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Original research
Gender-specific aspects of socialisation and risk of cardiovascular disease among community-dwelling older adults: a prospective cohort study using machine learning algorithms and a conventional method
  1. Achamyeleh Birhanu Teshale1,
  2. Htet Lin Htun1,
  3. Alice J. Owen1,
  4. Joanne Ryan1,
  5. JR Baker2,
  6. Mor Vered3,
  7. Christopher M Reid1,4,
  8. Robyn L. Woods1,
  9. Michael Berk1,5,
  10. Andrew Tonkin1,
  11. Johannes T Neumann1,6,7,
  12. Monique F Kilkenny8,9,
  13. Aung Zaw Zaw Phyo1,
  14. Mark R Nelson10,
  15. Nigel Stocks11,
  16. Carlene Britt1,
  17. Rosanne Freak-Poli1,12
  1. 1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2Primary & Community Care Services Ltd, Thornleigh, New South Wales, Australia
  3. 3Department of Data Science and AI, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
  4. 4School of Public Health, Curtin University, Bentley, Western Australia, Australia
  5. 5Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University and Barwon Health, Geelong, Victoria, Australia
  6. 6Department of Cardiology, University Heart & Vascular Centre, Hamburg, Germany
  7. 7German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
  8. 8Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  9. 9Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, The University of Melbourne, Heidelberg, Victoria, Australia
  10. 10Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  11. 11Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
  12. 12School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Dr Rosanne Freak-Poli, Monash University, Clayton, Victoria, Australia; rosanne.freak-poli{at}monash.edu

Abstract

Background Gender influences cardiovascular disease (CVD) through norms, social relations, roles and behaviours. This study identified gender-specific aspects of socialisation associated with CVD.

Methods A longitudinal study was conducted, involving 9936 (5,231 women and 4705 men) initially healthy, community-dwelling Australians aged 70 years or more from the ASPirin in Reducing Events in the Elderly (ASPREE) study and ASPREE Longitudinal Study of Older Persons, with a median follow-up time of 6.4 years. Variable categorisation, variable selection (using machine learning (ML) models; Elastic Net and extreme gradient boosting) and Cox-regression were employed separately by binary gender to identity socialisation factors (n=25 considered) associated with CVD.

Results Different socialisation factors were identified using the ML models. In the Cox model, for both genders, being married/partnered was associated with a reduced risk of CVD (men: HR 0.76, 95% CI 0.60 to 0.96; women: HR 0.67, 95% CI 0.58 to 0.95). For men, having 3–8 relatives they felt close to and could call on for help (HR 0.76, 95% CI 0.58 to 0.99; reference <3 relatives), having 3–8 relatives they felt at ease talking with about private matters (HR 0.70, 95% CI 0.55 to 0.90; reference <3 relatives) or playing games such as chess or cards (HR 0.82, 95% CI 0.67 to 1.00) was associated with reduced risk of CVD. For women, living with others (HR 0.71, 95% CI 0.55 to 0.91) or having ≥3 friends they felt at ease talking with about private matters (HR 0.74, 95% CI 0.58 to 0.95; reference <3 friends) was associated with a lower risk of CVD.

Conclusions This study demonstrates the need to prioritise gender-specific social factors to improve cardiovascular health in older adults.

  • SOCIAL CAPITAL
  • CARDIOVASCULAR DISEASES
  • GERIATRICS
  • GERONTOLOGY
  • PUBLIC HEALTH

Data availability statement

Data may be obtained from a third party and are not publicly available. The ASPREE and ALSOP are not publicly available since they are ongoing. However, they are available to partnering and external researchers for projects of appropriate scientific merit and expressions of interest to analyse data from these datasets are co-ordinated through the ASPREE Access Management Site (AMS) (https://aspree.org/aus/researchers/).

https://doi.org/10.1136/jech-2023-221860

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The ASPREE and ALSOP are not publicly available since they are ongoing. However, they are available to partnering and external researchers for projects of appropriate scientific merit and expressions of interest to analyse data from these datasets are co-ordinated through the ASPREE Access Management Site (AMS) (https://aspree.org/aus/researchers/).

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    Footnotes

    • X @DrFreakPoli

    • Presented at The abstract for this work was presented at the 2023 Annual Scientific Meeting of the Australasian Epidemiological Association and the 21st National Conference of Emerging Researchers in Ageing.

    • Contributors RFP, ABT and HLH contributed to the concept or design of the work and performed the analysis. ABT wrote the first draft of the manuscript. All authors participated in the interpretation of the data, gave critical comments on the drafted manuscript and approved the final version of the manuscript as submitted and agree to be accountable for all aspects of the work. The corresponding author certifies that all mentioned authors satisfy the requirements for authorship. All authors approved the final version for submission.

    • Funding ASPREE was supported by grants from the National Institute on Aging and the National Cancer Institute at the US National Institutes of Health (grant numbers:. U01AG029824 and U19AG062682); the National Health and Medical Research Council of Australia (NHMRC, grant numbers: 334047 and 1127060); Monash University (Australia) and the Victorian Cancer Agency (Australia). ALSOP was supported by funding from Monash University, ANZ Trustees, the Wicking Trust and the Mason Foundation. Other funding resources and collaborating organisations of the ASPREE study and ALSOP substudy are listed at http://www.aspree.org. AT and HLH are supported by Monash International Tuition Scholarship and Monash Graduate Scholarship. JR is supported by an NHMRC Investigator Grant Leadership Level 1 (2016438). MB is supported by an NHMRC Senior Principal Research Fellowship and Leadership 3 Investigator grant (1156072 and 2017131). MFK report receiving research fellowship support from the National Heart Foundation of Australia (105737).

    • Disclaimer Funders played no role in the design of the study, data collection, analysis and interpretation of data, decision to publish, and in the writing of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.