- D A N I S H A G I N G R E S E A R C H C E N T E R - Fatigue – an indicator of early aging? Why do we age so differently? Anette Ekmann MScPH Collaboration: Copenhagen / Odense Supervisors: Kirsten Avlund Merete Osler Kaare Christensen Rikke Lund PhD-student 1st March 2009 VELUX FONDEN Funded by:

- D A N I S H A G I N G R E S E A R C H C E N T E R - What do we (not) know? middle agedold age Disability Mortality fatigue disease ? Co-morbidity ? SES Lifestyle Health Work environment Social relations SES Lifestyle Health / medication Social relations ? Sources: e.g. Avlund et al. 2007, Bültmann et al 2002, Watt et al. 2000

- D A N I S H A G I N G R E S E A R C H C E N T E R - The aim To analyse factors underlying fatigue in middle aged men (cross-sectionally) Study population The Danish Metropolit Cohort Men born in Copenhagen in 1953 Living in Denmark Questionnaire in 2004 n=6292 (66%) fatigue SES Lifestyle Health Work environment Social relations ?

- D A N I S H A G I N G R E S E A R C H C E N T E R - Measure of fatigue Fatigue being measured by SF-36 four vitality questions How much of the time during the past 4 weeks did you Feel full of pep? Have a lot of energy? Feel worn out? Feel tired? Scores are summed and transformed into a scale ranging from equals high fatigue score High fatigue scoreLow fatigue score Sources: e.g. Bjorner et al. 1998

- D A N I S H A G I N G R E S E A R C H C E N T E R - Results – lifestyle and health/diseases OR for high fatigue score. Within group adjusted OR* (CI 95 ) Fully adjusted OR** (CI 95 ) Leisure time physical activity Low vs. high1,92 (1,63-2,25)1,41 (1,15-1,73) BMI>25 (high) vs. 25 (normal)1,13 (1,00-1,28)1,04 (0,88-1,22) Binge drinking (past month)Yes vs. no1,37 (1,19-1,59)1,07 (0,88-1,29) Weekly drinking0-21 drinks vs. >21 drinks1,28 (1,11-1,47)1,05 (0,87-1,27) SmokingYes vs. no1,53 (1,35-1,73)1,32 (1,12-1,56) Diet (vegetables / fruit)Low vs. high intake1,65 (1,46-1,87)1,45 (1,23-1,71) Self rated healthPoor vs. good10,78 (8,53-13,61)11,34 (7,93-16,22) Chronic diseaseYes vs. no1,69 (1,47-1,93)1,71 (1,46-2,01) Pain (present)Yes vs. no3,28 (2,70-3,97)3,08 (2,38-3,80) Depression (past 2 weeks)Yes vs. no27,03 (12,28-59,52)22,61 (7,69-66,51) *Adjusted by other variable within the group **Further adjusted by social relations, lifestyle, work factors, health, SES

- D A N I S H A G I N G R E S E A R C H C E N T E R - Results – social relations OR for high fatigue score. Within group adjusted OR (CI 95 ) Fully adjusted OR (CI 95 ) Social participation:low vs. high1,81 (1,59-2,05)1,41 (1,19-1,66) Co-habitation:alone vs. together1,70 (1,45-2,00)1,08 (0,84-1,39) Relation to children: Contact frequency:low vs. high0,96 (0,82-1,11)- Perceived practical help:no vs. yes1,36 (1,15-1,62)1,33 (1,09-1,61) Too high demands of you:yes vs. no1,42 (1,22-1,64)1,38 (1,16-1,64) Relation to family: Contact frequency:low vs. high1,31 (1,13-1,52)1,17 (0,98-1,40) Perceived practical help:no vs. yes1,06 (0,91-1,31)- Too high demands of you:yes vs. no1,10 (0,92-1,31)- Relation to friends: Contact frequency:low vs. high1,31 (1,10-1,55)1,29 (1,04-1,59) Perceived practical help:no vs. yes1,24 (1,04-1,47)1,18 (0,95-1,45) Too high demands of you:yes vs. no1,16 (0,94-1,44)- **Further adjusted by social relations, lifestyle, work factors, health, SES *Adjusted by other variable within the group

- D A N I S H A G I N G R E S E A R C H C E N T E R - Results – work and SES OR for high fatigue score. Mutually adjusted OR (CI 95 )Fully adjusted OR (CI 95 ) Months of unemployment within past 5 years 0-6 vs. >6 month0,86 (0,33-2,23)- High pace workYes vs. no1,07 (0,65-1,78)- Meaningful tasksNo vs. yes1,76 (0,99-3,11)- Getting help and support from colleagues No vs. yes1,09 (0,62-1,92)- Feeling part of work communityNo vs. yes3,24 (1,87-5,63)2,03 (1,68-2,45) Social classIV-V vs. I-III1,69 (1,50-1,91)1,36 (1,45-1,60) Leased or owned accommodations Tenant vs. owner1,40 (1,15-1,71)0,96 (0,79-1,17) Living in apartment or houseApartment vs. house0,95 (0,78-1,16)- Do your family own a car ?No vs. yes1,53 (1,29-1,81)1,09 (0,84-1,42) *Adjusted by other variable within the group **Further adjusted by social relations, lifestyle, work factors, health, SES

- D A N I S H A G I N G R E S E A R C H C E N T E R - Conclusions Middle aged men who feel fatigued have poor lifestyle poor health weak social relations low social class do not feel part of their work community

- D A N I S H A G I N G R E S E A R C H C E N T E R - Future plans 1. Do healthy middle aged men with high fatigue score have higher risk of developing diseases over time than healthy men with low fatigue score? 2. Does fatigue gives higher risk of developing morbidity and co-morbidity in older people? 3. Do genetic factors influence the relationship between fatigue and onset of subsequent disease? fatigue SES Lifestyle Health (Work environment) Social relations disease ? fatigueCo-morbidities ? Genetic factor SES Lifestyle Health Social relations Disability mortality middle agedold age