Variation in biological status among Polish males and underlying socio-economic factors

ANTHROPOLOGICAL REVIEW • Vol. 71, 17-32 (2008)

Variation in biological status among Polish malesand underlying socio-economic factors

Maria Kaczmarek, Magdalena SkrzypczakDepartment of Human Biological Development, Institute of Anthropology,Faculty of Biology, Adam Mickiewicz University, Umultowska 89, Poznań,Poland; E-mail: [email protected]

ABSTRACT The main purpose of this study was to evaluate the socio-economic and life-style factors associated with biological status of Polish men. Data were collected duringa cross-sectional survey carried out in Poznań and several localities in Western Poland,between 2000 and 2002. The sample consisted of 2509 men ranging from 30 to 90 years ofage. Biological status was expressed in terms of functional-biological age (BA) computedas a composite z-score of 11 biomarkers according to the method proposed by Borkan andNorris [1980a], and physiological reserve index (PR) developed by Goffaux et al. [2005]. Theaverage biological age profiles (BAP) were compared in several subgroups of participants.The subgroups were categorized based on demographic, socio-economic and lifestyle char-acteristics. It was found that values of systolic and diastolic blood pressure, BMI, physicaland emotional aging indicators and perceived satisfaction with life were significantly associ-ated with most of the study factors, except for smoking habit and education level. The multi-variate logistic regression models revealed that two factors, financial situation and physicalactivity, were significantly associated with the physiological reserve index estimation. Thestudy confirmed the role of the socio-economic and lifestyle factors likely to play in men’sbiological status and aging rates.

KEY WORDS: biological age, physiological reserve, biomarkers, socio-economic status,lifestyle

The age-specific decline in physio-logical functions, though similar in gen-eral pattern, shows large inter-individualvariation. It may be attributed to bio-logical and environmental causes suchas differential rate of age-related func-tional decline of specific organ systems,health-risk behaviours, and chronic de-generative disorders related to physio-

logical aging [ŹIVIĆNJAK et al. 1997,RAUTIO et al. 2001, GOFFAUX et al.2005]. For this reason, the assessment ofaging per se becomes difficult. Manyattempts to measure the aging rate havebeen made during the past decades. Inmost cases, the researchers attempted tofind physiological or biochemical vari-ables correlated with chronological age,

Received 16 September 2008; accepted 1 December 2008DOI: 10.2478/v10044-008-0010-8© 2008 Polish Anthropological Society

M. Kaczmarek, M. Skrzypczak18

a set (battery) of markers, which wouldenable the detection of subtle changes inthe aging rate [BORKAN and NORRIS1980a, NAKAMURA 1982, REFF andSCHNEIDER 1982, SZKLARSKA and RO-GUCKA 2001]. GOFFAUX et al. [2005]proposed a concept of physiologicalreserve defined as “the outcome of theinteraction of aging, lifestyle, and dis-ease” and “the key to estimating biologi-cal age since the loss of reserve is thehallmark of aging”. The concept ofphysiological reserve index is shown inFigure 1. Test batteries have been usedto determine biological age also referredto as physiological age or functional age.Individuals with scores above the meanfor their age group are likely to be bio-logically older than those below the mean[BORKAN and NORRIS 1980a]. Age-related traits, which develop on the baseof a complex genetically regulated proc-ess such as aging, can be decomposed toits genetic and environmental compo-nents [CRAWFORD 2005] with heritabilityestimates ranging from 27% to 57%[KARASIK et al. 2005]. Environmentalfactors include the individual’s socio-economic status, defined by education,income, social isolation, lifestyle factorssuch as smoking, drinking, exercising,marital status and others [BORKAN and

NORRIS 1980b, FACCHINI et al. 1989,LAWLOR et al. 2003, KARASIK et al.2005, GOGGINS et al. 2005, KACZMAREKand LASIK 2006].

Socio-economic factors associated withbiological status are of special interestbecause of the social and economicsituation of Polish men after the politicaltransformation of the 1990s [Report ofNational Census 2002, Report of CBOS2006]. In terms of life expectancy,Poland ranks only 25th in Europe,although data of Central Statistical Officeshow a clear increasing trend in thelifespan of both men and women. Cur-rently (the 2004 data), life expectancy atbirth (e0) for Polish males is 74.1 years.Owing to demographic trends currentlyprevailing in the developed countries,including Poland, as early as after 2010most of these populations will be classi-fied as aging populations [KACZMAREKand SKRZYPCZAK 2002]. At the begin-ning of the 21st century Poland is acountry of high unemployment rate(21%), a country of contrasts and contra-dictions resulting from the transforma-tions, with well educated people havingproblems in finding a job and managinga financial situation often not corre-sponding to educational level. Moreover,it is better material status, and not highereducation, that gives a better chance fora “healthy lifestyle”. The socio-economicchanges have also brought about an in-creased level of social stress.

In light of the above-mentioned facts,the present study attempts to evaluate thesocio-economic and lifestyle factors as-sociated with the biological status ofPolish men. The question posed in thispaper is whether men coming from a lowsocial stratum are biologically older thantheir peers from better-off conditions?

Aging Lifestyle

Disease andcomorbidity

Fig. 1. Venn diagram demonstrating an individ-ual’s physiological reserve [Goffaux et al. 2005]

Biological status among Polish males 19

Materials and Methods

For purposes of the present study, datafrom the cross-sectional survey carried outbetween 2000 and 2002 in Poznań andseveral other localities in Western Polandwere used. The study was approved by theBioethics Committee of the University ofMedical Sciences in Poznań.

The aim of the survey was to obtain asample that meets quality requirements.Out of 4000 individuals enrolled for thestudy, replies were received from 2509.This gives a final response rate of 62.7%.It is far from satisfactory, but men, unlikewomen, are very difficult subjects forscientific purposes. Thus, the study sam-ple consisted of 2509 men ranging from30 to 90 years of age.

The data were collected from inter-views carried out in private homes, in-stitutions, and industrial places by gradu-ate students specially trained for thisinquiry. The Polish version of the An-dropause-Specific Quality of Life Ques-tionnaire (AQOL) was used to collectdemographic, socio-economic and life-style data, subjective perception of one’squality of life (QoL), and health-relatedQoL indicators [KACZMAREK 2000].Eleven variables were chosen for com-puting biological age.

The studied men were divided in twogroups of chronological age: youngerthan 50 years of age, and equal to andolder than 50 years of age. The followingsocio-economic, demographic and life-style factors, each divided into two cate-gories, were included in analyses: maritalstatus classed as (1) single (includingbachelors, divorced, widowers) and (2)living with a partner (married/informalrelationship); education level classed as(1) low (primary/vocational) and (2) high

(secondary/university); place of residencecategorized as (1) village/small town and(2) medium-sized town/large city; finan-cial situation, based on answer to the ques-tion: Is your income sufficient to affordthe necessities of life?, distinguished as(1) poor or (2) good; physical activityclassed as (1) not physically active and(2) physically activity for more than 4hours a week; smoking habit classed as(1) currently smoking less than and >10cigarettes per day and (2) never smokedand past smoker.

The test battery included 11 biomark-ers, known to have a positive or negativelinear correlation with chronological age,characterizing the male physical andmental condition. These were as follows:anthropometric measurements (bodymass index BMI kg/m2 – calculated asbody weight in kg divided by the squareof standing height; weight and heightmeasured with GPM anthropometricinstruments); cardiovascular characteris-tics (systolic blood pressure SBP mmHgand diastolic blood pressure DBP mmHgmeasured on the left arm, after a suffi-cient sedentary period, using a sphygmo-manometer); pulse pressure PP mmHgcalculated as the difference between SBPand DBP, used as a measure of arterialstiffness; biochemical characters such astotal cholesterol TCH, cholesterol frac-tions HDL and LDL, triglicerydes TRIGLsourced from medical records or measu-red from blood serum, and health-relatedindicators of the aging male.

Health-related indicators of the agingmale’s quality of life were self-estimatedusing the aging male specific question-naire. The authors prepared and verifiedthe questionnaire as detailed in a previ-ous publication [KACZMAREK andSKRZYPCZAK 2002]. The scoring proce-

M. Kaczmarek, M. Skrzypczak20

dure was based on each man’s ”yes” or”no” to questions about physical (PSAM),and emotional (ESAM) health com-plaints occurring within the previousthree months. Physical complaints in-cluded hot flashes, night sweats, weak-ness, fatigue, and somatic pain. Emotio-nal complaints included depression, irri-tation, feeling down or “blue”, loss ofmemory and lack of concentration. A de-tailed explanation of the scoring proce-dure is shown in Figure 2.

The quality of life (QoL) was self-estimated and included a subjective feel-ing of well-being with life and particularlife domains as proposed by CAMPBELL[1976]. The following life domains wereevaluated: marriage, family, health,friends, job, home, leisure time, livingstandard, education, economic status andthe quality of life in Poland. The degreeof satisfaction in each area was scoredfrom 1 to 7. An overall index of lifequality for all the 11 areas ranged from11 to 77, indicating high dissatisfactionwithin range 11-33, moderate dissatis-faction/satisfaction – scores within range34-55, and high satisfaction – scoreswithin range 56-77.

Distributions of test battery traitsproved not to be normal; therefore, the

median and quartile range (Q1–Q3) wereused for the analysis. Biological age wascalculated according to the method pro-posed by BORKAN and NORRIS [1980a]as a composite z-score. The z-score wascalculated separately for each of thevariables using the formula: [(observedvalue - median)/the Q1–Q3 quartilerange]. Differences between z-scoresfor subgroups based on social statusand lifestyle in two age groups werecompared using the Mann-Whitney Utest. Differences between z-scores forbiological age indicators in age groupswere compared by means of theKruskal-Wallis test. Negative scoresreferred to younger biological age, andpositive ones to older biological age.The majority of parameters, such asblood pressure, showed positive sloping,but for two parameters, namely thequality of life and the cholesterol frac-tion HDL, negative scores were associ-ated with older biological age. To stan-dardize interpretation of results, scoresof negatively sloped variables weremultiplied by –1.

A graphic representation of results wasprepared in the form of a coordinate sys-tem, as proposed by BORKAN and NORRIS[1980a], with the biological age indicators

EMOTIONAL PHYSICALScores Yes No Scores Yes No

• I feel depressed 2 1 • I have hot flashes 2 1• I feel anxious or nervous 2 1 • I suffer from sweats 2 1• I prefer loneliness 2 1 • I have a headache 2 1• I feel down or blue 2 1 • I feel dizzy spells 2 1• I lost my memory 2 1 • I feel swarming in hands and foots 2 1• I lost my concentration 2 1 • I have a spine ache 2 1• I feel fear 2 1 • I have a muscle ache 2 1

• I feel tired or worn out 2 1Total scores: Min: 7 Max: 14 Total scores: Min: 8 Max: 16

Fig. 2. Diagrammatic representation of scoring procedure for an aging male’s complaints [Kaczmarekand Skrzypczak 2002]

Biological status among Polish males 21

situated on the X-axis and the z-scoresfor those indicators, on the Y-axis.

The physiologic reserve index (PR in-dex) was used to express the biologicalstatus of the aging male. It was calculatedas the sum of the test scores expressed inz-scores, each coming from the medianand the interquartile range Q1–Q3 [GOF-FAUX et al. 2005]. Values of the PR in-dex below zero indicated biologicallyyounger status whereas those equal to orabove zero indicated biologically olderstatus. Odds ratios of being biologicallyolder for particular socio-economic andlifestyle factors were then assessed usinglogistic regression models (Logit).

The studied men were divided in twogroups, one including men younger than50 years of age and the other includingmen equal to or older than 50 years ofage. The percentage distribution of mento the given age groups was 42%, and58%, respectively.

Computations were performed usingthe package of statistical programmesStatistica, StatSoft, Inc. (2005). STATI-STICA (data analysis software system),version 7.1. Statistical decisions weretaken with a 5% error probability.

Results

Selected socio-economic and lifestylecharacteristics for the two studied groupsof men are presented in Table 1. Thepercentage distribution of men by maritalstatus revealed that 85.8% of men wereliving with a partner (in marriage or in-formal relationship) and 14.2% weresingle (bachelors, widowers or divorced).The number of widowers significantlywere increased in the older group of menmaking up 7.8% of this sample comparedwith 1% in the younger group of men.

This confirms the cohort effect. Thenumber of bachelors and divorced menremained similar in both groups at around8% of the entire sample.

The great majority of studied mencame from urban areas (80.6%) and werephysically non-active (84%). Those hav-ing an academic level of education con-sisted of 22.7% of the total sample.

The cohort effect was also found withthe smoking habit with significantlylarger number of currently smoking menin the group aged below 50 years (44%vs 33%).

Values of the z-score for 11 indicatorsof the BA in the two groups of men areshown in Figure 3. Results of theKruskal-Wallis test revealed significantdifferences in all but the LDL, trigli-cerydes and quality of life indicators forthe BA between the study cohorts ofmen. Overall, chronologically youngermen were likely to be biologically youn-ger than their chronologically olderpeers (p<0.05).

The results of univariate analyses usingthe Mann-Whitney U test are shown inTable 2. The findings revealed that val-ues of systolic and diastolic blood pres-sure, BMI, indicators of male’s physicaland emotional aging and perceived satis-faction with life were significantly asso-ciated with most of the study factors,except for smoking and educational level.The bivariate relations were likely to bestronger within the group of younger mencompared to their older peers.

Figure 4 presents a set of average bio-logical age profiles plotted for socio-economic and lifestyle factors in twochronological groups of men. The find-ings showed that married/partnered menwere likely to be biologically youngerthan their single peers in relation to

M. Kaczmarek, M. Skrzypczak22

emotional well-being (ESAM and QoL).Physiological indicators of BA revealedthat single men were likely to be biologi-cally younger than their married/partner-ed counterparts in the group of menyounger than 50 years of age. In thegroup of men aged 50 years and older,single men were likely to be biologically

older than their married/partnered coun-terparts (Fig. 4A). Profiles of BA shownin Fig. 4B revealed that men with highereducation level were likely to be biologi-cally younger than their peers having loweducational attainment. Men from rural/small city areas were likely to be biologi-cally younger in terms of physiological

Table 1. Selected characteristics of the sample for two chronological age groups (percentages)

Age group (in years)Characteristic <50 >50Marital status

Married/ Informal Relationship 90.3 84.2 Divorced/Separated 3.1 3.7 Never Married 5.6 4.2 Widowed 1.0 7.8

χ2 =62.6 p<0.01Spearman R=0.1 p<0.01

Educational level Primary 4.8 10.1 Vocational 35.8 33.0 Secondary 37.6 33.4 Academic 21.8 23.5

χ2 =27.5 p<0.01Spearman R=-0.3 p=0.17

ResidenceVillage 22.0 17.9Small city 31.0 26.5Medium city 15.4 14.3Large city 31.6 41.3

χ2 =25.0 p<0.01Spearman R=0.09 p<0.01

Financial conditionPoor 47.4 39.6Good 52.6 60.4

χ2 =14.6 p<0.01Spearman R=0.08 p<0.01

Physical ActivityNon-Active 81.9 84.1Active>4h weekly 18.1 15.9

χ2 =2.25 p=0.13Spearman R=-0.03 p=0.13

SmokingCurrent smoker >10 cigarettes/daily 27.8 18.2 <10 cigarettes/daily 17.1 15.0Past smoker 24.9 33.6Never smoked 30.2 33.2

χ2 =42.6 p<0.01Spearman R=0.10 p<0.01

Biological status among Polish males 23

-0,5 -0,4 -0,3 -0,2 -0,1 0 0,1 0,2 0,3

SBP*

DBP*

PP*

TCH*

HDL*

LDL

TRIGL

BMI*

PSAM*

ESAM*

QoL

z-score

Age<50 years Age>=50 years

Fig. 3. Z-scores for biological age indicators significantly differentiated by chronological age (resultsof the Kruskal-Wallis test, * p<0.05)

Table 2. Results of the Mann-Whitney U test for indicators of biological age (BA) significantly associ-ated with socio-economic and lifestyle factors in two chronological age groups.

Age group (in years)<50 >50 <50 >50BA Indicator

Z p Z p Z p Z p

Marital status Education levelSBP -2.2 0.028PP -2.7 0.007BMI -2.6 0.009 3.2 0.001PSAM -2.6 0.010ESAM 2.9 0.004 -4.5 0.001QoL 3.8 0.000 -5.8 0.001 6.6 0.001 3.5 0.001

Residence Financial conditionTCH -3.8 0.001BMI 3.3 0.001 2.1 0.032LDL -2.1 0.032PSAM -2.6 0.009 -2.6 0.006 -2.9 0.004ESAM -2.9 0.004 -2.8 0.006 3.4 0.000 -2.2 0.026QoL 3.7 0.001 11.0 0.000 -11.2 0.001

Smoking habits Physical activitySBP 3.0 0.023DBP 2.8 0.005PP 2.0 0.039HDL 2.6 0.009BMI 5.2 0.001 2.3 0.023PSAM 2.1 0.036 2.9 0.003 2.2 0.025ESAM 2.9 0.003 -2.6 0.011 2.4 0.015 2.1 0.033QoL 2.9 0.001 -2.2 0.026 5.8 0.000 5.1 0.001

M. Kaczmarek, M. Skrzypczak24

Figure 4A – Marital Status< 50 years > 50 years

-0,50-0,40-0,30-0,20-0,100,000,100,200,300,400,50

SBP*

DB

P

PP TCH

HD

L

LDL

TRIG

L

BM

I*

PSAM

*

ESAM

*

QoL*

z-score single living with partner

-0,50

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PP*

TCH

HD

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LDL

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L

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QoL*

z-score single living with partner

Figure 4B – Education Level< 50 years > 50 years

-0,50-0,40

-0,30

-0,20-0,10

0,000,10

0,200,30

0,400,50

SBP

DB

P

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LDL

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L

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I

PSAM

ESAM

QoL*

z-score lower education higher education

-0,30

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SBP

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HD

L

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TRIG

L

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PSAM

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QoL*

z-score lower education higher education

Figure 4C – Place of Residence< 50 years > 50 years

-0,30

-0,20

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0,00

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0,30

SBP

DB

P

PP TCH

HD

L

LDL*

TRIG

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PSAM

*

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*

QoL

z-score village/small town town/city

-0,30

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*

HD

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*

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*

QoL*

z-scorevillage/small town town/city

Figure 4D – Financial Situation< 50 years > 50 years

-0,40

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-0,10

0,00

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0,40

SBP

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z-scorepoor good

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SBP

DB

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L

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I

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*

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*

QoL*

z-scorepoor good

Figure 4E – Physical Activity< 50 years > 50 years

-0,40

-0,30

-0,20

-0,10

0,00

0,10

0,20

0,30

0,40

SBP*

DB

P*

PP*

TCH

HD

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LDL

TRIG

L

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I*

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*

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QoL*

z-score lack of excercises intensive excercises

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z-score lack of excercises intensive excercises

Fig. 4. Median biological age profiles for several SES-based subgroups of participants (significantvalues of Mann-Whitney U test indicated by asterisks); (A)-marital status; (B)-education level;(C)-place of residence; (D)-financial situation; (E)-physical activity; (F)-smoking habits

Biological status among Polish males 25

traits than their counterparts from largecities, while they were older in terms ofsubjective well-being (Fig. 4C). It wasalso found that men from better-off lifeconditions were likely to be biologicallyyounger than their poorer counterparts(Fig. 4D). Physically active men werelikely to be biologically younger thantheir non-active peers (Fig. 4E). Smokingdid not differentiate physiological traitsin either studied cohort of men. But cur-rently smoking men were likely to bebiologically older than their never-smoked peers when quality of life andindicators of emotional aging were con-sidered (Fig. 4F). The abovementionedrelations were true for both studiedgroups of men.

The distribution of physiologic reserveindex scores [(Me=0; X=0.29; Q1–Q3(-1.3–1.6); min-max (-11.5–13.8)] showed

significant abnormality (Kolmogorov-Smirnov D=0.07 p<0.01), with skewingtowards older biological age (skew=0.74).Therefore, the median values and inter-quartile range were used for further com-putations instead of arithmetic means. Ofall factors included in Logit analyses,physical activity and financial situationwere significantly associated with bio-logical age estimation based on PR index(Table 3). The findings showed thatphysical activity significantly decreasedthe probability of being biologically olderwith OR=0.4 in the group of men agedunder 50 years and OR=0.7 in men aged50 years and above. In both groups ofmen, the better financial situation in-creased the probability of being biologi-cally younger by~60% compared to thoseliving under poor financial conditions(OR=0.6, and OR=0.7).

Figure 4F – Smoking cigarettes< 50 years > 50 years

-0,40

-0,30

-0,20

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0,00

0,10

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SBP

DB

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HD

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LDL

TRIG

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*

ESAM

*

QoL*

z-score smoker non smoker

-0,40

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0,00

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SBP

DB

P

PP TCH

HD

L

LDL

TRIG

L

BM

I

PSAM

ESAM

*

QoL*

z-score smoker non smoker

Table 3. Socio-economic and lifestyle variables significantly associated with the physiological reserveindex in two age groups – results of Logit regression (OR – odds ratio, +95% CI- confidence interval)

Variables β SE Wald chi2 p OR(±95% CI)

Age <50 years χ2=44.1 p<0.01Constant value 2.6 0.7 15.2 0.001 13.9 (3.7 – 52.5)Physical activity -0.9 0.2 14.8 0.001 0.4 (0.3 – 0.6)Financial situation -0.6 0.2 13.3 0.001 0.6 (0.4 – 0.8)

Age > 50 years χ2=19.9 p<0.01Constant value 1.8 0.5 12.1 0.001 6.1 (2.2 – 16.9)Physical activity -0.4 0.2 4.9 0.027 0.7 (0.4 – 0.9)Financial situation -0.4 0.1 8.0 0.005 0.7 (0.5 – 0.9)

M. Kaczmarek, M. Skrzypczak26

Discussion

Socio-economic and lifestyle charac-teristics of the sample were comparedwith data for the entire population ofPolish males [Report of National Census2002, Report of CBOS 2006, WHO2003a]. Results of this comparison con-firmed that the sample under study mightbe representative for Polish males.

Concerning marital status, the samplereflects the general structure of maritalstatus in Poland with evidence for thecohort effect. This is not true for educa-tional level. The structure of educationfor the sample and the entire Polishpopulation differed significantly (p<0.05)on account of the larger number of welleducated men in the sample. Indeed, themajority of study participants came fromurban communities, were better educatedthan their rural counterparts, and morewilling to participate in the study andcomprehend its importance. The urbani-zation gradient of education, mirrored inthe sample, is a well documented phe-nomenon in Poland.

A sedentary or physically inactive life-style is very common among Polish men.Almost 33% of Polish men, aged 30-45are estimated to spend time mainly in thesitting position and exercising only occa-sionally if ever. The prevalence of physi-cally inactive men in the older age groupincreases to 37% in the 45-59 and 60-74ranges, and to about 46% in the group ofmen aged over 75. About 84% of allstudied men reported inactive forms ofleisure time, mainly in the sitting posi-tion, watching TV or reading.

Prevalence of smoking cigarettes wassimilar for the sample and the entire Pol-ish population. Non-smokers were most-

ly represented by well educated, finan-cially better-off residents of large cities.

The main purpose of this study was tosolve the question as to whether mencoming from lower social strata are sub-ject to more rapid biological aging thantheir chronological peers living in privi-leged social and economic conditions.

A number of definitions describe bio-logical aging. It has been defined as ‘theprogressive loss of function accompaniedby decreasing fertility and increasingmortality [that occurs] with advancingage’ [KIRKWOOD and AUSTAD 2000]. Itis universal and progressive and repre-sents the steady decrease in physiologicalability to meet demands that occurs withincreasing chronological age [BOND etal. 1993].

Biological aging includes all time de-pendent changes in structure and functionof the organism that eventually contributeto diminished efficiency and increasedvulnerability to disease and death. Themeaning of biological aging is thereforeoften explained as “a quantity expressingthe ‘true global state’ of the aging organ-ism better than the corresponding

chronological age” or as “age corre-sponding better to ‘true life expectancy’of the individual than his or her chrono-logical age” [KLEMERA and DOUBAL2006: 240].

ADAMS and WHITE [2004] regard bio-logical aging as the progressive declinein physiological ability to meet demandsthat occurs over time. They claim thatorganism ages due to the accumulation ofdamage at the cellular level and the rateof this process is determined by bothenvironmental and genetic factors.

CRAWFORD [2005], after reviewingdefinitions of biological aging, summa-

Biological status among Polish males 27

rized: “(1) aging is part of the life cycle,but is associated with post-developmentalfeatures, (2) there is physiological dete-rioration, and (3) an increased probabilityof death”. His own definition consideredbiological aging as the “sum total ofphysiological, morphological, and be-havioural characteristics observed afterthe age of reproduction and correlatedwith increases in chronological age”[CRAWFORD 2005: 4].

Much of the controversy regarding theassessment of differential rate of biologi-cal aging stems from a common problemwith either the univariate or the multi-variate approach for computing theoutcome biological age. UTTLEY andCRAWFORD [1994] claim that twoapproaches referred to above “providemeasures of age status relative to one’schronological peers”. However, themethods are quite different. The advan-tages of the multivariate analyses are thatonly with this approach might theinteractions within a group of inde-pendent variables be considered, whereasthe univariate approach might lead tooverestimating the importance of eithercomponent of the entire battery of tests.Although different, these methods pro-vide similar results as was shown inUttley’s 1991 study on variables relatedto survival [cited after UTTLEY andCRAWFORD 1994]. Moreover, interac-tions among independent variables cancomplicate the interpretation of results.Therefore, in this study the battery of 11tests, including physiological, functionaland psychological measures, was trans-formed into biological age scores re-flecting the individual’s rate of aging.Median biological age profiles wereplotted for several subgroups of partici-pants based on socio-economic and life-

style variables. These profiles were com-pared using the univariate approach. Theoverall measure of biological age, ex-pressed in terms of physiologic reserveindex, was then included in Logit model.Odds ratios were estimated for beingbiologically older compared to chrono-logical age peers.

A number of studies have shown thatsocio-economic factor is significantlyassociated with biological status in re-spect of physiological, psychological andfunctional characteristics of adult indi-viduals [RAUTIO et al. 2001, SZKLARSKAand ROGUCKA 2001, ADAMS and WHITE2004]. It is claimed that poor people usu-ally age more quickly than rich peopledue to the unhealthy environments towhich they are exposed. They usuallylack the internal and external resourcesneeded to prevent the transformation ofimpairments and functional limitationsinto disability [SHUMWAY-COOK et al.2002, HEIKKINEN 2006]. In contrast, thepermissive social background is claimedto warrant easier access to resources,health and medical care. Positive lifestylebehaviors are considered to favour “goodold age” [UTTLEY and CRAWFORD 1994].

People from the higher socio-economicclass are likely to be biologically youngerthan their chronological age peers fromthe lower status group [KARASIK et al.2004].O

The statistical analyses showed thatall studied variables, except for LDL,TRIGL and QoL, revealed a clear pro-gressive decline with age, indicating thatolder biological age was associated witholder chronological age. Involutionchanges in the androgenic activity of themale body usually occur gradually anddisplay large intra- and interindividualvariation. They may on average be pro-

M. Kaczmarek, M. Skrzypczak28

nounced at 50 years of age and older[ŹIVIĆNJAK et al. 1997; BRIBIESCAS2001, 2005; BATES et al. 2005; KACZ-MAREK et al. 2005]. For example, thesame biological status of “younger” and“older” men in terms of LDL and tri-glicerydes could be the result of andro-pausal changes as well as socio-econo-mic conditions.

Several epidemiological studies haveshown evidence for the association oflow social class or low education levelwith increased morbidity and mortality[CHEN et al. 1999, WELON et al. 1999,NILSSON et al. 2003], but the significanceof this relationship decreases with chro-nological age above 50 years. The sametendency was found in the present work.In the group of men aged below 50, thebiological age calculated for physical,physiological and psychological traits,was significantly associated with socio-economic and lifestyle variables suchas marital status, education, residence,financial situation, physical activity, andsmoking. In the group of men aged 50and above, the social and lifestyle factorswere differently associated with markersof biological aging, particularly withpsychological well-being (ESAM, QoL).

Of all the variables, education level,marital status, and physical activity re-vealed greatest influence on the biologi-cal status of aging men. This findingcorresponds well with BORKAN andNORRIS [1980b], KARASIK et al. [2004],FACCHINI et al. [1992]. However, itshould be noted that the present study didnot show unequivocally the significanceof educational level for biological aging.The subgroup of men with higher educa-tion level was likely to be biologicallyyounger than their poorly educatedcounterparts with regard to quality of life.

This result could be explained by the lackof difference in healthy lifestyle betweenPoles of different education level, aspresented in the introduction to thisstudy. In spite of the highly stressfulsituation of highly educated Polish menat productive age, they are biologicallyyounger in the emotional sphere. Thismay be accounted for by social support,membership in various types of groups orassociations, and a cooperative networkof social relationships. As emphasized byDERGANCE et al. [2003], cultural factors,such as beliefs, motivations, and avail-ability of services influence individualbehavior. Furthermore, the results of thepresent study show, that it is not bettereducation, but better financial situation,that is likely to give better possibilitiesfor a healthy lifestyle and a younger bio-logical age. Financial income appeared tobe the second most predictive factor forthe physiologic reserve index of complexbiological age. As RAUTIO et al. [2001]emphasized, “in persons over 65, higherincomes are associated with better physi-cal and cognitive capacity”.

A comparative analysis of the maritalstatus subgroups provided interestingresults, being similar for both age groups:single men were biologically youngerconsidering their physiological status andbiologically older as regards their emo-tional well-being. This finding corre-sponds well with many other studies.BEN-SHLOMO et al. [1993] and GLIKS-MAN et al. [1995] found that mar-ried/partnered men were more advancedin decline in such parameters as BMI,blood pressure, and lipid levels than theirsingle counterparts. Both, thisstudy andthe abovementioned, found marriagelikely to be protective for men’s psycho-logical well-being. It should be added,

Biological status among Polish males 29

however, that the significance of maritalstatus and its protective function for ag-ing men remains inconclusive.

Place of residence was another socialvariable prominently associated withbiological age in both studied groups ofmen. Men living in urban areas werelikely to be biologically younger thantheir rural counterparts, however this wastrue only for BMI and quality of lifescores. Some other physiological traitsput urban men among the biologicallyolder compared to the rural counterparts.This finding is in good agreement withresults obtained by FACCHINI et al.[1989].

Concerning cigarette smoking it shouldbe noted that over the past 20 years Po-land has been the country with the high-est cigarette consumption in the world.About 70% of Polish men have smokedfor more than 10 years and about 40%smoke more than 20 cigarettes a day[BALCZEWSKA 2004]. The risk of deathcaused by smoking constitutes of 18-19%of all death causes [WHO 2003a]. Fortu-nately, in the 2000s the prevalence ofsmoking among men was “only” 40% (ascompared with 64% in the 1970s) [WHO2003b]. The finding of this study, show-ing lower figures of physiological traitsindicative of younger biological age andhigher figures for psychological traitsindicative of older biological age, com-pared to chronological age peers, may beexplained by the specific situation forPolish men, who have difficulty withemployment and financial standing – andfor whom smoking of cigarettes mightbe considered a form of stress reac-tion/realese.

The physical activity of the men stud-ied didn’t change across age groups, with

only about 17% of men in each age groupexercising at least 4 hours per week.Comparing this finding with data col-lected in other countries (in the USAonly 12% of adults aged 75 reportedmoderate physical activity: in the Nordiccommunity about 25% are physicallyactive [HEIKKINEN 2006]), the physicalactivity of Polish males does not appeartoo bad.

Logistic regression models of thephysiological reserve index revealed thatof all the studied socio-economic andlifestyle factors, physical activity had thegreatest influence on biological age in thegroup of men aged below 50. It is gener-ally assumed that physical activity is oneof the most effective ways for older peo-ple to reduce the risk of mortality, hos-pitalization, incidence of various dis-eases, particularly cardiovascular andmetabolic, and to increase functionalcapacity and quality of life [LAWLOR etal. 2003, CRESS et al. 2006, HEIKKINEN2006].

In conclusion it might be said that bio-logical status of Polish adult males isassociated with financial life conditionsand lifestyle behaviours, with physicalactivity topping the list. The adverseeffects of low socio-economic statusmanifest in faster aging.

The study confirmed the leading role ofsocio-economic and lifestyle factors inthe biological status of aging males andthe need for study of the conditions underwhich successful aging may occur.

Acknowledgements

We would like to thank the two re-viewers for their useful comments onthis manuscript.

M. Kaczmarek, M. Skrzypczak30

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Streszczenie

Celem pracy była ocena wybranych czynników społeczno-ekonomicznych oraz elementówstylu życia wywierających wpływ na stan biologiczny mężczyzn. Badaną grupę stanowiło 2509mężczyzn w wieku od 30 do 90 lat, pochodzących z różnych warstw społeczno-ekonomicz-nych. Badania, przeprowadzone w latach 2000-2002 na terenie Poznania oraz zachodniej Pol-ski, miały charakter przekrojowy. Stan biologiczny określano posługując się koncepcją wiekubiologicznego zaproponowaną przez BORKANA i NORRISA [1980a] oraz metodą wyznaczaniawskaźnika rezerwy fizjologicznej (PR) opracowaną przez GOFFAUX et al. [2005] (ryc. 1). Wiekbiologiczny określano na podstawie 11 biomarkerów obejmujących pomiary antropometrycz-ne, charakterystyki układu krążenia i biochemiczne, jakość życia oraz emocjonalne i fizyczneobjawy towarzyszące starzeniu się mężczyzn (ryc. 2). Posługując się formułą [(wartość obser-wowana – mediana)/odległość kwartylowa], uzyskiwano wartości z, które przypisywano dokategorii wieku biologicznego: młodszy (ujemne wartości) i starszy (dodatnie wartości) odprzeciętnego. Następnie wykreślano profile wieku biologicznego, odrębnie w grupie mężczyzn

M. Kaczmarek, M. Skrzypczak32

młodszych (mniej niż 50 lat) oraz starszych (50 lat i więcej), kategoryzowanych w zależnościod czynników społeczno-ekonomicznych oraz określających styl życia. Wartość wskaźnika PRuzyskano sumując wszystkie wartości z dla każdego osobnika.

Charakterystykę próby przedstawiono w tabeli 1. Wykazano, że mężczyźni chronologiczniemłodsi byli również biologicznie młodsi w porównaniu z mężczyznami chronologicznie star-szymi (ryc. 3). Stwierdzono, że w obu grupach wieku parametrami najczęściej istotnie różnią-cymi się pomiędzy grupami o odmiennym statusie społecznym oraz stylu życia były parametryokreślające ciśnienie krwi, BMI, fizyczne i emocjonalne objawy towarzyszące starzeniu sięoraz jakość życia. Poziom wykształcenia oraz palenie papierosów najsłabiej różnicowały wiekbiologiczny mężczyzn w obu grupach wieku (tab. 2). Na ryc. 4 przedstawiono profile wiekubiologicznego wyznaczone dla mężczyzn kategoryzowanych w zależności od stanu cywilnego,poziomu wykształcenia, miejsca zamieszkania, sytuacji finansowej, aktywności fizycznej orazpalenia papierosów. Analiza regresji logistycznej wykazała, że sytuacja finansowa oraz aktyw-ność fizyczna, były istotnie powiązane z wskaźnikiem rezerwy fizjologicznej PR, komplekso-wo oceniającym wiek biologiczny badanych mężczyzn (tab. 3). Wyniki uzyskane w pracypotwierdzają wpływ czynników społeczno-ekonomicznych oraz stylu życia na zróżnicowaniestanu biologicznego oraz wskaźników starzenia się mężczyzn.