionnaire. ATHLOS Health Ageing Scale was estimated from 41 variables in pooled data from 16 cohorts. Standardized beta coefficients were estimated using multivariable linear regression models. Results: In multivariable adjusted models, there were significant positive associations between the ATHLOS Healthy Ageing Scale score and intake of protein (b = 0.030, 95% CI 0.001; 0.059 in men; b = 0.056, 95% CI 0.027; 0.085 in women), monounsaturated fatty acids (MUFA) (b = 0.042, 95% CI 0.013; 0.071 in men; b = 0.035, 95% CI 0.006; 0.064 in women), polyunsaturated fatty acids (PUFA) (b = 0.053, 95% CI 0.024; 0.082 in men; b = 0.063, 95% CI 0.034; 0.092 in women), and omega-3 PUFA (b = 0.031, 95% CI 0.002;0.060 in men; b = 0.054, 95% CI 0.026; 0.082 in women). Carbohydrate intake was inversely associated with the ATHLOS Healthy Ageing Scale in women. Total fat intake was positively associated with the ATHLOS Healthy Ageing Scale in men. Conclusions: A number of nutrients were associated with the healthy ageing score, suggesting that dietary habits may play an important role in healthy ageing. Further research in other settings and with a prospective design is strongly warranted.

@article{barmpas_divisive_2022,
	title = {A divisive hierarchical clustering methodology for enhancing the ensemble prediction power in large scale population studies: the {ATHLOS} project},
	volume = {10},
	issn = {2047-2501},
	shorttitle = {A divisive hierarchical clustering methodology for enhancing the ensemble prediction power in large scale population studies},
	url = {https://link.springer.com/10.1007/s13755-022-00171-1},
	doi = {10.1007/s13755-022-00171-1},
	language = {en},
	number = {1},
	urldate = {2022-04-18},
	journal = {Health Information Science and Systems},
	author = {Barmpas, Petros and Tasoulis, Sotiris and Vrahatis, Aristidis G. and Georgakopoulos, Spiros V. and Anagnostou, Panagiotis and Prina, Matthew and Ayuso-Mateos, José Luis and Bickenbach, Jerome and Bayes, Ivet and Bobak, Martin and Caballero, Francisco Félix and Chatterji, Somnath and Egea-Cortés, Laia and García-Esquinas, Esther and Leonardi, Matilde and Koskinen, Seppo and Koupil, Ilona and Paja̧k, Andrzej and Prince, Martin and Sanderson, Warren and Scherbov, Sergei and Tamosiunas, Abdonas and Galas, Aleksander and Haro, Josep Maria and Sanchez-Niubo, Albert and Plagianakos, Vassilis P. and Panagiotakos, Demosthenes},
	month = dec,
	year = {2022},
	pmcid = {PMC9013733},
	pmid = {35529251},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies, ML, Machine Learning},
	pages = {6},
}

@incollection{s_trianntafyllou_unsupervised_2022,
	address = {Boca Raton},
	edition = {1},
	title = {Unsupervised {Learning} for {Large} {Scale} {Data}},
	isbn = {978-1-00-320312-4},
	url = {https://www.taylorfrancis.com/books/9781003203124/chapters/10.1201/9781003203124-5},
	language = {en},
	urldate = {2022-10-21},
	booktitle = {Statistical {Modeling} of {Reliability} {Structures} and {Industrial} {Processes}},
	publisher = {CRC Press},
	author = {Barmpas, Petros and Tasoulis, Sotiris and Vrahatis, Aristidis G. and Anagnostou, Panagiotis and Georgakopoulos, Spiros and Prina, Matthew and Ayuso-Mateos, José Luis and Bickenbach, Jerome and Bayes, Ivet and Bobaki, Martin and Caballero, Francisco Félix and Chatterji, Somnath and Egea-Cortés, Laia and García-Esquinas, Esther and Leonardi, Matilde and Koskinen, Seppo and Koupil, Ilona and Pająk, Andrzej and Prince, Martin and Sanderson, Warren and Scherbov, Sergei and Tamosiunas, Abdonas and Galas, Aleksander and MariaHaro, Josep and Sanchez-Niubo, Albert and Plagianakos, Vassilis P. and Panagiotakos, Demosthenes},
	collaborator = {S. Trianntafyllou, Ioannis and Ram, Mangey},
	month = aug,
	year = {2022},
	doi = {10.1201/9781003203124-5},
	pages = {55--76},
}

@article{gondek_inequality_2021,
	title = {Inequality in hospitalization due to non-communicable diseases in {Sweden}: {Age}-cohort analysis of the {Uppsala} {Birth} {Cohort} {Multigenerational} {Study}},
	volume = {13},
	issn = {23528273},
	shorttitle = {Inequality in hospitalization due to non-communicable diseases in {Sweden}},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S2352827321000161},
	doi = {10.1016/j.ssmph.2021.100741},
	language = {en},
	urldate = {2022-11-22},
	journal = {SSM - Population Health},
	author = {Gondek, Dawid and Ploubidis, George B. and Hossin, Muhammad Zakir and Gao, Menghan and Bann, David and Koupil, Ilona},
	month = mar,
	year = {2021},
	pmcid = {PMC7841359},
	pmid = {33537404},
	pages = {100741},
}

@article{zawisza_methodological_2021,
	title = {Methodological challenges in harmonisation of the variables used as indicators of social capital in epidemiological studies of ageing – results of the {ATHLOS} project},
	copyright = {All rights reserved},
	issn = {0144-686X, 1469-1779},
	url = {https://www.cambridge.org/core/product/identifier/S0144686X21001677/type/journal_article},
	doi = {10.1017/S0144686X21001677},
	abstract = {Abstract
            The present article aims to highlight methodological aspects related to understanding and conceptualising social capital for the purposes of population research as well as describing the key challenges in the harmonisation process of indicators of social capital. The study was conducted in the frame of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. After a review of social capital theories developed in social science and a subsequent review of the documentation of 18 international cohorts, decision trees of the harmonisation of social variables were developed. The known-group validity was verified. The results focused on generalised trust, civic engagement and social participation are presented. The summary of the availability of any indicators of these concepts is classified in seven domains (generalised trust, political participation, religious participation, senior-specific participation, participation in sport groups, participation in volunteer/charity group activities, any participation) across surveys. The results of the analysis for known-group validity support the construct validity of the harmonised variables.},
	language = {en},
	urldate = {2021-12-21},
	journal = {Ageing and Society},
	author = {Zawisza, Katarzyna and Woźniak, Barbara and Tobiasz-Adamczyk, Beata and Galas, Aleksander and Giné-Vázquez, Iago and Sanchez-Niubo, Albert and Ayuso-Mateos, José Luis and Koskinen, Seppo and Leonardi, Matilde and Bobak, Martin and Haro, Josep Maria},
	month = dec,
	year = {2021},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {1--28},
}

Abstract The present article aims to highlight methodological aspects related to understanding and conceptualising social capital for the purposes of population research as well as describing the key challenges in the harmonisation process of indicators of social capital. The study was conducted in the frame of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. After a review of social capital theories developed in social science and a subsequent review of the documentation of 18 international cohorts, decision trees of the harmonisation of social variables were developed. The known-group validity was verified. The results focused on generalised trust, civic engagement and social participation are presented. The summary of the availability of any indicators of these concepts is classified in seven domains (generalised trust, political participation, religious participation, senior-specific participation, participation in sport groups, participation in volunteer/charity group activities, any participation) across surveys. The results of the analysis for known-group validity support the construct validity of the harmonised variables.

@article{anagnostou_enhancing_2021,
	title = {Enhancing the {Human} {Health} {Status} {Prediction}: {The} {ATHLOS} {Project}},
	issn = {0883-9514, 1087-6545},
	shorttitle = {Enhancing the {Human} {Health} {Status} {Prediction}},
	url = {https://www.tandfonline.com/doi/full/10.1080/08839514.2021.1935591},
	doi = {10.1080/08839514.2021.1935591},
	language = {en},
	urldate = {2021-06-18},
	journal = {Applied Artificial Intelligence},
	author = {Anagnostou, P. and Tasoulis, S. and Vrahatis, A. G. and Georgakopoulos, S. and Prina, M. and Ayuso-Mateos, J. L. and Bickenbach, J. and Bayes-Marin, I. and Caballero, F. F. and Egea-Cortés, L. and García-Esquinas, E. and Leonardi, M. and Scherbov, S. and Tamosiunas, A. and Galas, A. and Haro, J. M. and Sanchez-Niubo, A. and Plagianakos, V. and Panagiotakos, D.},
	month = jun,
	year = {2021},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies, ML, Machine Learning},
	pages = {1--23},
}

@article{cabello_role_2021,
	title = {The role of ageing in the wish to be dead: disentangling age, period and cohort effects in suicide ideation in {European} population},
	volume = {30},
	issn = {2045-7960, 2045-7979},
	shorttitle = {The role of ageing in the wish to be dead},
	url = {https://www.cambridge.org/core/product/identifier/S2045796021000020/type/journal_article},
	doi = {10.1017/S2045796021000020},
	abstract = {Abstract
            
              Aims
              To investigate potential age, period and birth cohort effects in the prevalence of suicide ideation in European ageing population.
            
            
              Methods
              A total of 50 782 community-dwelling adults (aged + 50) from 20 different European countries were collected in the Survey Health Ageing and Retirement study. A multilevel logistic regression model of repeated measures was modelled to assess the effects of age and other variables, including the variability of observations over three levels: birth cohort groups, time period assessment and individual differences.
            
            
              Results
              The larger effect of variability was attributed to individual-level factors (57.8\%). Youngest-old people (65–79 years) showed lower suicide ideation than middle-aged people (50–64 years). No significative differences were found for suicide ideation between middle-aged people and oldest-old (80 + years). Only 0.85\% and 0.13\% of the total variability of suicide ideation accounted for birth cohort and period effects, respectively. Cohorts born between 1941 and 1944 possessed the lowest estimates of suicide ideation. Conversely, suicide ideation started to rise with post-War generations and reached a significant level for people born from 1953–1957 to 1961–1964. Regarding the time period, participants assessed in 2006–2007 showed a lower likelihood of suicide ideation. The rest of the cohorts and period groups did not show any significant effect on the prevalence of suicide ideation.
            
            
              Conclusions
              Our results suggest that age and suicide ideation relationship is not linear in middle and older age. The European Baby boomers born from 50s to mid-60s might report higher suicide ideation than their ancestors. This scenario would imply a greater need for mental healthcare services for older people in the future.},
	language = {en},
	urldate = {2022-11-22},
	journal = {Epidemiology and Psychiatric Sciences},
	author = {Cabello, M. and Rico-Uribe, L. A. and Martinez-Ávila, J. C. and Sánchez-Niubò, A. and Caballero, F. F. and Borges, G. and Mellor-Marsá, B. and Haro, J. M. and Prina, M. and Koskinen, S. and Ayuso-Mateos, J. L.},
	year = {2021},
	pmcid = {PMC8061246},
	pmid = {33597061},
	pages = {e17},
}

Abstract Aims To investigate potential age, period and birth cohort effects in the prevalence of suicide ideation in European ageing population. Methods A total of 50 782 community-dwelling adults (aged + 50) from 20 different European countries were collected in the Survey Health Ageing and Retirement study. A multilevel logistic regression model of repeated measures was modelled to assess the effects of age and other variables, including the variability of observations over three levels: birth cohort groups, time period assessment and individual differences. Results The larger effect of variability was attributed to individual-level factors (57.8%). Youngest-old people (65–79 years) showed lower suicide ideation than middle-aged people (50–64 years). No significative differences were found for suicide ideation between middle-aged people and oldest-old (80 + years). Only 0.85% and 0.13% of the total variability of suicide ideation accounted for birth cohort and period effects, respectively. Cohorts born between 1941 and 1944 possessed the lowest estimates of suicide ideation. Conversely, suicide ideation started to rise with post-War generations and reached a significant level for people born from 1953–1957 to 1961–1964. Regarding the time period, participants assessed in 2006–2007 showed a lower likelihood of suicide ideation. The rest of the cohorts and period groups did not show any significant effect on the prevalence of suicide ideation. Conclusions Our results suggest that age and suicide ideation relationship is not linear in middle and older age. The European Baby boomers born from 50s to mid-60s might report higher suicide ideation than their ancestors. This scenario would imply a greater need for mental healthcare services for older people in the future.

@article{bayes-marin_risk_2021,
	title = {Risk of all-cause mortality associated with chronic obstructive pulmonary disease and the role of healthy ageing trajectories: a population-based study of middle-aged and older adults},
	volume = {11},
	issn = {2044-6055, 2044-6055},
	shorttitle = {Risk of all-cause mortality associated with chronic obstructive pulmonary disease and the role of healthy ageing trajectories},
	url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2021-050947},
	doi = {10.1136/bmjopen-2021-050947},
	abstract = {Objectives
              The aims were to study the risk of all-cause mortality associated with chronic obstructive pulmonary disease (COPD) and healthy ageing trajectories (HAT) in three birth cohorts and to determine the moderating role of HAT in the association between COPD and all-cause mortality.
            
            
              Design
              Prospective cohort study.
            
            
              Setting
              Data from waves 1 to 5 of The Survey of Health, Ageing and Retirement in Europe.
            
            
              Participants
              The total sample was 28 857 community-dwelling individuals aged 50+ years.
            
            
              Main outcome
              All-cause mortality associated with COPD and HAT adjusting for covariates. We performed Aalen additive hazards models to explore these associations. Interactions between COPD and HAT were also explored. Analyses were conducted separately in three birth cohorts ({\textgreater}1945, 1936–1945 and ≤1935). Latent class growth analysis was used to classify participants into HAT.
            
            
              Results
              Three parallel HAT were found in the three birth cohorts (‘low’, ‘medium’ and ‘high’ healthy ageing). Participants with COPD had an increased mortality risk, but this effect was no longer significant after adjusting for covariates. The ‘low’ HAT was associated with increased mortality risk in the three subsamples, although this effect was lower after adjustment. The interaction between COPD and HAT was significant only in the ≤1935 birth cohort, indicating that those with COPD and a ‘low’ trajectory had a greater risk of mortality.
            
            
              Conclusions
              The healthy ageing scale may be a suitable tool to identify patients at higher risk to mitigate disease burden and improve patients’ quality of life.},
	language = {en},
	number = {7},
	urldate = {2021-08-17},
	journal = {BMJ Open},
	author = {Bayes-Marin, Ivet and Sanchez-Niubo, Albert and Fernández, Daniel and Haro, Josep Maria and Olaya, Beatriz},
	month = jul,
	year = {2021},
	pmcid = {PMC8320253},
	pmid = {34321308},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {e050947},
}

Objectives The aims were to study the risk of all-cause mortality associated with chronic obstructive pulmonary disease (COPD) and healthy ageing trajectories (HAT) in three birth cohorts and to determine the moderating role of HAT in the association between COPD and all-cause mortality. Design Prospective cohort study. Setting Data from waves 1 to 5 of The Survey of Health, Ageing and Retirement in Europe. Participants The total sample was 28 857 community-dwelling individuals aged 50+ years. Main outcome All-cause mortality associated with COPD and HAT adjusting for covariates. We performed Aalen additive hazards models to explore these associations. Interactions between COPD and HAT were also explored. Analyses were conducted separately in three birth cohorts (\textgreater1945, 1936–1945 and ≤1935). Latent class growth analysis was used to classify participants into HAT. Results Three parallel HAT were found in the three birth cohorts (‘low’, ‘medium’ and ‘high’ healthy ageing). Participants with COPD had an increased mortality risk, but this effect was no longer significant after adjusting for covariates. The ‘low’ HAT was associated with increased mortality risk in the three subsamples, although this effect was lower after adjustment. The interaction between COPD and HAT was significant only in the ≤1935 birth cohort, indicating that those with COPD and a ‘low’ trajectory had a greater risk of mortality. Conclusions The healthy ageing scale may be a suitable tool to identify patients at higher risk to mitigate disease burden and improve patients’ quality of life.

@article{michel_whos_2021,
	title = {{WHO}'s report for the decade of healthy ageing 2021–30 sets the stage for globally comparable data on healthy ageing},
	volume = {2},
	issn = {26667568},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S2666756821000027},
	doi = {10.1016/S2666-7568(21)00002-7},
	language = {en},
	number = {3},
	urldate = {2021-04-03},
	journal = {The Lancet Healthy Longevity},
	author = {Michel, Jean-Pierre and Leonardi, Matilde and Martin, Mike and Prina, Matthew},
	month = mar,
	year = {2021},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {e121--e122},
}

@article{marois_projecting_2021,
	title = {Projecting health-ageing trajectories in {Europe} using a dynamic microsimulation model},
	volume = {11},
	issn = {2045-2322},
	url = {http://www.nature.com/articles/s41598-021-81092-z},
	doi = {10.1038/s41598-021-81092-z},
	abstract = {Abstract
            The extent of the challenges and opportunities that population ageing presents depends heavily on the population’s health. Hence, for the development of appropriate strategies that enable countries to adopt the emerging demographic and epidemiological realities, information on future health trajectories of elderly population is a natural requirement. This study presents an innovative methodological framework for projecting the health of individuals using a dynamic microsimulation model that considers interactions between sociodemographic characteristics, health, mortality, bio-medical and behavioral risk factors. The model developed, called ATHLOS-Mic, is used to project the health of cohorts born before 1960 for the period 2015–2060 for selected European Countries using SHARE data to illustrate the possible effects of some selected risk factors and education on future health trajectories. Results show that, driven by a better educational attainment, each generation will be healthier than the previous one at same age. Also, we see that, on average, an individual of our base population will live about 18 more years since the start of the projection period, but only 5 years in good health. Finally, we find that a scenario that removes the effect of having a low level of education on individual health has the largest impact on the projected average health, the average number of years lived per person, and the average number of years lived in good health.},
	language = {en},
	number = {1},
	urldate = {2021-01-26},
	journal = {Scientific Reports},
	author = {Marois, Guillaume and Aktas, Arda},
	month = jan,
	year = {2021},
	pmcid = {PMC7815779},
	pmid = {33469046},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {1785},
}

Abstract The extent of the challenges and opportunities that population ageing presents depends heavily on the population’s health. Hence, for the development of appropriate strategies that enable countries to adopt the emerging demographic and epidemiological realities, information on future health trajectories of elderly population is a natural requirement. This study presents an innovative methodological framework for projecting the health of individuals using a dynamic microsimulation model that considers interactions between sociodemographic characteristics, health, mortality, bio-medical and behavioral risk factors. The model developed, called ATHLOS-Mic, is used to project the health of cohorts born before 1960 for the period 2015–2060 for selected European Countries using SHARE data to illustrate the possible effects of some selected risk factors and education on future health trajectories. Results show that, driven by a better educational attainment, each generation will be healthier than the previous one at same age. Also, we see that, on average, an individual of our base population will live about 18 more years since the start of the projection period, but only 5 years in good health. Finally, we find that a scenario that removes the effect of having a low level of education on individual health has the largest impact on the projected average health, the average number of years lived per person, and the average number of years lived in good health.

@article{nguyen_trajectories_2021,
	title = {Trajectories of healthy ageing among older adults with multimorbidity: {A} growth mixture model using harmonised data from eight {ATHLOS} cohorts},
	volume = {16},
	issn = {1932-6203},
	shorttitle = {Trajectories of healthy ageing among older adults with multimorbidity},
	url = {https://dx.plos.org/10.1371/journal.pone.0248844},
	doi = {10.1371/journal.pone.0248844},
	abstract = {Objectives
              In this study we aimed to 1) describe healthy ageing trajectory patterns, 2) examine the association between multimorbidity and patterns of healthy ageing trajectories, and 3) evaluate how different groups of diseases might affect the projection of healthy ageing trajectories over time.
            
            
              Setting and participants
              Our study was based on 130880 individuals from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) harmonised dataset, as well as 9171 individuals from Waves 2–7 of the English Longitudinal Study of Ageing (ELSA).
            
            
              Methods
              Using a healthy ageing index score, which comprised 41 items, covering various domains of health and ageing, as outcome, we employed the growth mixture model approach to identify the latent classes of individuals with different healthy ageing trajectories. A multinomial logistic regression was conducted to assess if and how multimorbidity status and multimorbidity patterns were associated with changes in healthy ageing, controlled for sociodemographic and lifestyle risk factors.
            
            
              Results
              Three similar patterns of healthy ageing trajectories were identified in the ATHLOS and ELSA datasets: 1) a ‘high stable’ group (76\% in ATHLOS, 61\% in ELSA), 2) a ‘low stable’ group (22\% in ATHLOS, 36\% in ELSA) and 3) a ‘rapid decline’ group (2\% in ATHLOS, 3\% in ELSA). Those with multimorbidity were 1.7 times (OR = 1.7, 95\% CI: 1.4–2.1) more likely to be in the ‘rapid decline’ group and 11.7 times (OR = 11.7 95\% CI: 10.9–12.6) more likely to be in the ‘low stable’ group, compared with people without multimorbidity. The cardiorespiratory/arthritis/cataracts group was associated with both the ‘rapid decline’ and the ‘low stable’ groups (OR = 2.1, 95\% CI: 1.2–3.8 and OR = 9.8, 95\% CI: 7.5–12.7 respectively).
            
            
              Conclusion
              Healthy ageing is heterogeneous. While multimorbidity was associated with higher odds of having poorer healthy ageing trajectories, the extent to which healthy ageing trajectories were projected to decline depended on the specific patterns of multimorbidity.},
	language = {en},
	number = {4},
	urldate = {2021-04-08},
	journal = {PLOS ONE},
	author = {Nguyen, Hai and Moreno-Agostino, Dario and Chua, Kia-Chong and Vitoratou, Silia and Prina, A. Matthew},
	editor = {Zhan, Y},
	month = apr,
	year = {2021},
	pmcid = {PMC8023455},
	pmid = {33822803},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies, Mplus, growth mixture modeling (GMM)},
	pages = {e0248844},
}

Objectives In this study we aimed to 1) describe healthy ageing trajectory patterns, 2) examine the association between multimorbidity and patterns of healthy ageing trajectories, and 3) evaluate how different groups of diseases might affect the projection of healthy ageing trajectories over time. Setting and participants Our study was based on 130880 individuals from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) harmonised dataset, as well as 9171 individuals from Waves 2–7 of the English Longitudinal Study of Ageing (ELSA). Methods Using a healthy ageing index score, which comprised 41 items, covering various domains of health and ageing, as outcome, we employed the growth mixture model approach to identify the latent classes of individuals with different healthy ageing trajectories. A multinomial logistic regression was conducted to assess if and how multimorbidity status and multimorbidity patterns were associated with changes in healthy ageing, controlled for sociodemographic and lifestyle risk factors. Results Three similar patterns of healthy ageing trajectories were identified in the ATHLOS and ELSA datasets: 1) a ‘high stable’ group (76% in ATHLOS, 61% in ELSA), 2) a ‘low stable’ group (22% in ATHLOS, 36% in ELSA) and 3) a ‘rapid decline’ group (2% in ATHLOS, 3% in ELSA). Those with multimorbidity were 1.7 times (OR = 1.7, 95% CI: 1.4–2.1) more likely to be in the ‘rapid decline’ group and 11.7 times (OR = 11.7 95% CI: 10.9–12.6) more likely to be in the ‘low stable’ group, compared with people without multimorbidity. The cardiorespiratory/arthritis/cataracts group was associated with both the ‘rapid decline’ and the ‘low stable’ groups (OR = 2.1, 95% CI: 1.2–3.8 and OR = 9.8, 95% CI: 7.5–12.7 respectively). Conclusion Healthy ageing is heterogeneous. While multimorbidity was associated with higher odds of having poorer healthy ageing trajectories, the extent to which healthy ageing trajectories were projected to decline depended on the specific patterns of multimorbidity.

@article{moreno-agostino_mediators_2021,
	title = {Mediators of the socioeconomic status and life satisfaction relationship in older adults: a multi-country structural equation modeling approach},
	volume = {25},
	issn = {1360-7863, 1364-6915},
	shorttitle = {Mediators of the socioeconomic status and life satisfaction relationship in older adults},
	url = {https://www.tandfonline.com/doi/full/10.1080/13607863.2019.1698513},
	doi = {10.1080/13607863.2019.1698513},
	language = {en},
	number = {3},
	urldate = {2022-11-21},
	journal = {Aging \& Mental Health},
	author = {Moreno-Agostino, Darío and de la Fuente, Javier and Leonardi, Matilde and Koskinen, Seppo and Tobiasz-Adamczyk, Beata and Sánchez-Niubò, Albert and Chatterji, Somnath and Haro, Josep Maria and Ayuso-Mateos, José Luis and Miret, Marta},
	month = mar,
	year = {2021},
	pages = {585--592},
}

@article{gkotzamanis_determinants_2021,
	title = {Determinants of verbal fluency trajectories among older adults from the {English} {Longitudinal} {Study} of {Aging}},
	issn = {2327-9095, 2327-9109},
	url = {https://www.tandfonline.com/doi/full/10.1080/23279095.2021.1913739},
	doi = {10.1080/23279095.2021.1913739},
	language = {en},
	urldate = {2021-05-14},
	journal = {Applied Neuropsychology: Adult},
	author = {Gkotzamanis, Viktor and Koliopanos, Giorgos and Sanchez-Niubo, Albert and Olaya, Beatriz and Caballero, Francisco Félix and Ayuso-Mateos, José Luis and Chatterji, Somnath and Haro, Josep Maria and Panagiotakos, Demosthenes B.},
	month = may,
	year = {2021},
	keywords = {ELSA, English Longitudinal Study of Ageing},
	pages = {1--10},
}

@article{lu_comparing_2021,
	title = {Comparing socio-economic inequalities in healthy ageing in the {United} {States} of {America}, {England}, {China} and {Japan}: evidence from four longitudinal studies of ageing},
	volume = {41},
	issn = {0144-686X, 1469-1779},
	shorttitle = {Comparing socio-economic inequalities in healthy ageing in the {United} {States} of {America}, {England}, {China} and {Japan}},
	url = {https://www.cambridge.org/core/product/identifier/S0144686X19001740/type/journal_article},
	doi = {10.1017/S0144686X19001740},
	abstract = {Abstract
            Healthy ageing has become a popular topic worldwide. So far, a consensus measure of healthy ageing has not been reached; and no studies have compared the magnitude of socio-economic inequality in healthy ageing outside Europe. This study aims to create a universal measure of healthy ageing and compare socio-economic inequalities in healthy ageing in the United States of America (USA), England, China and Japan. We included 10,305 American, 6,590 English, 5,930 Chinese and 1,935 Japanese participants for longitudinal analysis. A harmonised healthy ageing index (HAI) was developed to measure healthy ageing multi-dimensionally. Educational, income and wealth rank scores were derived accounting for the entire socio-economic distribution and the sample size of each category of socio-economic indicator. Associations between socio-economic rank scores and HAIs were assessed using multi-level modelling to calculate the Slope Indices of Inequality. Healthy ageing trajectories were predicted based on the full-adjusted age-cohort models. We found that education was a universally influential socio-economic predictor of healthy ageing. Moving from the highest to the lowest educational groups was associated with a 6.7 (5.2–8.2), 8.2 (6.0–10.4), 13.9 (11.4–16.3) and 6.1 per cent (3.9–8.2\%) decrease in average HAI at 60 years in the USA, England, China and Japan, respectively. After 60 years, the educational inequality in healthy ageing kept increasing in the USA and China. The educational inequality in healthy ageing in China was also greater than any other socio-economic inequality in the four countries. Wealth was more influential in predicting healthy ageing inequality among American, English and Japanese participants, while income was more influential among Chinese participants. The socio-economic inequality in healthy ageing in Japan was relatively small. Chinese and American participants had worse healthy ageing profiles than Japanese and English participants.},
	language = {en},
	number = {7},
	urldate = {2022-11-21},
	journal = {Ageing and Society},
	author = {Lu, Wentian and Pikhart, Hynek and Sacker, Amanda},
	month = jul,
	year = {2021},
	pages = {1495--1520},
}

Abstract Healthy ageing has become a popular topic worldwide. So far, a consensus measure of healthy ageing has not been reached; and no studies have compared the magnitude of socio-economic inequality in healthy ageing outside Europe. This study aims to create a universal measure of healthy ageing and compare socio-economic inequalities in healthy ageing in the United States of America (USA), England, China and Japan. We included 10,305 American, 6,590 English, 5,930 Chinese and 1,935 Japanese participants for longitudinal analysis. A harmonised healthy ageing index (HAI) was developed to measure healthy ageing multi-dimensionally. Educational, income and wealth rank scores were derived accounting for the entire socio-economic distribution and the sample size of each category of socio-economic indicator. Associations between socio-economic rank scores and HAIs were assessed using multi-level modelling to calculate the Slope Indices of Inequality. Healthy ageing trajectories were predicted based on the full-adjusted age-cohort models. We found that education was a universally influential socio-economic predictor of healthy ageing. Moving from the highest to the lowest educational groups was associated with a 6.7 (5.2–8.2), 8.2 (6.0–10.4), 13.9 (11.4–16.3) and 6.1 per cent (3.9–8.2%) decrease in average HAI at 60 years in the USA, England, China and Japan, respectively. After 60 years, the educational inequality in healthy ageing kept increasing in the USA and China. The educational inequality in healthy ageing in China was also greater than any other socio-economic inequality in the four countries. Wealth was more influential in predicting healthy ageing inequality among American, English and Japanese participants, while income was more influential among Chinese participants. The socio-economic inequality in healthy ageing in Japan was relatively small. Chinese and American participants had worse healthy ageing profiles than Japanese and English participants.

@article{de_la_torre-luque_metabolic_2021,
	title = {Metabolic dysregulation in older adults with depression and loneliness: {The} {ATHLOS} study},
	volume = {123},
	issn = {03064530},
	shorttitle = {Metabolic dysregulation in older adults with depression and loneliness},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0306453020303413},
	doi = {10.1016/j.psyneuen.2020.104918},
	language = {en},
	urldate = {2021-01-26},
	journal = {Psychoneuroendocrinology},
	author = {de la Torre-Luque, Alejandro and Lara, Elvira and de la Fuente, Javier and Rico-Uribe, Laura Alejandra and Caballero, Francisco Felix and Lopez-Garcia, Pilar and Sanchez-Niubo, Albert and Bobak, Martin and Koskinen, Seppo and Haro, Josep Maria and Ayuso-Mateos, Jose Luis},
	month = jan,
	year = {2021},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {104918},
}

@article{stefler_socioeconomic_2021,
	title = {Socioeconomic inequalities in physical and cognitive functioning: cross-sectional evidence from 37 cohorts across 28 countries in the {ATHLOS} project},
	issn = {0143-005X, 1470-2738},
	shorttitle = {Socioeconomic inequalities in physical and cognitive functioning},
	url = {https://jech.bmj.com/lookup/doi/10.1136/jech-2020-214714},
	doi = {10.1136/jech-2020-214714},
	abstract = {Background
              Physical and cognitive functioning in older age follows a socioeconomic gradient but it is unclear whether the strength of the association differs between populations. Using harmonised data from an international collaboration of cohort studies, we assessed socioeconomic inequalities in physical and cognitive functioning and explored if the extent of inequalities varied across countries based on their economic strength or wealth distribution.
            
            
              Methods
              Harmonised data from 37 population-based cohorts in 28 countries were used, with an overall sample size of 126 765. Socioeconomic position of participants was indicated by education and household income. Physical functioning was assessed by self-reported mobility and activities of daily living; and cognitive functioning by memory and verbal fluency tests. Relative (RII) and slope (SII) index of inequality were calculated in each cohort, and their association with the source country’s Gross Domestic Product (GDP) and Gini-index was assessed with correlation and cross-level interaction in multilevel models.
            
            
              Results
              RII and SII values indicated consistently higher risk of low physical and cognitive functioning in participants with lower education or income across cohorts. Regarding RII, there were weak but statistically significant correlations and interactions with GDP and Gini-index, suggesting larger inequalities in countries with lower Gini-index and higher GDP. For SII, no such correlations were observed.
            
            
              Conclusion
              This study confirms that socioeconomic inequalities in physical and cognitive functioning exist across different social contexts but the magnitude of these inequalities varies. Relative inequalities appear to be larger in higher-income countries but it remains to be seen whether such observation can be replicated.},
	language = {en},
	urldate = {2021-04-03},
	journal = {Journal of Epidemiology and Community Health},
	author = {Stefler, Denes and Prina, Matthew and Wu, Yu-Tzu and Sánchez-Niubò, Albert and Lu, Wentian and Haro, Josep Maria and Marmot, Michael and Bobak, Martin},
	month = mar,
	year = {2021},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {jech--2020--214714},
}

Background Physical and cognitive functioning in older age follows a socioeconomic gradient but it is unclear whether the strength of the association differs between populations. Using harmonised data from an international collaboration of cohort studies, we assessed socioeconomic inequalities in physical and cognitive functioning and explored if the extent of inequalities varied across countries based on their economic strength or wealth distribution. Methods Harmonised data from 37 population-based cohorts in 28 countries were used, with an overall sample size of 126 765. Socioeconomic position of participants was indicated by education and household income. Physical functioning was assessed by self-reported mobility and activities of daily living; and cognitive functioning by memory and verbal fluency tests. Relative (RII) and slope (SII) index of inequality were calculated in each cohort, and their association with the source country’s Gross Domestic Product (GDP) and Gini-index was assessed with correlation and cross-level interaction in multilevel models. Results RII and SII values indicated consistently higher risk of low physical and cognitive functioning in participants with lower education or income across cohorts. Regarding RII, there were weak but statistically significant correlations and interactions with GDP and Gini-index, suggesting larger inequalities in countries with lower Gini-index and higher GDP. For SII, no such correlations were observed. Conclusion This study confirms that socioeconomic inequalities in physical and cognitive functioning exist across different social contexts but the magnitude of these inequalities varies. Relative inequalities appear to be larger in higher-income countries but it remains to be seen whether such observation can be replicated.

@article{wu_sex_2021,
	title = {Sex differences in mortality: results from a population-based study of 12 longitudinal cohorts},
	volume = {193},
	issn = {0820-3946, 1488-2329},
	shorttitle = {Sex differences in mortality},
	url = {http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200484},
	doi = {10.1503/cmaj.200484},
	language = {en},
	number = {11},
	urldate = {2021-04-03},
	journal = {Canadian Medical Association Journal},
	author = {Wu, Yu-Tzu and Niubo, Albert Sanchez and Daskalopoulou, Christina and Moreno-Agostino, Dario and Stefler, Denes and Bobak, Martin and Oram, Sian and Prince, Martin and Prina, Matthew},
	month = mar,
	year = {2021},
	pmcid = {PMC8096404},
	pmid = {33722827},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {E361--E370},
}

@article{gkotzamanis_determinants_2021,
	title = {Determinants of {Processing} {Speed} {Trajectories} among {Middle} {Aged} or {Older} {Adults}, and {Their} {Association} with {Chronic} {Illnesses}: {The} {English} {Longitudinal} {Study} of {Aging}},
	volume = {11},
	issn = {2075-1729},
	shorttitle = {Determinants of {Processing} {Speed} {Trajectories} among {Middle} {Aged} or {Older} {Adults}, and {Their} {Association} with {Chronic} {Illnesses}},
	url = {https://www.mdpi.com/2075-1729/11/4/357},
	doi = {10.3390/life11040357},
	abstract = {The aim of this study was to identify latent groups of similar trajectories in processing speed through aging, as well as factors that are associated with these trajectories. In the context of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project, data from the English Longitudinal Study of Aging (ELSA) (n = 12099) were analyzed. Latent groups of similar trajectories in the processing scores as well as their predictors and covariates were investigated, using group-based trajectory models (GBTM). The coefficient estimates for potential group predictors correspond to parameters of multinomial logit functions that are integrated in the model. Potential predictors included sex, level of education, marital status, level of household wealth, level of physical activity, and history of smoking, while time-varying covariates included incidence of cardiovascular disease (CVD), diabetes mellitus, depressive symptoms, and sleep disturbances. Four trajectories were identified and named after their baseline scores and shapes: High (4.4\%), Middle/Stable (31.5\%), Low/Stable (44.5\%), and Low Decline (19.6\%). Female sex, higher levels of education, mild level of physical activity, having been married, and higher level of wealth were associated with a higher probability of belonging to any of the higher groups compared to the Low/Decline that was set as reference, while presence of CVD, diabetes mellitus, and depressive symptoms were associated with lower processing speed scores within most trajectories. All the aforementioned factors might be valid targets for interventions to reduce the burden of age-related cognitive impairment.},
	language = {en},
	number = {4},
	urldate = {2021-05-06},
	journal = {Life},
	author = {Gkotzamanis, Viktor and Koliopanos, Giorgos and Sanchez-Niubo, Albert and Olaya, Beatriz and Caballero, Francisco and Ayuso-Mateos, José and Chatterji, Somnath and Haro, Josep and Panagiotakos, Demosthenes},
	month = apr,
	year = {2021},
	pmcid = {PMC8072694},
	pmid = {33919625},
	keywords = {ELSA, English Longitudinal Study of Ageing},
	pages = {357},
}

The aim of this study was to identify latent groups of similar trajectories in processing speed through aging, as well as factors that are associated with these trajectories. In the context of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project, data from the English Longitudinal Study of Aging (ELSA) (n = 12099) were analyzed. Latent groups of similar trajectories in the processing scores as well as their predictors and covariates were investigated, using group-based trajectory models (GBTM). The coefficient estimates for potential group predictors correspond to parameters of multinomial logit functions that are integrated in the model. Potential predictors included sex, level of education, marital status, level of household wealth, level of physical activity, and history of smoking, while time-varying covariates included incidence of cardiovascular disease (CVD), diabetes mellitus, depressive symptoms, and sleep disturbances. Four trajectories were identified and named after their baseline scores and shapes: High (4.4%), Middle/Stable (31.5%), Low/Stable (44.5%), and Low Decline (19.6%). Female sex, higher levels of education, mild level of physical activity, having been married, and higher level of wealth were associated with a higher probability of belonging to any of the higher groups compared to the Low/Decline that was set as reference, while presence of CVD, diabetes mellitus, and depressive symptoms were associated with lower processing speed scores within most trajectories. All the aforementioned factors might be valid targets for interventions to reduce the burden of age-related cognitive impairment.

@incollection{mazzuco_new_2020,
	address = {Cham},
	title = {New {Approaches} to the {Conceptualization} and {Measurement} of {Age} and {Ageing}},
	volume = {49},
	isbn = {978-3-030-42471-8 978-3-030-42472-5},
	url = {http://link.springer.com/10.1007/978-3-030-42472-5_12},
	abstract = {Abstract
            
              People’s views on population ageing are influenced by the statistics that they read about it. The statistical measures in common use today were first developed around a century ago, in a very different demographic environment. For around two decades, we have been studying population ageing and have been arguing that its conventional portrayal is misleading. In this chapter, we summarize some of that research, which provides an alternative picture of population ageing, one that is more appropriate for twenty-first century. More details about our new view of population ageing can be found in. (Sanderson and Scherbov 2019). Population ageing can be measured in different ways. An example of this can found in the UN’s
              Profiles in Ageing, 2017
              . One way is to report on the forecasted increase in the number of people 60+ years old in the world.},
	language = {en},
	urldate = {2022-11-22},
	booktitle = {Developments in {Demographic} {Forecasting}},
	publisher = {Springer International Publishing},
	author = {Scherbov, Sergei and Sanderson, Warren C.},
	editor = {Mazzuco, Stefano and Keilman, Nico},
	year = {2020},
	doi = {10.1007/978-3-030-42472-5_12},
	note = {Series Title: The Springer Series on Demographic Methods and Population Analysis},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {243--258},
}

Abstract People’s views on population ageing are influenced by the statistics that they read about it. The statistical measures in common use today were first developed around a century ago, in a very different demographic environment. For around two decades, we have been studying population ageing and have been arguing that its conventional portrayal is misleading. In this chapter, we summarize some of that research, which provides an alternative picture of population ageing, one that is more appropriate for twenty-first century. More details about our new view of population ageing can be found in. (Sanderson and Scherbov 2019). Population ageing can be measured in different ways. An example of this can found in the UN’s Profiles in Ageing, 2017 . One way is to report on the forecasted increase in the number of people 60+ years old in the world.

@article{de_la_fuente_development_2020,
	title = {Development of a {Combined} {Sensory}-{Cognitive} {Measure} {Based} on the {Common} {Cause} {Hypothesis}: {Heterogeneous} {Trajectories} and {Associated} {Risk} {Factors}},
	volume = {60},
	issn = {0016-9013, 1758-5341},
	shorttitle = {Development of a {Combined} {Sensory}-{Cognitive} {Measure} {Based} on the {Common} {Cause} {Hypothesis}},
	url = {https://academic.oup.com/gerontologist/article/60/5/e357/5497002},
	doi = {10.1093/geront/gnz066},
	abstract = {Abstract
            
              Background and Objectives
              There is a link between sensory and cognitive functioning across old age. However, there are no integrative measures for assessing common determinants of sensory-cognitive functioning. This study aims to develop a combined measure of sensory-cognitive functioning, and to identify heterogeneous trajectories and associated risk factors.
            
            
              Research Design and Methods
              Two thousand two hundred and fifty-five individuals aged 60 years and over selected from the first six waves (2002–2012) of the English Longitudinal Study of Ageing completed a set of five self-reported visual and hearing functioning items and four cognitive items. Several health-related outcomes were also collected.
            
            
              Results
              The common cause model presented longitudinal factorial invariance (Tucker-Lewis index [TLI] = 0.989; Comparative Fit Index [CFI] = 0.991; Root Mean Square Error of Approximation [RMSEA] = 0.026). A common factor explained 32\%, 36\%, and 26\% of the visual, hearing, and cognitive difficulties, respectively. The developed sensory-cognitive measure predicted incident dementia over 10 years (area under the curve = .80; 95\% confidence interval [CI] = .75, .86). A three-trajectory model was proved to fit better, according to growth mixture modeling. Low levels of education and household wealth, disability, diabetes, high blood pressure, depressive symptoms, and low levels of physical activity were risk factors associated with the classes showing trajectories with a steeper increase of sensory-cognitive difficulties.
            
            
              Discussion and Implications
              A time-invariant factor explains both sensory and cognitive functioning over 8 years. The sensory-cognitive measure derived from this factor showed a good performance for predicting dementia 10 years later. Several easily identifiable socioeconomic and health-related risk factors could be used as early markers of subsequent sensory-cognitive decline. Therefore, the proposed latent measure could be useful as a cost-effective indicator of sensory-cognitive functioning.},
	language = {en},
	number = {5},
	urldate = {2022-11-22},
	journal = {The Gerontologist},
	author = {de la Fuente, Javier and Moreno-Agostino, Dario and de la Torre-Luque, Alejandro and Prina, A Matthew and Haro, Josep María and Caballero, Francisco Félix and Ayuso-Mateos, José Luis},
	editor = {Meeks, Suzanne},
	month = jul,
	year = {2020},
	pmcid = {PMC7362620},
	pmid = {31115438},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {e357--e366},
}

Abstract Background and Objectives There is a link between sensory and cognitive functioning across old age. However, there are no integrative measures for assessing common determinants of sensory-cognitive functioning. This study aims to develop a combined measure of sensory-cognitive functioning, and to identify heterogeneous trajectories and associated risk factors. Research Design and Methods Two thousand two hundred and fifty-five individuals aged 60 years and over selected from the first six waves (2002–2012) of the English Longitudinal Study of Ageing completed a set of five self-reported visual and hearing functioning items and four cognitive items. Several health-related outcomes were also collected. Results The common cause model presented longitudinal factorial invariance (Tucker-Lewis index [TLI] = 0.989; Comparative Fit Index [CFI] = 0.991; Root Mean Square Error of Approximation [RMSEA] = 0.026). A common factor explained 32%, 36%, and 26% of the visual, hearing, and cognitive difficulties, respectively. The developed sensory-cognitive measure predicted incident dementia over 10 years (area under the curve = .80; 95% confidence interval [CI] = .75, .86). A three-trajectory model was proved to fit better, according to growth mixture modeling. Low levels of education and household wealth, disability, diabetes, high blood pressure, depressive symptoms, and low levels of physical activity were risk factors associated with the classes showing trajectories with a steeper increase of sensory-cognitive difficulties. Discussion and Implications A time-invariant factor explains both sensory and cognitive functioning over 8 years. The sensory-cognitive measure derived from this factor showed a good performance for predicting dementia 10 years later. Several easily identifiable socioeconomic and health-related risk factors could be used as early markers of subsequent sensory-cognitive decline. Therefore, the proposed latent measure could be useful as a cost-effective indicator of sensory-cognitive functioning.

@article{scherbov_measuring_2020,
	title = {Measuring inequalities of development at the sub-national level: {From} the human development index to the human life indicator},
	volume = {15},
	issn = {1932-6203},
	shorttitle = {Measuring inequalities of development at the sub-national level},
	url = {https://dx.plos.org/10.1371/journal.pone.0232014},
	doi = {10.1371/journal.pone.0232014},
	language = {en},
	number = {4},
	urldate = {2022-11-22},
	journal = {PLOS ONE},
	author = {Scherbov, Sergei and Gietel-Basten, Stuart},
	editor = {Khan, Hafiz T.A.},
	month = apr,
	year = {2020},
	pmcid = {PMC7192420},
	pmid = {32352971},
	pages = {e0232014},
}

@article{nguyen_factors_2020,
	title = {Factors {Associated} {With} {Multimorbidity} {Patterns} in {Older} {Adults} in {England}: {Findings} {From} the {English} {Longitudinal} {Study} of {Aging} ({ELSA})},
	volume = {32},
	issn = {0898-2643, 1552-6887},
	shorttitle = {Factors {Associated} {With} {Multimorbidity} {Patterns} in {Older} {Adults} in {England}},
	url = {http://journals.sagepub.com/doi/10.1177/0898264319891026},
	doi = {10.1177/0898264319891026},
	abstract = {Objective: We aimed to identify the patterns of multimorbidity in older adults and explored their association with sociodemographic and lifestyle risk factors. Method: The sample included 9,171 people aged 50+ from Wave 2 of the English Longitudinal Study of Aging (ELSA). Latent Class Analysis (LCA) was performed on 26 chronic diseases to determine clusters of common diseases within individuals and their association with sociodemographic and lifestyle risk factors. Result: Three latent classes were identified: (a) a cardiorespiratory/arthritis/cataracts class, (b) a metabolic class, and (c) a relatively healthy class. People aged 70 to 79 were 9.91 times (95\% Confidence Interval [CI] = [5.13, 19.13]) more likely to be assigned to the cardiorespiratory/arthritis/cataracts class, while regular drinkers and physically inactive people were 0.33 times (95\% CI = [0.24, 0.47]) less likely to be assigned to this class. Conclusion: Future research should investigate these patterns further to gain more insights into the needs of people with multimorbidity.},
	language = {en},
	number = {9},
	urldate = {2022-11-22},
	journal = {Journal of Aging and Health},
	author = {Nguyen, Hai and Chua, Kia-Chong and Dregan, Alexandru and Vitoratou, Silia and Bayes-Marin, Ivet and Olaya, Beatriz and Prina, A. Matthew},
	month = oct,
	year = {2020},
	pages = {1120--1132},
}

Objective: We aimed to identify the patterns of multimorbidity in older adults and explored their association with sociodemographic and lifestyle risk factors. Method: The sample included 9,171 people aged 50+ from Wave 2 of the English Longitudinal Study of Aging (ELSA). Latent Class Analysis (LCA) was performed on 26 chronic diseases to determine clusters of common diseases within individuals and their association with sociodemographic and lifestyle risk factors. Result: Three latent classes were identified: (a) a cardiorespiratory/arthritis/cataracts class, (b) a metabolic class, and (c) a relatively healthy class. People aged 70 to 79 were 9.91 times (95% Confidence Interval [CI] = [5.13, 19.13]) more likely to be assigned to the cardiorespiratory/arthritis/cataracts class, while regular drinkers and physically inactive people were 0.33 times (95% CI = [0.24, 0.47]) less likely to be assigned to this class. Conclusion: Future research should investigate these patterns further to gain more insights into the needs of people with multimorbidity.

@article{critselis_adherence_2020,
	title = {Adherence to the {Mediterranean} diet and healthy ageing: {Current} evidence, biological pathways, and future directions},
	volume = {60},
	issn = {1040-8398, 1549-7852},
	shorttitle = {Adherence to the {Mediterranean} diet and healthy ageing},
	url = {https://www.tandfonline.com/doi/full/10.1080/10408398.2019.1631752},
	doi = {10.1080/10408398.2019.1631752},
	language = {en},
	number = {13},
	urldate = {2022-11-22},
	journal = {Critical Reviews in Food Science and Nutrition},
	author = {Critselis, Elena and Panagiotakos, Demosthenes},
	month = jul,
	year = {2020},
	pages = {2148--2157},
}

@article{de_la_torre-luque_course_2020,
	title = {The course of depression in late life: a longitudinal perspective},
	volume = {29},
	issn = {2045-7960, 2045-7979},
	shorttitle = {The course of depression in late life},
	url = {https://www.cambridge.org/core/product/identifier/S204579602000058X/type/journal_article},
	doi = {10.1017/S204579602000058X},
	abstract = {Abstract
            Depression in old age deserves special attention in view of the fact of progressive population ageing, because of the way in which depression and risk factors interact in this period of life and the particularly negative impact of late-life depression on health and quality of life. This editorial aims to provide some insight into longitudinal aspects of depression in old age. Depression may follow varying trajectories (e.g. episode emergence, recurrence) across the lifespan. Late-life depression is not an exception. A symptom-based approach is presented as an appropriate research method to study the predictors and course of affective syndromes in old age. Findings from our studies on depressive symptom trajectories in old age revealed that participants with a course of unremitting elevated symptoms showed the highest levels of loneliness across the trajectory groups and that participants with subclinical symptoms also showed higher levels of loneliness than their counterparts with a minimal-symptom course trajectory. This highlights the need to address loneliness as a way of dealing with depression in old age.},
	language = {en},
	urldate = {2021-01-26},
	journal = {Epidemiology and Psychiatric Sciences},
	author = {de la Torre-Luque, Alejandro and Ayuso-Mateos, Jose Luis},
	year = {2020},
	pmcid = {PMC7443808},
	pmid = {32723402},
	pages = {e147},
}

Abstract Depression in old age deserves special attention in view of the fact of progressive population ageing, because of the way in which depression and risk factors interact in this period of life and the particularly negative impact of late-life depression on health and quality of life. This editorial aims to provide some insight into longitudinal aspects of depression in old age. Depression may follow varying trajectories (e.g. episode emergence, recurrence) across the lifespan. Late-life depression is not an exception. A symptom-based approach is presented as an appropriate research method to study the predictors and course of affective syndromes in old age. Findings from our studies on depressive symptom trajectories in old age revealed that participants with a course of unremitting elevated symptoms showed the highest levels of loneliness across the trajectory groups and that participants with subclinical symptoms also showed higher levels of loneliness than their counterparts with a minimal-symptom course trajectory. This highlights the need to address loneliness as a way of dealing with depression in old age.

@article{nguyen_multimorbidity_2020,
	title = {Multimorbidity patterns, all‐cause mortality and healthy aging in older {English} adults: {Results} from the {English} {Longitudinal} {Study} of {Aging}},
	volume = {20},
	issn = {1444-1586, 1447-0594},
	shorttitle = {Multimorbidity patterns, all‐cause mortality and healthy aging in older {English} adults},
	url = {https://onlinelibrary.wiley.com/doi/10.1111/ggi.14051},
	doi = {10.1111/ggi.14051},
	language = {en},
	number = {12},
	urldate = {2021-01-26},
	journal = {Geriatrics \& Gerontology International},
	author = {Nguyen, Hai and Wu, Yu‐Tzu and Dregan, Alexandru and Vitoratou, Silia and Chua, Kia‐Chong and Prina, A Matthew},
	month = dec,
	year = {2020},
	pages = {1126--1132},
}

@article{sandoval-insausti_mediterranean_2020,
	title = {The {Mediterranean} {Diet} {Protects} the {Renal} {Function} in {Older} {Adults}: {A} {Prospective} {Cohort} {Study}},
	volume = {4},
	issn = {2475-2991},
	shorttitle = {The {Mediterranean} {Diet} {Protects} the {Renal} {Function} in {Older} {Adults}},
	url = {https://academic.oup.com/cdn/article/4/Supplement_2/562/5844193},
	doi = {10.1093/cdn/nzaa046_062},
	abstract = {Abstract
            
              Objectives
              It is not clear if the adherence to a Mediterranean diet is associated with changes in kidney function. The aim of this study is to assess the prospective association between the adherence to the Mediterranean diet and renal function decline.
            
            
              Methods
              Prospective cohort study of 975 community-dwelling individuals aged 60 and older who were recruited during 2008–10 in Spain, and followed up to December, 2015. At baseline, food consumption was obtained with a validated, computerized face-to-face diet history. The “a priori” adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS score: low adherence 0–5 points, moderate adherence 6–8 points, high adherence 9–14 points). To identify “a posteriori” dietary patterns, 880 foods were categorized into 36 different groups according to similarities in their nutritional profile. Factor analysis (principal components analysis) was applied to generate independent dietary patterns. At baseline and at the end of follow-up, serum creatinine (SC) and glomerular filtration rate (GFR) levels were ascertained and changes were calculated. Two end-points were considered: SC increase and GFR decrease beyond that expected for age. Logistic regression models were built and adjusted for prevalent and incident cardiovascular risk factors.
            
            
              Results
              At the end of follow-up 150 cases of SC increase and 146 cases of GFR decrease occurred. The fully adjusted ORs (95\% CI) of SC increase were 0.75 (0.49–1.15) for participants with a moderate adherence to the MEDAS score, and 0.58 (0.36–0.95) for those with a high adherence, when comparing to participants with a low adherence; (p-trend: 0.026). Results for GFR decrease had the same direction (p-trend: 0.049). The fully adjusted ORs (95\% CI) of SC increase according to increasing quartiles of adherence to an “a posteriori” Mediterranean-like dietary pattern were 1.00, 0.62 (0.37–1.03), 0.57 (0.33–0.99), and 0.46 (0.24–0.86); (p-trend: 0.017). Results for GFR decrease were similar (p-trend: 0.007).
            
            
              Conclusions
              A higher adherence to a Mediterranean dietary pattern was associated with a lower risk of kidney function decline.
            
            
              Funding Sources
              State Secretary of R + D and FEDER/FSE, the ATHLOS project (EU H2020), and the CIBERESP, Instituto de Salud Carlos III. Madrid, Spain.},
	language = {en},
	number = {Supplement\_2},
	urldate = {2022-11-22},
	journal = {Current Developments in Nutrition},
	author = {Sandoval-Insausti, Helena and Bayan-Bravo, Ana and Donat-Vargas, Carolina and Rey-Garcia, Jimena and Banegas, Jose Ramon and Rodriguez-Artalejo, Fernando and Guallar-Castillon Q2818013A, Pilar},
	month = jun,
	year = {2020},
	pmcid = {PMC7257899},
	pages = {562--562},
}

Abstract Objectives It is not clear if the adherence to a Mediterranean diet is associated with changes in kidney function. The aim of this study is to assess the prospective association between the adherence to the Mediterranean diet and renal function decline. Methods Prospective cohort study of 975 community-dwelling individuals aged 60 and older who were recruited during 2008–10 in Spain, and followed up to December, 2015. At baseline, food consumption was obtained with a validated, computerized face-to-face diet history. The “a priori” adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS score: low adherence 0–5 points, moderate adherence 6–8 points, high adherence 9–14 points). To identify “a posteriori” dietary patterns, 880 foods were categorized into 36 different groups according to similarities in their nutritional profile. Factor analysis (principal components analysis) was applied to generate independent dietary patterns. At baseline and at the end of follow-up, serum creatinine (SC) and glomerular filtration rate (GFR) levels were ascertained and changes were calculated. Two end-points were considered: SC increase and GFR decrease beyond that expected for age. Logistic regression models were built and adjusted for prevalent and incident cardiovascular risk factors. Results At the end of follow-up 150 cases of SC increase and 146 cases of GFR decrease occurred. The fully adjusted ORs (95% CI) of SC increase were 0.75 (0.49–1.15) for participants with a moderate adherence to the MEDAS score, and 0.58 (0.36–0.95) for those with a high adherence, when comparing to participants with a low adherence; (p-trend: 0.026). Results for GFR decrease had the same direction (p-trend: 0.049). The fully adjusted ORs (95% CI) of SC increase according to increasing quartiles of adherence to an “a posteriori” Mediterranean-like dietary pattern were 1.00, 0.62 (0.37–1.03), 0.57 (0.33–0.99), and 0.46 (0.24–0.86); (p-trend: 0.017). Results for GFR decrease were similar (p-trend: 0.007). Conclusions A higher adherence to a Mediterranean dietary pattern was associated with a lower risk of kidney function decline. Funding Sources State Secretary of R + D and FEDER/FSE, the ATHLOS project (EU H2020), and the CIBERESP, Instituto de Salud Carlos III. Madrid, Spain.

@article{macguire_reducing_2020,
	title = {Reducing {Health} {Inequalities} in {Aging} {Through} {Policy} {Frameworks} and {Interventions}},
	volume = {8},
	issn = {2296-2565},
	url = {https://www.frontiersin.org/article/10.3389/fpubh.2020.00315/full},
	doi = {10.3389/fpubh.2020.00315},
	urldate = {2022-11-22},
	journal = {Frontiers in Public Health},
	author = {MacGuire, Frances A. S.},
	month = jul,
	year = {2020},
	pmcid = {PMC7411218},
	pmid = {32850574},
	pages = {315},
}

@phdthesis{nguyen_multimorbidity_2020,
	address = {London},
	type = {Ph.{D}.},
	title = {Multimorbidity and healthy ageing : patterns, risk factors, health outcomes and trajectories},
	shorttitle = {Multimorbidity and healthy ageing},
	url = {https://kclpure.kcl.ac.uk/portal/en/theses/multimorbidity-and-healthy-ageing(b8167cc4-5b3f-4995-a2b0-71fb755f6da5).html},
	abstract = {This thesis, as part of the larger Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project, examined the patterns and risk factors of multimorbidity (the coexistence or two or more chronic illnesses in the same individual), as well as its relationship with mortality and healthy ageing (the process of developing and maintaining the functional ability that enables wellbeing in older age) in older adults. A key line of enquiry that this thesis pursues was exploring the heterogeneity of multimorbidity and healthy ageing, and the multifaceted association between these two concepts. This was carried out in several stages. The first line of investigation was the heterogeneity of multimorbidity in its operationalisation. This was described and summarised in a systematic review and meta-analysis. Wide variations in the prevalence of multimorbidity was found in 70 observational studies in community settings, ranging from 3.5\% to 70\% in high income countries (HICs), and from 1\% to 90\% in lower-and-middle-income countries (LMICs). Results from the meta-analysis showed that one third of the world's population had multimorbidity. Multimorbidity prevalence was higher in HICs compared to LMICs (37\% vs 29\% respectively). The second line of investigation was the heterogeneity of multimorbidity patterns (i.e. clusters of diseases). Using latent class analysis (LCA) based on data from 26 chronic conditions in the English Longitudinal Study of Ageing (ELSA), three patterns of multimorbidity were identified: 1) the cardiorespiratory/arthritis/cataracts group, 2) the metabolic group and 3) the relatively healthy group. The complexity level of multimorbidity was also revealed through this analysis, where the most complex multimorbidity pattern was found to be the cardiorespiratory/arthritis/cataracts group. The associations between these multimorbidity patterns and sociodemographic and lifestyle risk factors were also examined. Age, sex, wealth, smoking and physical activity were found to be associated with the most complex multimorbidity group. This supports the hypothesis that discordant multimorbidity where diseases with different aetiology and treatments cluster together could be attributable to upstream health risk factors. The third line of investigation was the heterogeneity of the associations between multimorbidity patterns and health outcomes such as mortality and healthy ageing. Multimorbidity is often associated with poorer health outcomes. However, in this thesis it was found that those with multimorbidity could still achieve a relatively high level of healthy ageing, despite a negative association between the two. Only people belonging to the cardiorespiratory/arthritis/cataract group had higher risks of mortality during a 10-year follow up period. The association between multimorbidity and mortality did not differ when considering levels of healthy ageing. Nonetheless, healthy ageing seemed to have a mediating effect on the multimorbidity-mortality relationship. This supports the hypothesis that healthy ageing lies on the causal pathway between multimorbidity and mortality. The fourth line of investigation was the heterogeneity of healthy ageing trajectories over the life course. In this line of enquiry, the relationship between multimorbidity and healthy ageing was explored further, in which the patterns of healthy ageing trajectories among 130880 participants from eight ATHLOS cohorts were identified and the impact of multimorbidity on the projection of healthy ageing trajectories was examined. Three patterns of healthy ageing trajectories were identified using the growth mixture modelling approach: 1) the 'high stable' group, which displayed a high level of healthy ageing at baseline and a slow decline over time, 2) a 'low stable' group, which showed a low level of healthy ageing at baseline and a slow decline over the follow-up period, and 3) a 'rapid decline' group, which presented a high level of healthy ageing at baseline but a steep downward slope over 11 waves. The presence of multimorbidity significantly increased the likelihood of an individual being in the 'rapid decline' or the 'low stable' groups. In conclusion, this thesis illustrated the heterogeneity of multimorbidity and healthy ageing. It reiterated that multimorbidity is not synonymous with ill health. A person-centred integrated care model thus should be implemented to cater for the heterogeneous needs of people with multimorbidity.},
	language = {eng},
	urldate = {2022-11-22},
	school = {King's College London},
	author = {Nguyen, Hai},
	year = {2020},
	note = {Accepted: 2020},
}

This thesis, as part of the larger Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project, examined the patterns and risk factors of multimorbidity (the coexistence or two or more chronic illnesses in the same individual), as well as its relationship with mortality and healthy ageing (the process of developing and maintaining the functional ability that enables wellbeing in older age) in older adults. A key line of enquiry that this thesis pursues was exploring the heterogeneity of multimorbidity and healthy ageing, and the multifaceted association between these two concepts. This was carried out in several stages. The first line of investigation was the heterogeneity of multimorbidity in its operationalisation. This was described and summarised in a systematic review and meta-analysis. Wide variations in the prevalence of multimorbidity was found in 70 observational studies in community settings, ranging from 3.5% to 70% in high income countries (HICs), and from 1% to 90% in lower-and-middle-income countries (LMICs). Results from the meta-analysis showed that one third of the world's population had multimorbidity. Multimorbidity prevalence was higher in HICs compared to LMICs (37% vs 29% respectively). The second line of investigation was the heterogeneity of multimorbidity patterns (i.e. clusters of diseases). Using latent class analysis (LCA) based on data from 26 chronic conditions in the English Longitudinal Study of Ageing (ELSA), three patterns of multimorbidity were identified: 1) the cardiorespiratory/arthritis/cataracts group, 2) the metabolic group and 3) the relatively healthy group. The complexity level of multimorbidity was also revealed through this analysis, where the most complex multimorbidity pattern was found to be the cardiorespiratory/arthritis/cataracts group. The associations between these multimorbidity patterns and sociodemographic and lifestyle risk factors were also examined. Age, sex, wealth, smoking and physical activity were found to be associated with the most complex multimorbidity group. This supports the hypothesis that discordant multimorbidity where diseases with different aetiology and treatments cluster together could be attributable to upstream health risk factors. The third line of investigation was the heterogeneity of the associations between multimorbidity patterns and health outcomes such as mortality and healthy ageing. Multimorbidity is often associated with poorer health outcomes. However, in this thesis it was found that those with multimorbidity could still achieve a relatively high level of healthy ageing, despite a negative association between the two. Only people belonging to the cardiorespiratory/arthritis/cataract group had higher risks of mortality during a 10-year follow up period. The association between multimorbidity and mortality did not differ when considering levels of healthy ageing. Nonetheless, healthy ageing seemed to have a mediating effect on the multimorbidity-mortality relationship. This supports the hypothesis that healthy ageing lies on the causal pathway between multimorbidity and mortality. The fourth line of investigation was the heterogeneity of healthy ageing trajectories over the life course. In this line of enquiry, the relationship between multimorbidity and healthy ageing was explored further, in which the patterns of healthy ageing trajectories among 130880 participants from eight ATHLOS cohorts were identified and the impact of multimorbidity on the projection of healthy ageing trajectories was examined. Three patterns of healthy ageing trajectories were identified using the growth mixture modelling approach: 1) the 'high stable' group, which displayed a high level of healthy ageing at baseline and a slow decline over time, 2) a 'low stable' group, which showed a low level of healthy ageing at baseline and a slow decline over the follow-up period, and 3) a 'rapid decline' group, which presented a high level of healthy ageing at baseline but a steep downward slope over 11 waves. The presence of multimorbidity significantly increased the likelihood of an individual being in the 'rapid decline' or the 'low stable' groups. In conclusion, this thesis illustrated the heterogeneity of multimorbidity and healthy ageing. It reiterated that multimorbidity is not synonymous with ill health. A person-centred integrated care model thus should be implemented to cater for the heterogeneous needs of people with multimorbidity.

@article{kreutzkamp_zunehmende_2020,
	title = {Zunehmende {Schmerzen} im {Alter}: {Bei} einigen {Risikofaktoren} lässt sich gegensteuern},
	volume = {36},
	issn = {2194-2536, 2364-1010},
	shorttitle = {Zunehmende {Schmerzen} im {Alter}},
	url = {https://www.springermedizin.de/doi/10.1007/s00940-020-1760-7},
	doi = {10.1007/s00940-020-1760-7},
	language = {de},
	number = {4},
	urldate = {2022-11-22},
	journal = {Schmerzmedizin},
	author = {Kreutzkamp, Barbara},
	month = jul,
	year = {2020},
	pages = {29--29},
}

@incollection{tobiasz-adamczyk_rola_2020,
	address = {Kraków},
	title = {Rola zmiennych społecznych w projekcie {ATHLOS}},
	copyright = {http://ruj.uj.edu.pl/4dspace/License/copyright/licencja\_copyright.pdf},
	isbn = {978-83-233-4885-6},
	url = {https://ruj.uj.edu.pl/xmlui/handle/item/165477},
	language = {pol},
	booktitle = {Trajektorie starzenia się związane ze zdrowiem: długofalowe możliwości i synergie ({ATHLOS})},
	publisher = {Wydawnictwo Uniwersytetu Jagiellońskiego},
	author = {Tobiasz-Adamczyk, Beata and Zawisza, Katarzyna},
	editor = {Tobiasz-Adamczyk, Beata},
	year = {2020},
	note = {Accepted: 2020-07-08T12:06:49Z},
	pages = {25--36},
}

@incollection{tobiasz-adamczyk_cele_2020,
	address = {Kraków},
	title = {Cele i założenia realizowane w projekcie {ATHLOS}},
	copyright = {http://ruj.uj.edu.pl/4dspace/License/copyright/licencja\_copyright.pdf},
	isbn = {978-83-233-4885-6},
	url = {https://ruj.uj.edu.pl/xmlui/handle/item/165451},
	abstract = {17-24},
	language = {pol},
	booktitle = {Trajektorie starzenia się związane ze zdrowiem: długofalowe możliwości i synergie ({ATHLOS})},
	publisher = {Wydawnictwo Uniwersytetu Jagiellońskiego},
	author = {Tobiasz-Adamczyk, Beata},
	editor = {Tobiasz-Adamczyk, Beata},
	year = {2020},
	note = {Accepted: 2020-07-08T10:26:01Z},
	pages = {17--24},
}

17-24

@article{de_la_torreluque_functioning_2020,
	title = {Functioning profiles in a nationally representative cohort of {Spanish} older adults: {A} latent class study},
	volume = {28},
	issn = {0966-0410, 1365-2524},
	shorttitle = {Functioning profiles in a nationally representative cohort of {Spanish} older adults},
	url = {https://onlinelibrary.wiley.com/doi/10.1111/hsc.13031},
	doi = {10.1111/hsc.13031},
	language = {en},
	number = {6},
	urldate = {2022-11-21},
	journal = {Health \& Social Care in the Community},
	author = {de la Torre‐Luque, Alejandro and Cabello, Maria and Lara, Elvira and Fuente, Javier and Miret, Marta and Sanchez‐Niubo, Albert and Haro, Josep Maria and Ayuso‐Mateos, Jose Luis},
	month = nov,
	year = {2020},
	pages = {2190--2198},
}

@article{tyrovolas_alcohol_2020,
	title = {Alcohol {Drinking} and {Health} in {Ageing}: {A} {Global} {Scale} {Analysis} of {Older} {Individual} {Data} through the {Harmonised} {Dataset} of {ATHLOS}},
	volume = {12},
	copyright = {All rights reserved},
	issn = {2072-6643},
	url = {https://doi.org/10.3390%2Fnu12061746},
	doi = {10.3390/nu12061746},
	abstract = {We investigated the relation between alcohol drinking and healthy ageing by means of a validated health status metric, using individual data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. For the purposes of this study, the ATHLOS harmonised dataset, which includes information from individuals aged 65+ in 38 countries, was analysed (n = 135,440). Alcohol drinking was reflected by means of three harmonised variables: alcohol drinking frequency, current and past alcohol drinker. A set of 41 self-reported health items and measured tests were used to generate a specific health metric. In the harmonised dataset, the prevalence of current drinking was 47.5\% while of past drinking was 26.5\%. In the pooled sample, current alcohol drinking was positively associated with better health status among older adults ((b-coef (95\% CI): 1.32(0.45 to 2.19)) and past alcohol drinking was inversely related (b-coef (95\% CI): \−0.83 (\−1.51 to \−0.16)) with health status. Often alcohol consumption appeared to be beneficial only for females in all super-regions except Africa, both age group categories (65\–80 years old and 80+), both age group categories, as well as among all the financial status categories (all p \< 0.05). Regional analysis pictured diverse patterns in the association for current and past alcohol drinkers. Our results report the need for specific alcohol intake recommendations among older adults that will help them maintain a better health status throughout the ageing process.},
	number = {6},
	journal = {Nutrients},
	author = {Tyrovolas, Stefanos and Panaretos, Dimitris and Daskalopoulou, Christina and Gine-Vazquez, Iago and Niubo, Albert Sanchez and Olaya, Beatriz and Bobak, Martin and Prince, Martin and Prina, Matthew and Ayuso-Mateos, Jose Luis and Caballero, Francisco Felix and Garcia-Esquinas, Esther and Holger, Arndt and Scherbov, Sergei and Sanderson, Warren and Gheno, Ilenia and Koupil, Ilona and Bickenbach, Jerome and Chatterji, Somnath and Koskinen, Seppo and Raggi, Alberto and Pajak, Andrzej and Tobiasz-Adamczyk, Beata and Haro, Josep Maria and Panagiotakos, Demosthenes},
	month = jun,
	year = {2020},
	pmid = {32545243},
	pmcid = {PMC7353331},
	note = {Publisher: MDPI AG},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {1746},
}

We investigated the relation between alcohol drinking and healthy ageing by means of a validated health status metric, using individual data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. For the purposes of this study, the ATHLOS harmonised dataset, which includes information from individuals aged 65+ in 38 countries, was analysed (n = 135,440). Alcohol drinking was reflected by means of three harmonised variables: alcohol drinking frequency, current and past alcohol drinker. A set of 41 self-reported health items and measured tests were used to generate a specific health metric. In the harmonised dataset, the prevalence of current drinking was 47.5% while of past drinking was 26.5%. In the pooled sample, current alcohol drinking was positively associated with better health status among older adults ((b-coef (95% CI): 1.32(0.45 to 2.19)) and past alcohol drinking was inversely related (b-coef (95% CI): −0.83 (−1.51 to −0.16)) with health status. Often alcohol consumption appeared to be beneficial only for females in all super-regions except Africa, both age group categories (65–80 years old and 80+), both age group categories, as well as among all the financial status categories (all p < 0.05). Regional analysis pictured diverse patterns in the association for current and past alcohol drinkers. Our results report the need for specific alcohol intake recommendations among older adults that will help them maintain a better health status throughout the ageing process.

@article{ballesteros_mediterranean_2020,
	title = {Mediterranean diet and risk of falling in community-dwelling older adults},
	volume = {39},
	issn = {02615614},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0261561419300561},
	doi = {10.1016/j.clnu.2019.02.004},
	language = {en},
	number = {1},
	urldate = {2022-11-21},
	journal = {Clinical Nutrition},
	author = {Ballesteros, Juan-Manuel and Struijk, Ellen A. and Rodríguez-Artalejo, Fernando and López-García, Esther},
	month = jan,
	year = {2020},
	pages = {276--281},
}

@article{tyrovolas_skeletal_2020,
	title = {Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the {ATTICA} study},
	volume = {74},
	issn = {0143-005X, 1470-2738},
	shorttitle = {Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults},
	url = {https://jech.bmj.com/lookup/doi/10.1136/jech-2019-212268},
	doi = {10.1136/jech-2019-212268},
	abstract = {Background
              Skeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old.
            
            
              Methods
              ATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek general population (Caucasians; age ≥18 years; 1514 men). The 10 year study follow-up (2011–2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50\% men). The working sample consisted of 1019 participants, 45+ years old (men: n=534; women: n=485). A skeletal muscle mass index (SMI) was created to reflect SMM, using appendicular skeletal muscle mass (ASM) standardised by body mass index (BMI). ASM and SMI were calculated with specific indirect population formulas.
            
            
              Results
              The 10 year CVD incidence increased significantly across the baseline SMI tertiles (p{\textless}0.001). Baseline SMM showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95\% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81\% (95\% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile.
            
            
              Conclusions
              The presented findings support the importance of SMM evaluation in the prediction of long-term CVD risk among adults 45+ years old without pre-existing CVD. Preservation of SMM may contribute to CVD health.},
	language = {en},
	number = {1},
	urldate = {2022-11-21},
	journal = {Journal of Epidemiology and Community Health},
	author = {Tyrovolas, Stefanos and Panagiotakos, Demosthenes and Georgousopoulou, Ekavi and Chrysohoou, Christina and Tousoulis, Dimitrios and Haro, Josep Maria and Pitsavos, Christos},
	month = jan,
	year = {2020},
	pmcid = {PMC6929696},
	pmid = {31712252},
	keywords = {ATTICA study},
	pages = {26--31},
}

Background Skeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old. Methods ATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek general population (Caucasians; age ≥18 years; 1514 men). The 10 year study follow-up (2011–2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). The working sample consisted of 1019 participants, 45+ years old (men: n=534; women: n=485). A skeletal muscle mass index (SMI) was created to reflect SMM, using appendicular skeletal muscle mass (ASM) standardised by body mass index (BMI). ASM and SMI were calculated with specific indirect population formulas. Results The 10 year CVD incidence increased significantly across the baseline SMI tertiles (p\textless0.001). Baseline SMM showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81% (95% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile. Conclusions The presented findings support the importance of SMM evaluation in the prediction of long-term CVD risk among adults 45+ years old without pre-existing CVD. Preservation of SMM may contribute to CVD health.

@techreport{marois_projecting_2020,
	address = {Laxenburg, Austria},
	type = {{IIASA} {Working} {Paper}},
	title = {Projecting health trajectories in {Europe} using microsimulation},
	url = {https://pure.iiasa.ac.at/id/eprint/16323/},
	abstract = {This working paper presents an innovative methodological framework for projecting the health of individuals with a set of risk factors using a microsimulation model. The model developed, called ATHLOS-Mic, projects the health of cohorts born before 1960 and a set of risk factors for the horizon 2060 for some European countries. It simulates the lives of individuals using statistical models that explicitly take into account interactions between the different dimensions, either biological and behavioral risk factors (smoking, obesity, depression, arterial hypertension and physical activity), socioeconomic characteristics (education), a health metric, and mortality. Using data from SHARE-HD, we used parameters from statistical models to project dynamically changes in risk factors with a set of covariates and their impact on a health metric. The health metric is then used to modulate the probability of survival. A set of analytical scenarios are built showing the effect of each risk factors on future health trajectories. Results show that driven by a better educational attainment, each generation will be healthier than the previous one at same age. In average, an individual of our base population will live about 18 more years, but only 5 in good health. The scenario removing the effect of having a low level of education on the health metric is the one having the largest effect on both the projected average health metric, the average number of years lived per person, and the average number of years lived in good health. Summing up, removing all risk factors would add 2 years of life, but 6 years in good health.},
	number = {WP-20-004},
	institution = {IIASA},
	author = {Marois, G. and Aktas, A.},
	month = feb,
	year = {2020},
}

This working paper presents an innovative methodological framework for projecting the health of individuals with a set of risk factors using a microsimulation model. The model developed, called ATHLOS-Mic, projects the health of cohorts born before 1960 and a set of risk factors for the horizon 2060 for some European countries. It simulates the lives of individuals using statistical models that explicitly take into account interactions between the different dimensions, either biological and behavioral risk factors (smoking, obesity, depression, arterial hypertension and physical activity), socioeconomic characteristics (education), a health metric, and mortality. Using data from SHARE-HD, we used parameters from statistical models to project dynamically changes in risk factors with a set of covariates and their impact on a health metric. The health metric is then used to modulate the probability of survival. A set of analytical scenarios are built showing the effect of each risk factors on future health trajectories. Results show that driven by a better educational attainment, each generation will be healthier than the previous one at same age. In average, an individual of our base population will live about 18 more years, but only 5 in good health. The scenario removing the effect of having a low level of education on the health metric is the one having the largest effect on both the projected average health metric, the average number of years lived per person, and the average number of years lived in good health. Summing up, removing all risk factors would add 2 years of life, but 6 years in good health.

@article{philipov_subjective_2020,
	title = {Subjective length of life of {European} individuals at older ages: {Temporal} and gender distinctions},
	volume = {15},
	issn = {1932-6203},
	shorttitle = {Subjective length of life of {European} individuals at older ages},
	url = {https://dx.plos.org/10.1371/journal.pone.0229975},
	doi = {10.1371/journal.pone.0229975},
	language = {en},
	number = {3},
	urldate = {2022-11-21},
	journal = {PLOS ONE},
	author = {Philipov, Dimiter and Scherbov, Sergei},
	editor = {Forloni, Gianluigi},
	month = mar,
	year = {2020},
	pmcid = {PMC7077847},
	pmid = {32182263},
	pages = {e0229975},
}

@article{gao_associations_2020,
	title = {Associations of perinatal characteristics with endometriosis: a nationwide birth cohort study},
	volume = {49},
	issn = {0300-5771, 1464-3685},
	shorttitle = {Associations of perinatal characteristics with endometriosis},
	url = {https://academic.oup.com/ije/article/49/2/537/5527999},
	doi = {10.1093/ije/dyz140},
	abstract = {Abstract
            
              Background
              Perinatal characteristics are associated with subsequent risk of several chronic diseases. Previous studies regarding endometriosis were based on small samples and retrospective data and were limited by unmeasured confounding bias, leading to conflicting and inconclusive findings. We investigated the associations of maternal and birth characteristics with risk of endometriosis among Swedish women of reproductive age.
            
            
              Methods
              This total-population register-based cohort study consisted of 628 312 singleton women born in Sweden between 1973 and 1987, who were followed for diagnosed endometriosis from age 15 years until the end of 2012. Multivariable Cox regression was applied to examine associations with perinatal characteristics. Residual unmeasured confounding was assessed through within-family and E-value analyses.
            
            
              Results
              During follow-up, 8262 women received an endometriosis diagnosis. There were clear dose−response/linear associations of endometriosis with lower maternal education, endometriosis in the mother [adjusted hazard ratio (aHR): 2.24, 95\% confidence interval (CI): 2.04–2.46], maternal smoking during pregnancy (aHR: 1.18, 95\% CI: 1.04–1.33 for moderate smoker and aHR: 1.36, 95\% CI: 1.18–1.57 for heavy smoker vs non-smoker), lower birthweight, and lower birthweight-for-gestational age (aHR: 0.93 per standard deviation increase, 95\% CI: 0.91–0.95). Within-family and E-value analyses suggested that these perinatal characteristics are robust predictors of the incidence of endometriosis. We also found that an estimated 26\% of the association between maternal smoking and early-onset endometriosis could be explained by birthweight-for-gestational age.
            
            
              Conclusion
              This study finds support for fetal origins of endometriosis, in that exposure to adverse environment or restricted development during the perinatal period may increase the risk. Further research is needed to provide an understanding of the underlying mechanisms.},
	language = {en},
	number = {2},
	urldate = {2022-11-21},
	journal = {International Journal of Epidemiology},
	author = {Gao, Menghan and Scott, Kirk and Koupil, Ilona},
	month = apr,
	year = {2020},
	pmcid = {PMC7266550},
	pmid = {31270530},
	pages = {537--547},
}

Abstract Background Perinatal characteristics are associated with subsequent risk of several chronic diseases. Previous studies regarding endometriosis were based on small samples and retrospective data and were limited by unmeasured confounding bias, leading to conflicting and inconclusive findings. We investigated the associations of maternal and birth characteristics with risk of endometriosis among Swedish women of reproductive age. Methods This total-population register-based cohort study consisted of 628 312 singleton women born in Sweden between 1973 and 1987, who were followed for diagnosed endometriosis from age 15 years until the end of 2012. Multivariable Cox regression was applied to examine associations with perinatal characteristics. Residual unmeasured confounding was assessed through within-family and E-value analyses. Results During follow-up, 8262 women received an endometriosis diagnosis. There were clear dose−response/linear associations of endometriosis with lower maternal education, endometriosis in the mother [adjusted hazard ratio (aHR): 2.24, 95% confidence interval (CI): 2.04–2.46], maternal smoking during pregnancy (aHR: 1.18, 95% CI: 1.04–1.33 for moderate smoker and aHR: 1.36, 95% CI: 1.18–1.57 for heavy smoker vs non-smoker), lower birthweight, and lower birthweight-for-gestational age (aHR: 0.93 per standard deviation increase, 95% CI: 0.91–0.95). Within-family and E-value analyses suggested that these perinatal characteristics are robust predictors of the incidence of endometriosis. We also found that an estimated 26% of the association between maternal smoking and early-onset endometriosis could be explained by birthweight-for-gestational age. Conclusion This study finds support for fetal origins of endometriosis, in that exposure to adverse environment or restricted development during the perinatal period may increase the risk. Further research is needed to provide an understanding of the underlying mechanisms.

@article{raggi_predictors_2020,
	title = {Predictors of pain in general ageing populations: results from a multi-country analysis based on {ATHLOS} harmonized database},
	volume = {21},
	copyright = {All rights reserved},
	issn = {1129-2377},
	url = {https://doi.org/10.1186%2Fs10194-020-01116-3},
	doi = {10.1186/s10194-020-01116-3},
	abstract = {Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents.},
	number = {1},
	journal = {The Journal of Headache and Pain},
	author = {Raggi, Alberto and Leonardi, Matilde and Mellor-Marsá, Blanca and Moneta, Maria V. and Sanchez-Niubo, Albert and Tyrovolas, Stefanos and Giné-Vázquez, Iago and Haro, Josep M. and Chatterji, Somnath and Bobak, Martin and Ayuso-Mateos, Jose L. and Arndt, Holger and Hossin, Muhammad Z. and Bickenbach, Jerome and Koskinen, Seppo and Tobiasz-Adamczyk, Beata and Panagiotakos, Demosthenes and Corso, Barbara},
	month = may,
	year = {2020},
	pmid = {32375641},
	pmcid = {PMC7201730},
	note = {Publisher: Springer Science and Business Media LLC},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {45},
}

Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents.

@article{laclaustra_inflammatory_2020,
	title = {The inflammatory potential of diet is related to incident frailty and slow walking in older adults},
	volume = {39},
	issn = {02615614},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0261561419300317},
	doi = {10.1016/j.clnu.2019.01.013},
	language = {en},
	number = {1},
	urldate = {2022-11-21},
	journal = {Clinical Nutrition},
	author = {Laclaustra, Martin and Rodriguez-Artalejo, Fernando and Guallar-Castillon, Pilar and Banegas, Jose R. and Graciani, Auxiliadora and Garcia-Esquinas, Esther and Lopez-Garcia, Esther},
	month = jan,
	year = {2020},
	pages = {185--191},
}

@article{guido_pain_2020,
	title = {Pain rates in general population for the period 1991–2015 and 10-years prediction: results from a multi-continent age-period-cohort analysis},
	volume = {21},
	copyright = {All rights reserved},
	issn = {1129-2377},
	url = {https://doi.org/10.1186%2Fs10194-020-01108-3},
	doi = {10.1186/s10194-020-01108-3},
	abstract = {Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people. The aims of this study are to evaluate the temporal variations of pain rates among general populations for the period 1991–2015 and to project 10-year pain rates.},
	number = {1},
	journal = {The Journal of Headache and Pain},
	author = {Guido, Davide and Leonardi, Matilde and Mellor-Marsá, Blanca and Moneta, Maria V. and Sanchez-Niubo, Albert and Tyrovolas, Stefanos and Giné-Vázquez, Iago and Haro, Josep M. and Chatterji, Somnath and Bobak, Martin and Ayuso-Mateos, Jose L. and Arndt, Holger and Koupil, Ilona and Bickenbach, Jerome and Koskinen, Seppo and Tobiasz-Adamczyk, Beata and Panagiotakos, Demosthenes and Raggi, Alberto},
	month = may,
	year = {2020},
	pmid = {32404046},
	pmcid = {PMC7218619},
	note = {Publisher: Springer Science and Business Media LLC},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {52},
}

Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people. The aims of this study are to evaluate the temporal variations of pain rates among general populations for the period 1991–2015 and to project 10-year pain rates.

@article{bayes-marin_multimorbidity_2020,
	title = {Multimorbidity patterns in low-middle and high income regions: a multiregion latent class analysis using {ATHLOS} harmonised cohorts},
	volume = {10},
	issn = {2044-6055, 2044-6055},
	shorttitle = {Multimorbidity patterns in low-middle and high income regions},
	url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2019-034441},
	doi = {10.1136/bmjopen-2019-034441},
	abstract = {Objectives
              Our aim was to determine clusters of non-communicable diseases (NCDs) in a very large, population-based sample of middle-aged and older adults from low- and middle-income (LMICs) and high-income (HICs) regions. Additionally, we explored the associations with several covariates.
            
            
              Design
              The total sample was 72 140 people aged 50+ years from three population-based studies (English Longitudinal Study of Ageing, Survey of Health, Ageing and Retirement in Europe Study and Study on Global Ageing and Adult Health) included in the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project and representing eight regions with LMICs and HICs. Variables were previously harmonised using an ex-post strategy. Eight NCDs were used in latent class analysis. Multinomial models were made to calculate associations with covariates. All the analyses were stratified by age (50–64 and 65+ years old).
            
            
              Results
              Three clusters were identified: ‘cardio-metabolic’ (8.93\% in participants aged 50–64 years and 27.22\% in those aged 65+ years), ‘respiratory-mental-articular’ (3.91\% and 5.27\%) and ‘healthy’ (87.16\% and 67.51\%). In the younger group, Russia presented the highest prevalence of the ‘cardio-metabolic’ group (18.8\%) and England the ‘respiratory-mental-articular’ (5.1\%). In the older group, Russia had the highest proportion of both classes (48.3\% and 9\%). Both the younger and older African participants presented the highest proportion of the ‘healthy’ class. Older age, being woman, widowed and with low levels of education and income were related to an increased risk of multimorbidity. Physical activity was a protective factor in both age groups and smoking a risk factor for the ‘respiratory-mental-articular’.
            
            
              Conclusion
              Multimorbidity is common worldwide, especially in HICs and Russia. Health policies in each country addressing coordination and support are needed to face the complexity of a pattern of growing multimorbidity.},
	language = {en},
	number = {7},
	urldate = {2021-01-28},
	journal = {BMJ Open},
	author = {Bayes-Marin, Ivet and Sanchez-Niubo, Albert and Egea-Cortés, Laia and Nguyen, Hai and Prina, Matthew and Fernández, Daniel and Haro, Josep Maria and Olaya, Beatriz},
	month = jul,
	year = {2020},
	pmcid = {PMC7371222},
	pmid = {32690500},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {e034441},
}

Objectives Our aim was to determine clusters of non-communicable diseases (NCDs) in a very large, population-based sample of middle-aged and older adults from low- and middle-income (LMICs) and high-income (HICs) regions. Additionally, we explored the associations with several covariates. Design The total sample was 72 140 people aged 50+ years from three population-based studies (English Longitudinal Study of Ageing, Survey of Health, Ageing and Retirement in Europe Study and Study on Global Ageing and Adult Health) included in the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project and representing eight regions with LMICs and HICs. Variables were previously harmonised using an ex-post strategy. Eight NCDs were used in latent class analysis. Multinomial models were made to calculate associations with covariates. All the analyses were stratified by age (50–64 and 65+ years old). Results Three clusters were identified: ‘cardio-metabolic’ (8.93% in participants aged 50–64 years and 27.22% in those aged 65+ years), ‘respiratory-mental-articular’ (3.91% and 5.27%) and ‘healthy’ (87.16% and 67.51%). In the younger group, Russia presented the highest prevalence of the ‘cardio-metabolic’ group (18.8%) and England the ‘respiratory-mental-articular’ (5.1%). In the older group, Russia had the highest proportion of both classes (48.3% and 9%). Both the younger and older African participants presented the highest proportion of the ‘healthy’ class. Older age, being woman, widowed and with low levels of education and income were related to an increased risk of multimorbidity. Physical activity was a protective factor in both age groups and smoking a risk factor for the ‘respiratory-mental-articular’. Conclusion Multimorbidity is common worldwide, especially in HICs and Russia. Health policies in each country addressing coordination and support are needed to face the complexity of a pattern of growing multimorbidity.

@article{wu_education_2020,
	title = {Education and wealth inequalities in healthy ageing in eight harmonised cohorts in the {ATHLOS} consortium: a population-based study},
	volume = {5},
	issn = {24682667},
	shorttitle = {Education and wealth inequalities in healthy ageing in eight harmonised cohorts in the {ATHLOS} consortium},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S2468266720300773},
	doi = {10.1016/S2468-2667(20)30077-3},
	language = {en},
	number = {7},
	urldate = {2021-01-26},
	journal = {The Lancet Public Health},
	author = {Wu, Yu-Tzu and Daskalopoulou, Christina and Muniz Terrera, Graciela and Sanchez Niubo, Albert and Rodríguez-Artalejo, Fernando and Ayuso-Mateos, Jose Luis and Bobak, Martin and Caballero, Francisco Félix and de la Fuente, Javier and de la Torre-Luque, Alejandro and García-Esquinas, Esther and Haro, Jose Maria and Koskinen, Seppo and Koupil, Ilona and Leonardi, Matilde and Pajak, Andrzej and Panagiotakos, Demosthenes and Stefler, Denes and Tobias-Adamczyk, Beata and Prince, Martin and Prina, A Matthew},
	month = jul,
	year = {2020},
	pmcid = {PMC7739372},
	pmid = {32619540},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {e386--e394},
}

@article{critselis_ageing_2020,
	title = {Ageing trajectories of health—longitudinal opportunities and synergies ({ATHLOS}) {Healthy} {Ageing} {Scale} in adults from 16 international cohorts representing 38 countries worldwide},
	volume = {74},
	copyright = {All rights reserved},
	url = {https://doi.org/10.1136%2Fjech-2020-214496},
	doi = {10.1136/jech-2020-214496},
	number = {12},
	journal = {Journal of Epidemiology and Community Health},
	author = {Critselis, Elena and Panaretos, Dimitris and Sánchez-Niubò, Albert and Giné-Vázquez, Iago and Ayuso-Mateos, José Luis and Caballero, Francisco Felix and Fuente, Javier de la and Haro, Josep Maria and Panagiotakos, Demosthenes},
	month = aug,
	year = {2020},
	pmid = {32801117},
	note = {Publisher: BMJ},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {jech--2020--214496},
}

@article{moreno-agostino_impact_2020,
	title = {The impact of physical activity on healthy ageing trajectories: evidence from eight cohort studies},
	volume = {17},
	issn = {1479-5868},
	shorttitle = {The impact of physical activity on healthy ageing trajectories},
	url = {https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-00995-8},
	doi = {10.1186/s12966-020-00995-8},
	language = {en},
	number = {1},
	urldate = {2021-01-26},
	journal = {International Journal of Behavioral Nutrition and Physical Activity},
	author = {Moreno-Agostino, Darío and Daskalopoulou, Christina and Wu, Yu-Tzu and Koukounari, Artemis and Haro, Josep Maria and Tyrovolas, Stefanos and Panagiotakos, Demosthenes B. and Prince, Martin and Prina, A. Matthew},
	month = dec,
	year = {2020},
	pmcid = {PMC7364650},
	pmid = {32677960},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {92},
}

@article{sanchez-niubo_development_2020,
	title = {Development of a common scale for measuring healthy ageing across the world: results from the {ATHLOS} consortium},
	copyright = {All rights reserved},
	issn = {0300-5771},
	url = {https://doi.org/10.1093%2Fije%2Fdyaa236},
	doi = {10.1093/ije/dyaa236},
	abstract = {Research efforts to measure the concept of healthy ageing have been diverse and limited to specific populations. This diversity limits the potential to compare healthy ageing across countries and/or populations. In this study, we developed a novel measurement scale of healthy ageing using worldwide cohorts.In the Ageing Trajectories of Health-Longitudinal Opportunities and Synergies (ATHLOS) project, data from 16 international cohorts were harmonized. Using ATHLOS data, an item response theory (IRT) model was used to develop a scale with 41 items related to health and functioning. Measurement heterogeneity due to intra-dataset specificities was detected, applying differential item functioning via a logistic regression framework. The model accounted for specificities in model parameters by introducing cohort-specific parameters that rescaled scores to the main scale, using an equating procedure. Final scores were estimated for all individuals and converted to T-scores with a mean of 50 and a standard deviation of 10.A common scale was created for 343 915 individuals above 18 years of age from 16 studies. The scale showed solid evidence of concurrent validity regarding various sociodemographic, life and health factors, and convergent validity with healthy life expectancy (r = 0.81) and gross domestic product (r = 0.58). Survival curves showed that the scale could also be predictive of mortality.The ATHLOS scale, due to its reliability and global representativeness, has the potential to contribute to worldwide research on healthy ageing.},
	journal = {International Journal of Epidemiology},
	author = {Sanchez-Niubo, Albert and Forero, Carlos G. and Wu, Yu-Tzu and Giné-Vázquez, Iago and Prina, Matthew and Fuente, Javier De La and Daskalopoulou, Christina and Critselis, Elena and Torre-Luque, Alejandro De La and Panagiotakos, Demosthenes and Arndt, Holger and Ayuso-Mateos, José Luis and Bayes-Marin, Ivet and Bickenbach, Jerome and Bobak, Martin and Caballero, Francisco Félix and Chatterji, Somnath and Egea-Cortés, Laia and García-Esquinas, Esther and Leonardi, Matilde and Koskinen, Seppo and Koupil, Ilona and Mellor-Marsá, Blanca and Olaya, Beatriz and Pająk, Andrzej and Prince, Martin and Raggi, Alberto and Rodríguez-Artalejo, Fernando and Sanderson, Warren and Scherbov, Sergei and Tamosiunas, Abdonas and Tobias-Adamczyk, Beata and Tyrovolas, Stefanos and Haro, Josep Maria},
	month = dec,
	year = {2020},
	pmid = {33274372},
	pmcid = {PMC8271194},
	note = {Publisher: Oxford University Press (OUP)
eprint: https://academic.oup.com/ije/advance-article-pdf/doi/10.1093/ije/dyaa236/34695114/dyaa236.pdf},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {dyaa236},
}

Research efforts to measure the concept of healthy ageing have been diverse and limited to specific populations. This diversity limits the potential to compare healthy ageing across countries and/or populations. In this study, we developed a novel measurement scale of healthy ageing using worldwide cohorts.In the Ageing Trajectories of Health-Longitudinal Opportunities and Synergies (ATHLOS) project, data from 16 international cohorts were harmonized. Using ATHLOS data, an item response theory (IRT) model was used to develop a scale with 41 items related to health and functioning. Measurement heterogeneity due to intra-dataset specificities was detected, applying differential item functioning via a logistic regression framework. The model accounted for specificities in model parameters by introducing cohort-specific parameters that rescaled scores to the main scale, using an equating procedure. Final scores were estimated for all individuals and converted to T-scores with a mean of 50 and a standard deviation of 10.A common scale was created for 343 915 individuals above 18 years of age from 16 studies. The scale showed solid evidence of concurrent validity regarding various sociodemographic, life and health factors, and convergent validity with healthy life expectancy (r = 0.81) and gross domestic product (r = 0.58). Survival curves showed that the scale could also be predictive of mortality.The ATHLOS scale, due to its reliability and global representativeness, has the potential to contribute to worldwide research on healthy ageing.

@article{campanini_duration_2019,
	title = {Duration and {Quality} of {Sleep} and {Risk} of {Physical} {Function} {Impairment} and {Disability} in {Older} {Adults}: {Results} from the {ENRICA} and {ELSA} {Cohorts}},
	volume = {10},
	issn = {2152-5250},
	shorttitle = {Duration and {Quality} of {Sleep} and {Risk} of {Physical} {Function} {Impairment} and {Disability} in {Older} {Adults}},
	url = {http://www.aginganddisease.org/EN/10.14336/AD.2018.0611},
	doi = {10.14336/AD.2018.0611},
	language = {en},
	number = {3},
	urldate = {2022-11-21},
	journal = {Aging and disease},
	author = {Campanini, Marcela Z. and Mesas, Arthur E. and Carnicero-Carreño, Jose Antonio and Rodríguez-Artalejo, Fernando and Lopez-Garcia, Esther},
	year = {2019},
	pmcid = {PMC6538215},
	pmid = {31165000},
	keywords = {ELSA, English Longitudinal Study of Ageing, ENRICA},
	pages = {557},
}

@article{lana_habitual_2019,
	title = {Habitual {Meat} {Consumption} and {Changes} in {Sleep} {Duration} and {Quality} in {Older} {Adults}},
	volume = {10},
	issn = {2152-5250},
	url = {http://www.aginganddisease.org/EN/10.14336/AD.2018.0503},
	doi = {10.14336/AD.2018.0503},
	language = {en},
	number = {2},
	urldate = {2022-11-21},
	journal = {Aging and disease},
	author = {Lana, Alberto and Struijk, Ellen A. and Arias-Fernandez, Lucía and Graciani, Auxiliadora and Mesas, Arthur E. and Rodriguez-Artalejo, Fernando and Lopez-Garcia, Esther},
	year = {2019},
	pmcid = {PMC6457059},
	pmid = {31011478},
	pages = {267},
}

@article{ortola_alcohol_2019,
	title = {Alcohol consumption and all-cause mortality in older adults in {Spain}: an analysis accounting for the main methodological issues: {Alcohol} and mortality in older adults},
	volume = {114},
	issn = {09652140},
	shorttitle = {Alcohol consumption and all-cause mortality in older adults in {Spain}},
	url = {https://onlinelibrary.wiley.com/doi/10.1111/add.14402},
	doi = {10.1111/add.14402},
	language = {en},
	number = {1},
	urldate = {2022-11-21},
	journal = {Addiction},
	author = {Ortolá, Rosario and García-Esquinas, Esther and López-García, Esther and León-Muñoz, Luz M. and Banegas, José R. and Rodríguez-Artalejo, Fernando},
	month = jan,
	year = {2019},
	pages = {59--68},
}

@article{foscolou_effect_2019,
	title = {The {Effect} of {Exclusive} {Olive} {Oil} {Consumption} on {Successful} {Aging}: {A} {Combined} {Analysis} of the {ATTICA} and {MEDIS} {Epidemiological} {Studies}},
	volume = {8},
	issn = {2304-8158},
	shorttitle = {The {Effect} of {Exclusive} {Olive} {Oil} {Consumption} on {Successful} {Aging}},
	url = {http://www.mdpi.com/2304-8158/8/1/25},
	doi = {10.3390/foods8010025},
	abstract = {The consumption of dietary fats, which occur naturally in various foods, poses important impacts on health. The aim of this study was to elucidate the association of exclusive use of olive oil for culinary purposes with successful aging in adults aged {\textgreater}50 years old and residing in Greece. Use of olive oil in food preparation and bio-clinical characteristics of the Greek participants enrolled in the ATTICA (n = 1128 adults from Athens metropolitan area) and the MEDiterranean Islands Study (MEDIS) (n = 2221 adults from various Greek islands and Mani) studies, were investigated in relation to successful aging (SA). Participants were divided into the following three categories: (a) no olive oil consumption; (b) combined consumption of olive oil and other dietary fats; and (c) exclusive olive oil consumption. The SA was measured using the previously validated successful aging index (SAI). After adjusting for age, sex, and smoking habits, combined consumption of olive oil and other fats (vs. no olive oil use) was not significantly associated with SAI levels (p = 0.114). However, exclusive olive oil intake (vs. no use of olive oil) was significantly associated with SAI (p = 0.001), particularly among those aged older than 70 years. Therefore, the exclusive consumption of olive oil, as opposed to either combined or no olive oil consumption, beneficially impacts successful aging, particularly among individuals over 70 years of age. Primary public health prevention strategies should seek to encourage the enhanced adoption of such dietary practices in order to promote healthy aging and longevity.},
	language = {en},
	number = {1},
	urldate = {2022-11-21},
	journal = {Foods},
	author = {Foscolou, Alexandra and Critselis, Elena and Tyrovolas, Stefanos and Chrysohoou, Christina and Sidossis, Labros and Naumovski, Nenad and Matalas, Antonia-Leda and Rallidis, Loukianos and Polychronopoulos, Evangelos and Ayuso-Mateos, Jose and Haro, Jose and Panagiotakos, Demosthenes},
	month = jan,
	year = {2019},
	pmcid = {PMC6352251},
	pmid = {30642026},
	keywords = {ATTICA study, MEDIS},
	pages = {25},
}

The consumption of dietary fats, which occur naturally in various foods, poses important impacts on health. The aim of this study was to elucidate the association of exclusive use of olive oil for culinary purposes with successful aging in adults aged \textgreater50 years old and residing in Greece. Use of olive oil in food preparation and bio-clinical characteristics of the Greek participants enrolled in the ATTICA (n = 1128 adults from Athens metropolitan area) and the MEDiterranean Islands Study (MEDIS) (n = 2221 adults from various Greek islands and Mani) studies, were investigated in relation to successful aging (SA). Participants were divided into the following three categories: (a) no olive oil consumption; (b) combined consumption of olive oil and other dietary fats; and (c) exclusive olive oil consumption. The SA was measured using the previously validated successful aging index (SAI). After adjusting for age, sex, and smoking habits, combined consumption of olive oil and other fats (vs. no olive oil use) was not significantly associated with SAI levels (p = 0.114). However, exclusive olive oil intake (vs. no use of olive oil) was significantly associated with SAI (p = 0.001), particularly among those aged older than 70 years. Therefore, the exclusive consumption of olive oil, as opposed to either combined or no olive oil consumption, beneficially impacts successful aging, particularly among individuals over 70 years of age. Primary public health prevention strategies should seek to encourage the enhanced adoption of such dietary practices in order to promote healthy aging and longevity.

@article{bayan-bravo_association_2019,
	title = {The association of major patterns of physical activity, sedentary behavior and sleeping with mortality in older adults},
	volume = {37},
	issn = {0264-0414, 1466-447X},
	url = {https://www.tandfonline.com/doi/full/10.1080/02640414.2018.1504617},
	doi = {10.1080/02640414.2018.1504617},
	language = {en},
	number = {4},
	urldate = {2022-11-21},
	journal = {Journal of Sports Sciences},
	author = {Bayán-Bravo, Ana and Pérez-Tasigchana, Raúl F. and López-García, Esther and Martínez-Gómez, David and Rodríguez-Artalejo, Fernando and Guallar-Castillón, Pilar},
	month = feb,
	year = {2019},
	pages = {424--433},
}

@article{de_la_torre-luque_long-term_2019,
	title = {Long-term trajectories of depressive symptoms in old age: {Relationships} with sociodemographic and health-related factors},
	volume = {246},
	issn = {01650327},
	shorttitle = {Long-term trajectories of depressive symptoms in old age},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0165032718321578},
	doi = {10.1016/j.jad.2018.12.122},
	language = {en},
	urldate = {2022-11-21},
	journal = {Journal of Affective Disorders},
	author = {de la Torre-Luque, Alejandro and de la Fuente, Javier and Prina, Matthew and Sanchez-Niubo, Albert and Haro, Josep Maria and Ayuso-Mateos, Jose Luis},
	month = mar,
	year = {2019},
	pages = {329--337},
}

@article{engchuan_sociodemographic_2019,
	title = {Sociodemographic {Indicators} of {Health} {Status} {Using} a {Machine} {Learning} {Approach} and {Data} from the {English} {Longitudinal} {Study} of {Aging} ({ELSA})},
	volume = {25},
	issn = {1643-3750},
	url = {https://www.medscimonit.com/abstract/index/idArt/913283},
	doi = {10.12659/MSM.913283},
	language = {en},
	urldate = {2021-02-16},
	journal = {Medical Science Monitor},
	author = {Engchuan, Worrawat and Dimopoulos, Alexandros C. and Tyrovolas, Stefanos and Caballero, Francisco Félix and Sanchez-Niubo, Albert and Arndt, Holger and Ayuso-Mateos, Jose Luis and Haro, Josep Maria and Chatterji, Somnath and Panagiotakos, Demosthenes B.},
	month = mar,
	year = {2019},
	pmcid = {PMC6436225},
	pmid = {30879019},
	keywords = {ML, Machine Learning},
	pages = {1994--2001},
}

@article{gao_associations_2019,
	title = {Associations of birth characteristics with perimenopausal disorders: a prospective cohort study},
	volume = {10},
	issn = {2040-1744, 2040-1752},
	shorttitle = {Associations of birth characteristics with perimenopausal disorders},
	url = {https://www.cambridge.org/core/product/identifier/S204017441800065X/type/journal_article},
	doi = {10.1017/S204017441800065X},
	abstract = {Abstract
            
              Perimenopausal disorders (PDs) are prevalent and importantly affect quality of life among middle-aged women. Yet, very little is known about the developmental origins of these disorders. The objective of this study was to investigate the associations of birth characteristics with PDs. This cohort study is based on archived birth records for birth weight and gestational age, and followed prospectively in Swedish inpatient and outpatient registers for 8 years (
              n
              =3212). The main outcomes were menopausal and climacteric states (e.g. flushing, sleeplessness), perimenopausal bleeding and other PDs (e.g. atrophic vaginitis). Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for three subtypes of PDs separately. During the follow-up, 218 women had PDs, among whom 125 had menopausal and climacteric states, 61 had perimenopausal bleeding and 58 had other PDs as first recorded disorder. Birth weight was linearly associated with incidence rate of menopausal and climacteric states [HR=1.66 per 1 kg increase, 95\% confidence interval (95\% CI)=1.14–2.41]. Gestational age (rather than birth weight) was associated with incidence rate of other PDs (HR=0.87 per 1 week increase, 95\% CI=0.79–0.95). Neither birth weight nor gestational age was associated with perimenopausal bleeding. Similar results were found after adjustment for other early-life and adult socio-demographic characteristics. This observational study provides, for the first time, evidence regarding the developmental origins of PDs. Future research is required to investigate the underlying causal mechanisms, which may shed further light on the etiology of this class of disorders.},
	language = {en},
	number = {02},
	urldate = {2022-11-21},
	journal = {Journal of Developmental Origins of Health and Disease},
	author = {Gao, M. and Goodman, A. and Mishra, G. and Koupil, I.},
	month = apr,
	year = {2019},
	pages = {246--252},
}

Abstract Perimenopausal disorders (PDs) are prevalent and importantly affect quality of life among middle-aged women. Yet, very little is known about the developmental origins of these disorders. The objective of this study was to investigate the associations of birth characteristics with PDs. This cohort study is based on archived birth records for birth weight and gestational age, and followed prospectively in Swedish inpatient and outpatient registers for 8 years ( n =3212). The main outcomes were menopausal and climacteric states (e.g. flushing, sleeplessness), perimenopausal bleeding and other PDs (e.g. atrophic vaginitis). Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for three subtypes of PDs separately. During the follow-up, 218 women had PDs, among whom 125 had menopausal and climacteric states, 61 had perimenopausal bleeding and 58 had other PDs as first recorded disorder. Birth weight was linearly associated with incidence rate of menopausal and climacteric states [HR=1.66 per 1 kg increase, 95% confidence interval (95% CI)=1.14–2.41]. Gestational age (rather than birth weight) was associated with incidence rate of other PDs (HR=0.87 per 1 week increase, 95% CI=0.79–0.95). Neither birth weight nor gestational age was associated with perimenopausal bleeding. Similar results were found after adjustment for other early-life and adult socio-demographic characteristics. This observational study provides, for the first time, evidence regarding the developmental origins of PDs. Future research is required to investigate the underlying causal mechanisms, which may shed further light on the etiology of this class of disorders.

@article{gao_developmental_2019,
	title = {Developmental origins of endometriosis: a {Swedish} cohort study},
	volume = {73},
	issn = {0143-005X, 1470-2738},
	shorttitle = {Developmental origins of endometriosis},
	url = {https://jech.bmj.com/lookup/doi/10.1136/jech-2018-211811},
	doi = {10.1136/jech-2018-211811},
	abstract = {Background
              Endometriosis is a chronic condition affecting women of reproductive age and is associated with multiple health burdens. Yet, findings regarding its ‘developmental origins’ are inconsistent. We aimed to investigate the associations of birth characteristics with endometriosis. We also explored potential mediation by adult social and reproductive factors.
            
            
              Methods
              This cohort study consisted of 3406 women born in Uppsala, Sweden, between 1933 and 1972. We used data from archived birth records and endometriosis diagnoses at ages 15–50 recorded in the national patient registers. Socioeconomic and reproductive characteristics were obtained from routine registers. HRs were estimated from Cox regression.
            
            
              Results
              During the follow-up, 111 women have been diagnosed with endometriosis, and most cases are external endometriosis (ie, outside the uterus, n=91). Lower standardised birth weight for gestational age was associated with increased rate of endometriosis (HR 1.35 per standard deviation decrease; 95\% CI 1.08 to 1.67). This increased rate was also detected among women with fewer number of live births (HR 2.38; 95\% CI 1.40 to 4.07 for one child vs ≥2 children; HR 6.09; 95\% CI 3.88 to 9.57 for no child vs ≥2 children) and diagnosed infertility problem (HR 2.00; 95\% CI 1.10 to 3.61) prior to endometriosis diagnosis. All the observed associations were stronger for external endometriosis. However, no evidence was found that number of births was the mediator of the inverse association between standardised birth weight and endometriosis.
            
            
              Conclusion
              This study supports the developmental origins theory and suggests that exposure to growth restriction during the fetal period is associated with increased risk of endometriosis during reproductive years.},
	language = {en},
	number = {4},
	urldate = {2022-11-21},
	journal = {Journal of Epidemiology and Community Health},
	author = {Gao, Menghan and Allebeck, Peter and Mishra, Gita D and Koupil, Ilona},
	month = apr,
	year = {2019},
	pmcid = {PMC6581098},
	pmid = {30661033},
	pages = {353--359},
}

Background Endometriosis is a chronic condition affecting women of reproductive age and is associated with multiple health burdens. Yet, findings regarding its ‘developmental origins’ are inconsistent. We aimed to investigate the associations of birth characteristics with endometriosis. We also explored potential mediation by adult social and reproductive factors. Methods This cohort study consisted of 3406 women born in Uppsala, Sweden, between 1933 and 1972. We used data from archived birth records and endometriosis diagnoses at ages 15–50 recorded in the national patient registers. Socioeconomic and reproductive characteristics were obtained from routine registers. HRs were estimated from Cox regression. Results During the follow-up, 111 women have been diagnosed with endometriosis, and most cases are external endometriosis (ie, outside the uterus, n=91). Lower standardised birth weight for gestational age was associated with increased rate of endometriosis (HR 1.35 per standard deviation decrease; 95% CI 1.08 to 1.67). This increased rate was also detected among women with fewer number of live births (HR 2.38; 95% CI 1.40 to 4.07 for one child vs ≥2 children; HR 6.09; 95% CI 3.88 to 9.57 for no child vs ≥2 children) and diagnosed infertility problem (HR 2.00; 95% CI 1.10 to 3.61) prior to endometriosis diagnosis. All the observed associations were stronger for external endometriosis. However, no evidence was found that number of births was the mediator of the inverse association between standardised birth weight and endometriosis. Conclusion This study supports the developmental origins theory and suggests that exposure to growth restriction during the fetal period is associated with increased risk of endometriosis during reproductive years.

@article{garcia-esquinas_trajectories_2019,
	title = {Trajectories of {Accumulation} of {Health} {Deficits} in {Older} {Adults}: {Are} {There} {Variations} {According} to {Health} {Domains}?},
	volume = {20},
	issn = {15258610},
	shorttitle = {Trajectories of {Accumulation} of {Health} {Deficits} in {Older} {Adults}},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S1525861018307321},
	doi = {10.1016/j.jamda.2018.12.023},
	language = {en},
	number = {6},
	urldate = {2022-11-21},
	journal = {Journal of the American Medical Directors Association},
	author = {García-Esquinas, Esther and Ortolá, Rosario and Prina, Matthew and Stefler, Denes and Rodríguez-Artalejo, Fernando and Pastor-Barriuso, Roberto},
	month = jun,
	year = {2019},
	pages = {710--717.e6},
}

@article{machado-fragua_coffee_2019,
	title = {Coffee consumption and risk of physical function impairment, frailty and disability in older adults},
	volume = {58},
	issn = {1436-6207, 1436-6215},
	url = {http://link.springer.com/10.1007/s00394-018-1664-7},
	doi = {10.1007/s00394-018-1664-7},
	language = {en},
	number = {4},
	urldate = {2022-11-21},
	journal = {European Journal of Nutrition},
	author = {Machado-Fragua, Marcos D. and Struijk, Ellen A. and Graciani, Auxiliadora and Guallar-Castillon, Pilar and Rodríguez-Artalejo, Fernando and Lopez-Garcia, Esther},
	month = jun,
	year = {2019},
	pages = {1415--1427},
}

@article{de_la_torre-luque_stability_2019,
	title = {Stability of clinically relevant depression symptoms in old‐age across 11 cohorts: a multi‐state study},
	volume = {140},
	issn = {0001-690X, 1600-0447},
	shorttitle = {Stability of clinically relevant depression symptoms in old‐age across 11 cohorts},
	url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/acps.13107},
	doi = {10.1111/acps.13107},
	language = {en},
	number = {6},
	urldate = {2021-01-26},
	journal = {Acta Psychiatrica Scandinavica},
	author = {de la Torre-Luque, Alejandro and Fuente, J. and Sanchez‐Niubo, A. and Caballero, F. F. and Prina, M. and Muniz‐Terrera, G. and Haro, J. M. and Ayuso‐Mateos, J. L.},
	month = dec,
	year = {2019},
	keywords = {ATHLOS, Ageing Trajectories of Health – Longitudinal Opportunities and Synergies},
	pages = {541--551},
}

@article{daskalopoulou_healthy_2019,
	title = {Healthy ageing trajectories and lifestyle behaviour: the {Mexican} {Health} and {Aging} {Study}},
	volume = {9},
	copyright = {2019 The Author(s)},
	issn = {2045-2322},
	shorttitle = {Healthy ageing trajectories and lifestyle behaviour},
	url = {https://www.nature.com/articles/s41598-019-47238-w},
	doi = {10.1038/s41598-019-47238-w},
	abstract = {Projections show that the number of people above 60 years old will triple by 2050 in Mexico. Nevertheless, ageing is characterised by great variability in the health status. In this study, we aimed to identify trajectories of health and their associations with lifestyle factors in a national representative cohort study of older Mexicans. We used secondary data of 14,143 adults from the Mexican Health and Aging Study (MHAS). A metric of health, based on the conceptual framework of functional ability, was mapped onto four waves (2001, 2003, 2012, 2015) and created by applying Bayesian multilevel Item Response Theory (IRT). Conditional Growth Mixture Modelling (GMM) was used to identify latent classes of individuals with similar trajectories and examine the impact of physical activity, smoking and alcohol on those. Conditional on sociodemographic and lifestyle behaviour four latent classes were suggested: high-stable, moderate-stable, low-stable and decliners. Participants who did not engage in physical activity, were current or previous smokers and did not consume alcohol at baseline were more likely to be in the trajectory with the highest deterioration (i.e. decliners). This study confirms ageing heterogeneity and the positive influence of a healthy lifestyle. These results provide the ground for new policies.},
	language = {en},
	number = {1},
	urldate = {2020-07-08},
	journal = {Scientific Reports},
	author = {Daskalopoulou, Christina and Koukounari, Artemis and Wu, Yu-Tzu and Terrera, Graciela Muniz and Caballero, Francisco Félix and de la Fuente, Javier and Tyrovolas, Stefanos and Panagiotakos, Demosthenes B. and Prince, Martin and Prina, Matthew},
	month = jul,
	year = {2019},
	pmcid = {PMC6667468},
	pmid = {31363117},
	note = {Number: 1
Publisher: Nature Publishing Group},
	keywords = {MHAS, Mexican Health and Aging Study},
	pages = {11041},
}

Projections show that the number of people above 60 years old will triple by 2050 in Mexico. Nevertheless, ageing is characterised by great variability in the health status. In this study, we aimed to identify trajectories of health and their associations with lifestyle factors in a national representative cohort study of older Mexicans. We used secondary data of 14,143 adults from the Mexican Health and Aging Study (MHAS). A metric of health, based on the conceptual framework of functional ability, was mapped onto four waves (2001, 2003, 2012, 2015) and created by applying Bayesian multilevel Item Response Theory (IRT). Conditional Growth Mixture Modelling (GMM) was used to identify latent classes of individuals with similar trajectories and examine the impact of physical activity, smoking and alcohol on those. Conditional on sociodemographic and lifestyle behaviour four latent classes were suggested: high-stable, moderate-stable, low-stable and decliners. Participants who did not engage in physical activity, were current or previous smokers and did not consume alcohol at baseline were more likely to be in the trajectory with the highest deterioration (i.e. decliners). This study confirms ageing heterogeneity and the positive influence of a healthy lifestyle. These results provide the ground for new policies.