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Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study

Li J 1 , Fong DYT 1 , Lok KYW 1 , Wong JYH 2 , Man Ho M 1 , Choi EPH 1 Show all authors , Pandian V 3 , Davidson PM 4 , Duan W 5 , Tarrant M 6 , Lee JJ 1 , Lin CC 1 , Akingbade O 7 , Alabdulwahhab KM 8 , Ahmad MS 9 , Alboraie M 10 , Alzahrani MA 11 , Bilimale AS 12 , Boonpatcharanon S 13 , Byiringiro S 3 , Hasan MKC 14 , Schettini LC 15 , Corzo W 16 , De Leon JM 17 , De Leon AS 17 , Deek H 18 , Efficace F 19 , El Nayal MA 20 , El-Raey F 21 , Ensaldo-Carrasco E 22 , Escotorin P 23 , Fadodun OA 24 , Fawole IO 25 , Goh YS 26 , Irawan D 27 , Khan NE 28 , Koirala B 3 , Krishna A 29 , Kwok C 30 , Le TT 31 , Leal DG 32 , Lezana-Fernández MÁ 33 , Manirambona E 34 , Mantoani LC 35 , Meneses-González F 33 , Mohamed IE 36 , Mukeshimana M 37 , Nguyen CTM 31 , Nguyen HTT 31 , Nguyen KT 31 , Nguyen ST 31 , Nurumal MS 14 , Nzabonimana A 38 , Omer NAMA 39 , Ogungbe O 3 , Poon ACY 40 , Reséndiz-Rodriguez A 41 , Puang-Ngern B 13 , Sagun CG 17 , Shaik RA 9 , Shankar NG 42 , Sommer K 19 , Toro E 32 , Tran HTH 31 , Urgel EL 17 , Uwiringiyimana E 34 , Vanichbuncha T 13 , Youssef N 43

Affiliations 

  • 1 School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
  • 2 School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
  • 3 School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
  • 4 Vice-Chancellor and Principal, University of Wollongong, Wollongong, Australia
  • 5 Department of Social Work, East China University of Science and Technology, Shanghai, China
  • 6 School of Nursing, The University of British Columbia, Kelowna, British Columbia, Canada
  • 7 The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
  • 8 College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
  • 9 Department of Family & Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
  • 10 Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
  • 11 Department of Urology, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
  • 12 School of Public Health, JSS Medical College, JSS AHER, Mysuru, India
  • 13 Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
  • 14 Kulliyyah of Nursing, International Islamic University, Kuantan, Malaysia
  • 15 Italian Association against Leukemia, Lymphoma and Myeloma (AIL), Rome, Italy
  • 16 Diálogos Guatemala, Guatemala, Guatemala
  • 17 School of Nursing, Centro Escolar University, Manila, Philippines
  • 18 Nursing Department, Faculty of Health Science, Beirut Arab University, Beirut, Lebanon
  • 19 Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
  • 20 Department of Psychology, Beirut Arab University, Beirut, Lebanon
  • 21 Department of hepatogastroenterology and infectious diseases, Damietta faculty of medicine, Al-Azhar University, Cairo, Egypt
  • 22 Ergonomics Research Center (ECR), University of Guadalajara, Jalisco, Mexico
  • 23 Laboratory of Applied Prosocial Research, Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
  • 24 Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
  • 25 Faculty of Nursing, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
  • 26 Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
  • 27 School of Nursing, Wijaya Husada Health Institute, Bogor, Indonesia
  • 28 Department of Optometry, University of Kwazulu-Natal, Durban, South Africa
  • 29 Ecove, Ghaziabad, India
  • 30 School of Nursing, Paramedicine and Health Care Science, Charles Sturt University, New South Wales, Australia
  • 31 Nam Dinh University of Nursing, Nam Dinh, Vietnam
  • 32 Pontificia Universidad Católica de Valparaíso, School of Social Work, Valparaíso, Chile
  • 33 Research Department, National Commission for Medical Arbitration, Mexico, Mexico
  • 34 College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
  • 35 Department of Physiotherapy, Faculty of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Brazil
  • 36 Pharmacology and Toxicology Department, Faculty of Pharmacy, Benghazi University, Benghazi, Libya
  • 37 School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
  • 38 Center for Language Enhancement, College of Arts and Social Sciences, University of Rwanda, Huye, Rwanda
  • 39 Faculty of Medicine, Alzaiem Alazhari University, Khartoum North, Sudan
  • 40 Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao
  • 41 National Autonomous University of Mexico, Mexico
  • 42 Mental Health and Learning division, Wrexham Maelor Hospital, Wrexham, Wales, UK
  • 43 Medical-surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
J Glob Health, 2024 Apr 12;14:04068.
PMID: 38606605 DOI: 10.7189/jogh-14-04068

Abstract

BACKGROUND: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements.

METHODS: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test.

FINDINGS: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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