Circadian Activity Rhythms and Mortality: The Study of Osteoporotic Fractures

Authors

  • Gregory J. Tranah PhD,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Terri Blackwell MA,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Sonia Ancoli-Israel PhD,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Misti L. Paudel MPH,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Kristine E. Ensrud MD,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Jane A. Cauley DrPH,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Susan Redline MD,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Teresa A. Hillier MD,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Steven R. Cummings MD,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • Katie L. Stone PhD,

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • for the Study of Osteoporotic Fractures Research Group

    1. From the *California Pacific Medical Center Research Institute, San Francisco, California; Department of Psychiatry, University of California at San Diego, San Diego, California; Division of Epidemiology and Community Health; §Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; #Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; **Department of Medicine and ††Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio; and ‡‡Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, Oregon
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  • This study was presented at the American Aging Society meeting, Boulder, Colorado, June 1, 2008.

Address correspondence to Gregory Tranah, California Pacific Medical Center Research Institute, San Francisco Coordinating Center, UCSF, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, CA 94107. E-mail: gtranah@psg.ucsf.edu

Abstract

OBJECTIVES: To determine whether circadian activity rhythms are associated with mortality in community-dwelling older women.

DESIGN: Prospective study of mortality.

SETTING: A cohort study of health and aging.

PARTICIPANTS: Three thousand twenty-seven community-dwelling women from the Study of Osteoporotic Fractures cohort (mean age 84).

MEASUREMENTS: Activity data were collected using wrist actigraphy for a minimum of three 24-hour periods, and circadian activity rhythms were computed. Parameters of interest included height of activity peak (amplitude), midline estimating statistic of rhythm (mesor), strength of activity rhythm (robustness), and time of peak activity (acrophase). Vital status, with cause of death adjudicated through death certificates, was prospectively ascertained.

RESULTS: Over an average of 4.1 years of follow-up, there were 444 (14.7%) deaths. There was an inverse association between peak activity height and all-cause mortality rates, with higher mortality rates observed in the lowest activity quartile (hazard ratio (HR)=2.18, 95% confidence interval (CI)=1.63–2.92) than in the highest quartile after adjusting for age, clinic site, race, body mass index, cognitive function, exercise, instrumental activity of daily living impairments, depression, medications, alcohol, smoking, self-reported health status, married status, and comorbidities. A greater risk of mortality from all causes was observed for those in the lowest quartiles of mesor (HR=1.71, 95% CI=1.29–2.27) and rhythm robustness (HR=1.97, 95% CI=1.50–2.60) than for those in the highest quartiles. Greater mortality from cancer (HR=2.09, 95% CI=1.04–4.22) and stroke (HR=2.64, 95% CI=1.11–6.30) was observed for later peak activity (after 4:33 p.m.; >1.5 SD from mean) than for the mean peak range (2:50–4:33 p.m.).

CONCLUSION: Older women with weak circadian activity rhythms have higher mortality risk. If confirmed in other cohorts, studies will be needed to test whether interventions (e.g., physical activity, bright light exposure) that regulate circadian activity rhythms will improve health outcomes in older adults.

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