• Friday Edition Of The Journal Science And Technology

30 August 2019. Vol 365, Issue 6456. Table of Contents. Botany The allure of monkeyflowers; Ecology Amazon fires clearly linked to deforestation, scientists say. RACINE — On Wednesday night, Racine County District Attorney Tricia Hanson is to announce her decision of whether to issue charges against Mount Pleasant Police Sgt. Eric Giese in the fatal.

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Dogs may be beneficial in reducing cardiovascular risk in their owners by providing social support and motivation for physical activity. We aimed to investigate the association of dog ownership with incident cardiovascular disease (CVD) and death in a register-based prospective nation-wide cohort (n = 3,432,153) with up to 12 years of follow-up. Self-reported health and lifestyle habits were available for 34,202 participants in the Swedish Twin Register.

Time-to-event analyses with time-updated covariates were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). In single- and multiple-person households, dog ownership (13.1%) was associated with lower risk of death, HR 0.67 (95% CI, 0.65–0.69) and 0.89 (0.87–0.91), respectively; and CVD death, HR 0.64 (0.59–0.70), and 0.85 (0.81–0.90), respectively. In single-person households, dog ownership was inversely associated with cardiovascular outcomes (HR composite CVD 0.92, 95% CI, 0.89–0.94).

Ownership of hunting breed dogs was associated with lowest risk of CVD. Further analysis in the Twin Register could not replicate the reduced risk of CVD or death but also gave no indication of confounding by disability, comorbidities or lifestyle factors. In conclusion, dog ownership appears to be associated with lower risk of CVD in single-person households and lower mortality in the general population. Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for 45% of all deaths (4 million) in Europe in 2016. Dogs may be beneficial in reducing cardiovascular risk by providing a non-human form of social support and increasing physical activity. Dog ownership has been reported to be associated with alleviation of social isolation and improved perception of wellbeing, particularly in single persons and the elderly.

A meta-analysis of eleven observational studies found that dog owners walked more and were more physically active than non-owners. Two studies assessing changes in physical activity after acquisition of a dog or other pet found increased self-reported recreational walking. A recent study showed that dog ownership also supports the maintenance of physical activity during poor weather.

Previous findings on dog ownership and the risk of CVD are conflicting. In individuals without CVD, dog ownership has been reported as inversely associated with the prevalence of cardiovascular risk factors, such as dyslipidemia, hypertension and diabetes, but other studies found absent or inconclusive associations. In patients with coronary artery disease, dog ownership is reportedly associated with improved survival. Although the American Heart Association issued a Scientific Statement in 2013 concluding that “ dog ownership is probably associated with decreased CVD risk ” and that this effect “ may be causal ”, earlier studies have had several limitations, including lack of power, low responder rates and incomplete adjustment for potential confounders. We aimed to clarify the association of dog ownership with CVD and mortality by studying over 3.4 million Swedish adults followed through nationwide register linkage over a 12-year period.

In age and sex-adjusted analysis, dog ownership was inversely associated with risk of acute myocardial infarction, ischemic stroke, heart failure, and composite CVD (HRs 0.93–0.94; Table ). After multivariable adjustment, associations with CVD outcomes were attenuated (HRs 0.97–1.01), but remained significant in acute myocardial infarction, HR 0.97 (95% CI 0.95–0.99). Dog ownership was inversely associated with cardiovascular mortality (HR 0.77, 95% CI, 0.73–0.80), and all-cause mortality (adjusted HR 0.80, 95% CI, 0.79–0.82; Table ). Additional adjustment for education and socioeconomic index in those with enough information available (n = 3,136,671 and n = 1,660,140, respectively) did not affect the results compared to non-adjusted models (Supplementary Tables and ).

In the breed group analysis, we found that ownership of a dog from breeds originally bred for hunting (including terriers, retrievers, scent hounds and related dogs) was associated with a lower risk of CVD (Table ). Ownership of a mixed-breed dog was associated with higher risk of CVD, HR 1.13 (95% CI, 1.09–1.17). The HR for all-cause mortality was. Swedish Twin Register The final dataset included 34,202 individuals (45% men) with a mean age of 57 years. We identified 8.5% as registered dog owners at any time during the 14-year follow-up period.

The cohort had similar characteristics as the national cohort, except that fewer individuals lived in single households, probably due to differences in accuracy of measurement (register not complete for individuals cohabiting without common children vs phone survey in which partner information was recorded) (Supplementary Table ). Multivariable-adjusted estimates for composite CVD, HR 1.09 (95% CI, 0.92–1.28), and all-cause mortality, HR 0.89 (95% CI 0.73–1.09) overlapped with estimates from the national cohort, but the estimate for CVD was in the opposite direction. The serial addition of the different lifestyle covariates to the model only slightly altered the estimates (Fig. ). Overall, the results from the Twin Register did not demonstrate any difference in risk of CVD or mortality between dog owners and non-owners but remained robust to a range of different modifications explored in sensitivity analyses, including the exclusion of individuals with disabilities or unable to care for themselves (Fig. ). In this register-based nationwide prospective study including 3,432,153 individuals, dog ownership was associated with a lower risk of incident cardiovascular disease in single-person households and with lower cardiovascular and all-cause mortality in the general population. Ownership of hunting dog breeds was associated with a decreased risk of CVD, and ownership of all purebred breeds were associated with a lower risk of all-cause mortality.

Although further investigation in the Twin cohort did not show any association between dog ownership and CVD and mortality likely due to the smaller sample size, additional adjustment for detailed lifestyle and socioeconomic factors only marginally altered these estimates. A recent Norwegian prospective cohort study within a subset of the HUNT study (n = 28,746 in adjusted analysis, 4,233 events) showed no difference in all-cause mortality between dog owners and non-owners (adjusted HR 1.00, 95% CI 0.91–1.09). Adjustments were similar as in our study, but stratification by family type was not investigated, which would have been interesting to compare to our results, as the single household stratum was where the largest protective effect sizes were observed. The differences in results from our study could be due to differences in the population studied (largely rural in the HUNT study), difference in the study design (cohort vs register-based), measurement of dog-ownership (questionnaire vs register) and time of exposure definition (baseline vs time-updated) or pure chance. Three other previous studies conducted within the Second and Third National Health and Nutrition Examination Survey (NHANES II-III) of 4,435 (44% dog owners), 5,903 (11% dog owners) and 3,964 (22% dog owners) individuals, respectively, reported no effect of dog ownership on all-cause mortality (adjusted HRs 1.00, 95% CI, 0.85–1.20; 1.17, 95% CI, 0.94–1.46; and 0.82, 95% CI, 0.51–1.34, respectively). Whilst statistical methods were similar to our study, these studies suffered from a high degree of incomplete follow-up (50%) and small sample sizes, which do not apply to the present study based on comprehensive registers of the total population. Further, three smaller unrelated studies in the United States support an association of dog ownership with lower mortality after cardiovascular events.

Our sample size is hundredfold larger than the largest previously reported study and allows for more precise effect estimates and analyses of different CVD outcomes and in different subgroups. Using updated exposure information on dog ownership, we reduce the influence and analyses of misclassification. Cumulative dog ownership in the national cohort was similar to the 12.9% estimate in a cross-sectional 2012 survey and somewhat lower in the Swedish Twin Registry cohort since we were not able to take partners’ registration of dog ownership into account. Our observational study cannot provide evidence for a causal effect of dog ownership on cardiovascular disease or mortality. Although careful attention was paid to adjusting for potential confounders in a set of sensitivity analyses, it is still possible that personal characteristics that we did not have information about affect the choice of not only acquiring a dog, but also the breed and the risk of CVD. Such residual confounding in the present study may be indicated by the opposite direction of the association with CVD in mixed-breed dogs.

There might be direct effects of dog ownership on health outcomes. One mechanism by which dog ownership could reduce CVD risk and mortality is by alleviating psychosocial stress factors, such as social isolation, depression and loneliness - all reportedly lower in dog owners. These factors have been linked to increased risk of coronary heart disease, cardiovascular death and all-cause mortality. Dog ownership has also been associated with elevated parasympathetic and diminished sympathetic nervous system activity, lower reactivity to stress, and faster recovery of blood pressure following stressful activity. Apart from the social support, it has consistently been shown that dog owners achieve more physical activity and spend more time engaged in outdoor activities. We found that individuals in single households benefitted most from dog ownership regarding protection from CVD. Here, we defined a single household based on both marital status and the presence of children in the household.

A study on the psychological effects of dog ownership suggested that ownership benefits single persons more than married individuals Moreover, single dog-owners were shown to walk their dog more often than individuals in multiple-person households, and in general, it is plausible that not all members of a multiple-person household interact with the dog as much as a single owner. In both multiple- and single-person household strata, we found lower hazard ratios for dog ownership on all-cause mortality and cardiovascular mortality than on incident CVD. This discrepancy may be explained by less severe disease at hospital presentation in dog-owners, similar to the effect described in physically active persons. Alternatively, owning a dog may improve rehabilitation after an incident disease event by acting as motivation and support to mobilize for walks again. To our knowledge, our prospective nationwide study is by far the largest investigation of associations of dog ownership with human health reported to date.

The comprehensiveness of the Swedish population register system gave us access to a rich set of possible confounders and outcomes, allowed for accurate censoring and low numbers of missing data or lost participants. Our results are based on the Swedish population and likely generalizable to other European populations with similar demographics and cultural practices regarding dog ownership. We found statistically robust estimates that were consistent, although with lower precision, after adjustment in the smaller twin cohort for lifestyle factors such as smoking, obesity, physical impediment, assisted living and comorbidity.

Some limitations apply to our study. As earlier mentioned, there is a risk of unmeasured confounding, especially from personal characteristics affecting the choice of not only acquiring a dog, but also lifestyle and the risk of CVD and death.

Further, although we excluded individuals with a history of CVD at baseline and adjusted for comorbidities in sensitivity analyses, there remains a risk of reverse causation, in that individuals with disabilities or comorbidity may be less likely to own a dog, and may be at higher risk for CVD and death. Although registration of dog ownership is mandatory in Sweden, not all dogs are registered, and we noted that the number of dogs in the Board of Agriculture Register increased during the study period. Some dog owners might be misclassified as non-owners in the beginning of the study period, which could have introduced bias away from the null if misclassification was associated with cardio-protective factors. Likelihood of dog registration could also be linked to factors like personality that we were not able to control for. Taken together, we believe our longitudinal population-wide design provides the most robust evidence so far of a link between dog ownership and health outcomes, although bias from reverse causation, misclassification and confounding cannot be excluded. In conclusion, in a nationwide population based study with 12 years of follow-up, we show that dog ownership is associated with a lower risk of cardiovascular disease in single households and with a reduced risk of cardiovascular and all-cause death in the general population. Infrastructure support Support by NBIS (National Bioinformatics Infrastructure Sweden) for the use of the Mosler system for sensitive data is gratefully acknowledged.

There was no compensation received for this assistance. We would also like to acknowledge the Swedish Kennel Club and the National Board of Agriculture for granting access to the dog registers. They were not involved in any part of the study design, analysis, data interpretation, manuscript preparation or approval. Scientific support We acknowledge the assistance provided by Malin Ericsson of the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden in defining the socioeconomic variables from the Swedish Twin Registry.

We acknowledge the assistance provided by Dr Erik Bihagen of the Swedish Institute for Social Research in defining the socioeconomic variables in the Register of the Total Population. We acknowledge Dr Mark S. Clements of the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden for assistance with the statistical analysis. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.

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Friday Edition Of The Journal Science And Technology

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