Intellectual ability in young adulthood as an antecedent of physical functioning in older age.

2016

Objectives: low cognitive ability is associated with subsequent functional disability. Whether this association extends across adult life has been little studied. The aim of this study was to examine the association between intellectual ability in young adulthood and physical functioning during a 10-year follow-up in older age.Methods: three hundred and sixty persons of the Helsinki Birth Cohort Study (HBCS) male members, born between 1934 and 1944 and residing in Finland in 1971, took part in The Finnish Defence Forces Basic Intellectual Ability Test during the first 2 weeks of their military service training between 1952 and 1972. Their physical functioning was assessed twice using the Sh…

Telomere Length and Frailty: The Helsinki Birth Cohort Study

2018

Objectives: Telomere length is associated with aging-related pathologies. Although the association between telomere length and frailty has been studied previously, only a few studies assessing longitudinal changes in telomere length and frailty exist. Design: Longitudinal cohort study. Setting and participants: A subpopulation of the Helsinki Birth Cohort Study consisting of 1078 older adults aged 67 to 79 years born in Helsinki, Finland, between 1934 and 1944. Measures: Relative leukocyte telomere length (LTL) was measured using quantitative real-time polymerase chain reaction at the average ages of 61 and 71 years, and at the latter the participants were assessed for frailty according to …

The impact of maternal weight in pregnancy on glucose metabolism in non-diabetic offspring in late adulthood

2019

Aims: We aimed to examine the association between maternal adiposity and glucose metabolism in adult offspring without diabetes, simultaneous taking offspring own adiposity into account. Methods: This longitudinal birth cohort study (Helsinki Birth Cohort Study) included 1,440 non-diabetic subjects examined at a mean age of 62 years. Subjects were divided into quartiles according to maternal body mass index (BMI). The impact of maternal BMI on offspring body composition was also studied. Results: There were no differences in fasting glucose between the groups. In men, maternal BMI was inversely associated with mean 2-hour glucose concentration after a 75 g oral glucose tolerance test (p <0.…

Glucose regulation and pain in older people-The Helsinki Birth Cohort Study

2021

Aims: To assess if individuals with diabetes or prediabetes report more pain or have increased use of pain medication compared to normoglycaemic individuals. Methods: Using cross-sectional data, we studied 928 men and 1075 women from the Helsinki Birth Cohort Study in 2001-2004 at a mean age of 61.5 years. Glucose regulation was assessed with a 2-h 75 g oral glucose tolerance test, and applying World Health Organization criteria, participants were defined as having normoglycaemia, prediabetes (impaired fasting glucose or impaired glucose tolerance), newly diagnosed diabetes or previously diagnosed diabetes. Self-reported pain intensity and interference during the previous 4 weeks was estima…

Physical heaviness of work and sitting at work as predictors of mortality : a 26-year follow-up of the Helsinki Birth Cohort Study

2019

ObjectivesTo examine the relationships of late-career physical heaviness of work and sitting at work with mortality. A national-level job exposure matrix was used to determine the occupation-specific level of physical heaviness and sitting.DesignProspective cohort study between years 1990 and 2015.SettingCommunity.Participants5210 men and 4725 women from the Helsinki Birth Cohort Study with an occupational code at baseline (ages 45–57 years).Primary and secondary outcome measuresTotal, cardiovascular (International Classification of Diseases 10th Revision I00–I99), cancer (C00–C97) and external (S00–Y84) mortality.ResultsThe exposures, physical heaviness and sitting had a non-linear, invers…

A healthy Nordic diet and physical performance in old age : findings from the longitudinal Helsinki Birth Cohort Study

2016

AbstractEpidemiological studies have shown that a number of nutrients are associated with better physical performance. However, little is still known about the role of the whole diet, particularly a healthy Nordic diet, in relation to physical performance. Therefore, we examined whether a healthy Nordic diet was associated with measures of physical performance 10 years later. We studied 1072 participants from the Helsinki Birth Cohort Study. Participants’ diet was assessed using a validated 128-item FFQ at the mean age of 61 years, and a priori-defined Nordic diet score (NDS) was calculated. The score included Nordic fruits and berries, vegetables, cereals, PUFA:SFA and trans-fatty acids ra…

Body composition as a predictor of physical performance in older age : A ten- year follow-up of the Helsinki Birth Cohort Study

2018

Background: This study assessed how different measures of body composition predict physical performance ten years later among older adults. Methods: The participants were 1076 men and women aged 57 to 70 years. Body mass index (BMI), waist circumference, and body composition (bioelectrical impedance analysis) were measured at baseline and physical performance (Senior Fitness Test) ten years later. Linear regression analyses were adjusted for age, education, smoking, duration of the follow-up and physical activity. Results: Greater BMI, waist circumference, fat mass, and percent body fat were associated with poorer physical performance in both sexes (standardized regression coefficient [beta…

Glucose regulation and physical performance among older people: the Helsinki Birth Cohort Study

2018

Aims To assess whether disturbances in glucose regulation are associated with impairment in physical performance during a 10-year follow-up. Methods 475 Men and 603 women from the Helsinki Birth Cohort Study were studied. Glucose regulation was evaluated with a 2-h 75-g oral glucose tolerance test (OGTT) in 2001-2004. Subjects were categorised as having either impaired fasting glucose (IFG), impaired glucose tolerance (IGT), newly diagnosed diabetes or previously known diabetes. Physical performance was assessed approximately 10 years later using the validated senior fitness test (SFT). The relationship between glucose regulation and the overall SFT score was estimated using multiple linear…

Body composition and changes in health-related quality of life in older age: a 10-year follow-up of the Helsinki Birth Cohort Study

2020

Abstract Purpose Most studies examining the associations between body composition and health-related quality of life (HRQoL) in older age have been cross-sectional and analyzed only fat or lean mass. Hence, it is poorly known whether fat and lean mass are independently associated with subsequent changes in HRQoL. We investigated whether baseline lean and fat mass are associated with changes in HRQoL over a 10-year period in older adults. Methods We studied 1044 men and women from the Helsinki Birth Cohort Study (age 57–70 years at baseline). Bioelectrical impedance analysis was used to derive baseline fat mass index (FMI, fat mass/height2) and lean mass index (lean mass/height2), dichotomiz…

Infant and childhood growth and frailty in old age : the Helsinki Birth Cohort Study

2018

BackgroundEvidence from life course studies highlights the importance of infant and childhood growth as risk factors for adulthood chronic diseases.MethodsIn this sub-study of the Helsinki Birth Cohort Study, we studied 1078 individuals who had both information on body size from birth to 12 years of age and who were assessed for frailty according to the Fried criteria at the mean age of 71 years.ResultsGreater BMI gain between 2 and 11 years in boys was associated with frailty in old age (age-adjusted RRR 2.36, 95% CI 1.21, 4.63). No similar associations were observed in girls.ConclusionsMen who were frail in old age experienced accelerated BMI gain in childhood compared with those men who …

Early Life Origins of All-Cause and Cause-Specific Disability Pension: Findings from the Helsinki Birth Cohort Study

2015

BackgroundThere is some evidence linking sub-optimal prenatal development to an increased risk of disability pension (DP). Our aim was to investigate whether body size at birth was associated with transitioning into all-cause and cause-specific DP during the adult work career.Methods10 682 people born in 1934-44 belonging to the Helsinki Birth Cohort Study had data on birth weight extracted from birth records, and on time, type and reason of retirement between 1971 and 2011 extracted from the Finnish Centre for Pensions.ResultsAltogether 21.3% transitioned into DP during the 40-year follow-up, mainly due to mental disorders, musculoskeletal disorders and cardiovascular disease. Average age …

The healthy Nordic diet predicts muscle strength 10 years later in old women, but not old men

2017

Background a number of nutrients have been found to be associated with better muscle strength and mass; however, the role of the whole diet on muscle strength and mass remains still unknown. Objective to examine whether the healthy Nordic diet predicts muscle strength, and mass 10 years later among men and women. Methods about 1,072 participants belong to the Helsinki Birth Cohort Study, born 1934–44. Diet was assessed with a validated food-frequency questionnaire during 2001–04. The Nordic diet score (NDS) was calculated. The score included Nordic fruits, vegetables, cereals, ratio of polyunsaturated to saturated fatty acids, low-fat milk, fish, red meat, total fat and alcohol. Higher scor…

Association of childhood adversities and home atmosphere with functioning in old age: the Helsinki birth cohort study

2019

Objectivechildhood adversities have been linked with adverse health outcomes, but less is known about the long-term consequences of childhood home atmosphere. We investigated whether childhood adversities and home atmosphere were associated with physical and mental functioning in older age.Methodsin the Helsinki Birth Cohort Study 2003, participants born in the year 1934–44 had data available on nine childhood home atmosphere items, e.g. whether it was supportive and warm (sum score ranged between 0 and 36, higher score indicating better atmosphere), and nine childhood adversities, e.g. unemployment and divorce (sum score 0–9, coded into no; one; and two or more adversities) assessed in 200…

Impaired glucose regulation, depressive symptoms, and health-related quality of life

2020

IntroductionThis study aims to investigate whether the associations between impaired glucose regulation and health-related quality of life are modified by severity or type of depressive symptoms.Research design and methodsFor this cross-sectional study, we included 1939 individuals (mean age 61.5 years) from the Helsinki Birth Cohort Study. Between 2001 and 2004, a standard 2-hour 75 g oral glucose tolerance test was applied to define normoglycemia, pre-diabetes, and newly diagnosed diabetes. Information on previously diagnosed diabetes was collected from national registers and questionnaires. Pre-diabetes was defined as having either impaired fasting glucose or impaired glucose tolerance. …

Relationship between physical activity and physical performance in later life in different birth weight groups.

2017

There is strong evidence that physical activity (PA) has an influence on physical performance in later life. Also, a small body size at birth has been associated with lower physical functioning in older age and both small and high birth weight have shown to be associated with lower leisure time physical activity. However, it is unknown whether size at birth modulates the association between PA and physical performance in old age. We examined 695 individuals from the Helsinki Birth Cohort Study born in Helsinki, Finland between 1934 and 1944. At a mean age of 70.7 years PA was objectively assessed with a multisensory activity monitor and physical performance with the Senior Fitness Test (SFT…

Change in physical activity and health-related quality of life in old age-A 10-year follow-up study.

2019

The aim of the study was to examine the association between change in leisure-time physical activity (LTPA) and change in health-related quality of life (HRQoL) and symptoms of depression during a 10-year follow-up. This prospective study included 1036 men and women (mean age at baseline = 61.2 years) from the Helsinki Birth Cohort Study. Leisure-time physical activity was measured with a questionnaire, HRQoL with SF36 and depression symptoms with Beck's depression inventory (BDI). The association between the change in LTPA and change in HRQoL and BDI were investigated with sex-stratified general linear models adjusted for age, smoking, educational attainment, comorbidity score, and baselin…

Telomere length and physical performance among older people-The Helsinki Birth Cohort Study.

2019

Telomere length has been suggested a biomarker of aging and is associated with several chronic diseases. However, the association between telomere length and physical performance is not well known. Using both cross-sectional and longitudinal data, we studied 582 women and 453 men from the Helsinki Birth Cohort Study at two time-points; a baseline examination in 2001-2004 at a mean age of 61 years and a follow-up examination approximately 10 years later in 2011-2013. Telomere length was measured both at baseline and at follow-up using real-time quantitative polymerase chain reaction. Physical performance was evaluated only at follow-up using the Senior Fitness Test (SFT), which assesses stre…

Early life body mass trajectories and mortality in older age: Findings from the Helsinki Birth Cohort Study

2014

Overweight and obesity in childhood have been linked to an increased risk of adult mortality, but evidence is still scarce.We identified trajectories of body mass index (BMI) development in early life and investigated their mortality risk. Data come from the Helsinki Birth Cohort Study, in which 4943 individuals, born 1934-1944, had serial measures of weight and height from birth to 11 years extracted from health care records, weight and height data in adulthood, and register-based mortality data for 2000-2010.Three early BMI trajectories (increasing, average, and average-to-low for men and increasing, average, and low-to-high BMI for women) were identified. Women with an increasing or low-…

Maternal body mass index, change in weight status from childhood to late adulthood and physical activity in older age

2021

This study aimed to examine the longitudinal associations of maternal body mass index (BMI), weight status in childhood and late adulthood and device-measured total physical activity (TPA) in older age. The study involves 552 participants from Helsinki Birth Cohort Study who were born in Helsinki, Finland, in 1934-1944. TPA was measured with a multisensory body monitor at a mean age of 70 years and expressed in metabolic equivalent of task hours/day (METh/d). Childhood overweight (BMI > 85th percentile) was based on school health records at 6-7 years of age, and late adulthood overweight (BMI >= 25 kg/m(2)) was based on clinical measurements at the mean age of 61 years. Childhood overweight…

Glucose regulation and grip strength in adults: Findings from the Helsinki Birth Cohort Study.

2021

Aim: this study aimed to assess the association between grip strength and glucose regulation in a cross-sectional setting.Methods: using data from the Helsinki Birth Cohort Study, 924 men and 953 women were studied at a mean age of 61.6 years. Grip strength was assessed in the dominant hand using a Newtest Grip Force dynamometer. A standard 2-h 75 g oral glucose tolerance test (OGTT) was used to define glucose regulation. The participants were classified into four groups: normoglycaemia, prediabetes (impaired fasting glucose or impaired glucose tolerance), newly diagnosed diabetes and previously known diabetes. The association between grip strength and glucose regulation was assessed using …

Body size at birth and coronary heart disease-related hospital care in adult men : Findings from the Helsinki Birth Cohort Study

2017

Aim: We investigated, among those who had been hospitalized at least once due to coronary heart disease (CHD), the relationship between ponderal index (PI, birthweight/length3) at birth, a measure of thinness, and the age at first hospitalization due to CHD, the number of CHD-related hospital care episodes, and cost of CHD-related hospital care from young adulthood to old age. Methods and results: Data from the Helsinki Birth Cohort Study included 964 men born in Helsinki, Finland during 1934–1944, who had been hospitalized due to CHD and had birth anthropometrics data. PI (kg/m3) was categorized into low (27.5). CHD-related hospital care data were available from 1971 to 2013. We observed a…

Work-loss years among people diagnosed with diabetes: a reappraisal from a life course perspective

2018

Aims Early exit from the workforce has been proposed to be one of the unfavorable consequences of diabetes. We examined whether early exit from the workforce differed between persons who were and were not diagnosed with diabetes during their work career. Methods The cohort included 12,726 individuals of the Helsinki Birth Cohort Study, born between 1934 and 1944. Using data from nationwide registers, the cohort was followed up from early adulthood until they transitioned into retirement or died. Work- loss years were estimated using the restricted mean work years method. Results During a follow-up of 382,328 person-years for men and 349 894 for women, 36.8% transitioned into old age pension…

Occupational physical heaviness and sitting as predictors of mortality: a 26-year follow-up

2018

Birth Size and Childhood Growth as Determinants of Physical Functioning in Older Age: The Helsinki Birth Cohort Study

2011

The study reports on the associations of infant and childhood anthropometric measurements, early growth, and the combined effect of birth weight and childhood body mass index with older age physical functioning among 1,999 individuals born in 1934–1944 and belonging to the Helsinki Birth Cohort Study. Physical functioning was assessed by the Short Form 36 scale. Anthropometric data from infancy and childhood were retrieved from medical records. The risk of lower Short Form 36 physical functioning at the mean age of 61.6 years was increased for those with birth weight less than 2.5 kg compared with those weighing 3.0–3.5 kg at birth (odds ratio (OR) = 2.73, 95% confidence interval (CI): 1.57…

Effect of childhood developmental coordination disorder on adulthood physical activity; Arvo Ylppö longitudinal study

2022

Publisher Copyright: © 2022 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd. Individuals at risk of Developmental Coordination Disorder (DCD) have low levels of physical activity in childhood due to impaired motor competence; however, physical activity levels in adulthood have not been established. This study sought to determine the impact of DCD risk on physical activity levels in adults using accelerometry measurement. Participants (n = 656) from the Arvo Ylppö Longitudinal Study cohort had their motor competence assessed at the age of five years, and their physical activity quantified via device assessment at the age of 25 years. Betwe…

Early life determinants of frailty in old age : the Helsinki Birth Cohort Stud

2018

Background there is evidence suggesting that several chronic diseases have their origins in utero and that development taking place during sensitive periods may affect the aging process. We investigated whether early life determinants would be associated with frailty in old age. Methods at a mean age of 71 years, 1,078 participants belonging to the Helsinki Birth Cohort Study were assessed for frailty according to the Fried frailty criteria. Early life measurements (birth weight, length, mother body mass index [BMI] and parity) were obtained from birth, child welfare and school health records. Multinomial regression analysis was used to assess the association between early life determinants…

The Healthy Nordic Diet and Mediterranean Diet and Incidence of Disability 10 Years Later in Home-Dwelling Old Adults.

2019

Background/Objective: Diet has a major impact on a person's health. However, limited information exists on the long-term role of the whole diet on disability. We investigated the association of the healthy Nordic diet and the Mediterranean diet with incident disability 10 years later. Design: Longitudinal, with a follow-up of 10 years. Settings/Participants: A total of 962 home-dwelling men and women from the Helsinki Birth Cohort Study, mean age 61.6 years, who were free of disability at baseline. Measurements: At baseline, 2001-2004, the Nordic diet score (NDS) and modified Mediterranean diet score (mMDS) were calculated using a validated 128-item food-frequency questionnaire. Higher scor…

Maternal body mass index in pregnancy and offspring physical and psychosocial functioning in older age: findings from the Helsinki Birth Cohort Study…

2016

Maternal obesity is associated with several adverse long-term health outcomes in the offspring. In this study, we examined the association between maternal body mass index (BMI) and offspring physical and psychosocial functioning in late adulthood.The study included 1759 men and women born during 1934-1944 and belonging to the Helsinki Birth Cohort Study. Data on maternal weight and height in late pregnancy and on offspring birth weight were retrieved from hospital birth records. Physical and psychosocial functioning was assessed using the Short Form 36 scale.Maternal BMI was positively associated with poorer physical and psychosocial functioning among men, but not among women. This associa…

Advanced glycation end products measured by skin autofluorescence are associated with melancholic depressive symptoms - Findings from Helsinki Birth …

2021

Background: Millions of people live with depression and its burden of disease. Depression has an increased comorbidity and mortality that has remained unexplained. Studies have reported connections between advanced glycation end products (AGEs) and various disease processes, including mental health. The present study evaluated associations between AGEs, depressive symptoms, and types of depressive symptoms. Methods: From the Helsinki Birth Cohort Study, 815 participants with a mean age of 76 years were recruited for this cross-sectional study. Characteristics regarding self-reported lifestyle and medical history, as well as blood tests were obtained along with responses regarding depressive…

Maternal adiposity in pregnancy and offspring asthma in adulthood.

2018

High maternal body mass index in pregnancy was associated with an increased prevalence of offspring asthma in men in adult life

Work careers in adults separated temporarily from their parents in childhood during World War II.

2019

Introduction: Traumatic experiences, such as separation from parents in childhood causing early life stress (ELS) may increase the risk of adverse long-term health outcomes and biological age-related changes. This may have an impact on work career. Our aim was to examine long term consequences of ELS due to temporary separation from parents during World War II (WWII) in relation to work career. - Material and methods: The Helsinki Birth Cohort Study comprises 13,345 individuals born in Helsinki, Finland, between the years 1934–1944. From the original cohort, 1781 individuals were identified as being separated temporarily from their parents due to World War II. Information on date and type o…

Early life stress and frailty in old age: the Helsinki birth cohort study

2018

Background: Evidence suggests that early life stress (ELS) may extend its effect into adulthood and predispose an individual to adverse health outcomes. We investigated whether wartime parental separation, an indicator of severe ELS, would be associated with frailty in old age. Methods: Of the 972 participants belonging to the present sub-study of the Helsinki Birth Cohort Study, 117 (12. 0%) had been evacuated abroad unaccompanied by their parents in childhood during World War II. Frailty was assessed at a mean age of 71 years according to Fried's criteria. Results: Thirteen frail men (4 separated and 9 non-separated) and 20 frail women (2 separated and 18 non-separated) were identified. C…

The relationship between health-related quality of life and melancholic depressive symptoms is modified by brain insulin receptor gene network

2021

AbstractTo investigate whether expression-based polygenic risk scores for the insulin receptor gene network (ePRS-IRs) modifiy the association between type of depressive symptoms and health-related quality of life (HRQoL). This cross-sectional study includes 1558 individuals from the Helsinki Birth Cohort Study. Between 2001 and 2004, the Short Form-36 questionnaire was employed to assess mental and physical components of HRQoL and Beck Depression Inventory (BDI) to assess depressive symptoms. Depressive symptoms were categorized into minimal (BDI &lt; 10), non-melancholic and melancholic types of depression. The ePRS-IRs were calculated for the hippocampal (hePRS-IR) and the mesocorticolim…

Mental, Physical and Social Functioning in Independently Living Senior House Residents and Community-Dwelling Older Adults

2021

Senior houses provide social interaction and support, potentially supporting older people’s physical and mental functioning. Few studies have investigated functioning of senior house residents. The aim was to compare functioning between senior house residents and community-dwelling older adults in Finland. We compared senior house residents (n = 336, 69% women, mean age 83 years) to community-dwelling older adults (n = 1139, 56% women, mean age 74 years). Physical and mental functioning were assessed using the SF 36-Item Health Survey. Loneliness and frequency of social contacts were self-reported. The analyses were adjusted for age, socioeconomic factors and diseases. Physical functioning …

Objectively measured physical activity and physical performance in old age

2017

Abstract Background: Physical performance is a key factor that determines how older people cope with daily tasks and maintain independency. There is strong evidence suggesting that physical activity (PA) is important in maintaining physical performance in old age. However, most studies have been done using self-reported PA. Our aim was to explore the association between objectively measured PA and physical performance in old age. Methods: We studied 695 participants (mean age 70.7 years, SD 2.7) from the Helsinki Birth Cohort Study. Physical performance was assessed with the Senior Fitness Test (SFT) and PA with a multisensory activity monitor SenseWear Pro 3 Armband. Results: Total volume …

Childhood growth predicts higher bone mass and greater bone area in early old age: findings among a subgroup of women from the Helsinki Birth Cohort …

2017

Abstract Summary: We examined the associations between childhood growth and bone properties among women at early old age. Early growth in height predicted greater bone area and higher bone mineral mass. However, information on growth did not improve prediction of bone properties beyond that predicted by body size at early old age. Introduction: We examined the associations between body size at birth and childhood growth with bone area, bone mineral content (BMC), and areal bone mineral density (aBMD) in early old age. Methods: A subgroup of women (n = 178, mean 60.4 years) from the Helsinki Birth Cohort Study, born 1934–1944, participated in dual-energy X-ray absorptiometry (DXA) measuremen…

Non-melancholic depressive symptoms are associated with above average fat mass index in the Helsinki birth cohort study

2022

AbstractThere is an existing link between two of the most common diseases, obesity and depression. These are both of great public health concern, but little is known about the relationships between the subtypes of these conditions. We hypothesized that non-melancholic depressive symptoms have a stronger relationship with both body composition (lean mass and fat mass) and dysfunctional glucose metabolism than melancholic depression. For this cross-sectional study 1510 participants from the Helsinki Birth Cohort Study had their body composition evaluated as lean mass and fat mass (Lean Mass Index [LMI, kg/m2] + Fat Mass Index [FMI kg/m2] = Body Mass Index). Participants were evaluated for dep…

Adiposity-Related Predictors of Vascular Aging From a Life Course Perspective : Findings From the Helsinki Birth Cohort Study

2022

Depressive Symptoms and Mortality : Findings from Helsinki Birth Cohort Study

2023

Background Individuals with depression and depressive symptoms have a higher mortality rate than non-depressed individuals. The increased comorbidity and mortality associated with depression has remained largely unexplained. The underlying pathophysiological differences between depressive subtypes, melancholic and non-melancholic, may provide some explanation to this phenomenon. Methods 1995 participants (mean age 61 years) from the Helsinki Birth Cohort Study were recruited for this prospective study and followed up for a mean of 14.1 years. Information regarding medical history, lifestyle, and biochemical parameters were obtained. Depressive symptoms were assessed using the Beck Depressio…

Change in physical activity and health-related quality of life in old age : a 10-year follow-up study

2019

The aim of the study was to examine the association between change in leisure‐time physical activity (LTPA) and change in health‐related quality of life (HRQoL) and symptoms of depression during a 10‐year follow‐up. This prospective study included 1036 men and women (mean age at baseline = 61.2 years) from the Helsinki Birth Cohort Study. Leisure‐time physical activity was measured with a questionnaire, HRQoL with SF36 and depression symptoms with Beck's depression inventory (BDI). The association between the change in LTPA and change in HRQoL and BDI were investigated with sex‐stratified general linear models adjusted for age, smoking, educational attainment, comorbidity score, and baselin…