@article{PetersDoringLadwigetal.2011, author = {Peters, A. and Doring, A. and Ladwig, K.-H. and Meisinger, C. and Linkohr, B. and Autenrieth, C. and Baumeister, S.E. and Behr, J. and Bergner, A. and Bickel, H. and Bidlingmaier, M. and Dias, A. and Emeny, R.T. and Fischer, B. and Grill, E. and Gorzelniak, L. and Hansch, H. and Heidbreder, S. and Heier, M. and Horsch, A. and Huber, D. and R. M., Huber and Jorres, R.A. and Kaab, S. and Karrasch, S. and Kirchberger, I. and Klug, G. and Kranz, B. and Kuch, B. and Lacruz, M.E. and Lang, O. and Mielck, A. and Nowak, D. and Perz, S. and Schneider, A. and Schulz, H. and M{\"u}ller, Martin and Seidl, H. and Strobl, R. and Thorand, B. and Wende, R. and Weidenhammer, W. and Zimmermann, A.-K. and Wichmann, H.-E. and Holle, R.}, title = {Multimorbidity and successful aging: the population-based KORA-Age study}, series = {Health and quality of life outcomes}, journal = {Health and quality of life outcomes}, editor = {BioMed Central,}, year = {2011}, abstract = {Background Multimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D. Methods The EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method. Results The conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2. Conclusions There are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status.}, language = {en} } @article{RoehrigStroblMuelleretal.2014, author = {Roehrig, N. and Strobl, R. and M{\"u}ller, Martin and Perz, S. and Kaab, S. and Martens, E. and Peters, A. and Linkohr, B. and Grill, E.}, title = {Directed acyclic graphs helped to identify confounding in the association of disability and electrocardiographic findings: results from the KORA-Age study}, series = {Journal of clinical epidemiology}, journal = {Journal of clinical epidemiology}, editor = {PlumX Metrics,}, year = {2014}, abstract = {Objectives To examine the association between electrocardiographic (ECG) findings and disability status in older adults. Study Design and Setting KORA-Age, a population-based cross-sectional study of the MONICA/KORA project, a randomized sample from Southern Germany of people aged 65 years or older. Results A total of 534 (51.5\%) of 1,037 participants were characterized as disabled. Disabled participants were on average 4.5 years older than those who were not disabled. Crude associations of left-axis deviation, ventricular conduction defects, atrial fibrillation, and QT prolongation with disability status were significant (P < 0.05). In models controlled for age and sex, these effects remained constant except for QT prolongation. In the models adjusted for the minimal sufficient adjustment set (consisting of the variables sex, physical activity, age, obesity, diabetes, education, heart diseases, income, lung diseases, and stroke) identified by a directed acyclic graph (DAG), no significant association could be shown. Conclusion Associations between specific ECG findings and disability were found in unadjusted analysis and logistic models adjusted for age and sex. However, when adjusting for other possible confounders identified by the DAG, all these associations were no longer significant. It is important to adequately identify confounding in such settings.}, language = {en} }