Investigating the Association between Sociodemographic Factors and Chronic Disease Risk in Adults Aged 50 and above in the Hungarian Population

Round 1

Reviewer 1 Report (New Reviewer)

The manuscript discusses important sociodemographic factors in their relation to chronic diseases in adults older than 50 years. The study approach is good, but the questionnaire remains too superficial, leaving too much room for speculation in the discussion. Overall, however, the article is definitely worth reading, even if the questions in the questionnaire are too superficial for real results to be achieved.

 

Regarding the questions in detail:

 

Question 10: twice the same answer option

 

Question 32:

the same answer twice

 

Hoping to have been of service

Author Response

Dear Reviewer,

Please find below our response to your comments and concerns.

 

Comments from Reviewer 1

Comment: The manuscript discusses important sociodemographic factors in their relation to chronic diseases in adults older than 50 years. The study approach is good, but the questionnaire remains too superficial, leaving too much room for speculation in the discussion. Overall, however, the article is definitely worth reading, even if the questions in the questionnaire are too superficial for real results to be achieved.

Regarding the questions in detail:

Question 10: twice the same answer option

Question 32:

the same answer twice

Response: Thank you for taking the time to review our manuscript. We sincerely appreciate your valuable feedback and insights. We apologize for any confusion caused by the translation of the questionnaire from Hungarian to English. We understand that this translation process may have inadvertently led to the loss of some nuances and meanings present in the original Hungarian version. We have taken your comments into account and made the necessary adjustments to address the translation errors you pointed out, including the repetition of answer options in Questions 10 and 32. Furthermore, we have thoroughly reviewed the entire questionnaire to identify and rectify any other potential mistakes or ambiguities. Our aim is to ensure the questionnaire accurately captures the required information for meaningful results and insightful discussions.

Once again, thank you for your time and consideration in reviewing our submission. We appreciate your valuable feedback and suggestions for improving the quality of our manuscript.

Sincerely,

Dr. Attila Csaba Nagy

Reviewer 2 Report (Previous Reviewer 1)

Thank you for adding content in the manuscript

Author Response

Thank you very much for your review.

Reviewer 3 Report (Previous Reviewer 2)

Thank you for the work, your modifications and comments.

Author Response

Thank you very much for your review.

Reviewer 4 Report (Previous Reviewer 3)

Dear authors,

The manuscript was revised and improved.

The topic is interesting but the article requires minor revisions, particularly in the conclusion and references sections, before it could be published.

1. “Older adults aged 50 and above are more likely to develop chronic diseases  and to experience disability and comorbidity than younger age groups”

 People over 50 years old cannot be considered older adults.

 

2. Please review the entire manuscript and revise the citations

“….while other supplements show potential protective effects [13]. Numerous studies have investigated the association between supplementary intake of calcium and vitamin C and the risk of cardiovascular disease, with some reporting an elevated risk [28, 29].

The correct number of the citation is [14,15] not [28,29]

 

3. The conclusion is too lengthy. It should not include descriptions or discussions of the results. A conclusion should be concise, assertive, and limited to summarizing the findings of the study

Author Response

Thank you very much for your review. Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 5 Report (Previous Reviewer 4)

The manuscript is better than above. I think that it can be eligible for publication.

Author Response

Thank you very much for your review.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

It is interesting research especially since it had a representative distribution of gender- this is a very important feature

In addition, in the Conclusions section, I see a repetition of results rather than actual conclusions.

Conclusions should be based on the results of the study, not be repeated in a different wording - this needs improvement.

The study is so interesting and has so much data that drawing the right conclusions should not be a problem.

Please consider preparing conclusions in points - it is more understandable and specific.

 

Reviewer 2 Report

Thank you very much for the opportunity of reading your paper. NCD are an important subject nowadays and it will continue to increase with population aging, therefore studies as yours are valuable. Please consider the modifications below:

Introduction

The justification to carried out the study is not completely stated. In line 58 it is stated that “the associations between these factors and chronic diseases in older adults are not fully understood”, it would be recommendable to explain it further because in the same introduction these associations are described.

Methods

It is recommended to include a study design and setting were the type of design, setting and duration of the study are stated.

Which media sites “contained members that exclusively represent the target age group”? Were there patients’ association for CVD or other? Were the population selected only patients with CVD or healthy adults were also included? It is necessary to specify inclusion and exclusion criteria.

How was the questionnaire designed? Was it piloted in any way? There are checklists available (i.e. CROSS checklist https://www.equator-network.org/reporting-guidelines/a-consensus-based-checklist-for-reporting-of-survey-studies-cross/) for reporting surveys that should be used in the present paper.

The second phase of the study, with the interviews, must be described in detail in the methods section.

Were sample sizes for chronic conditions, CVD or diabetes calculated?

Anonymization of patients or approval by the ethics committee was not discussed (see “Institutional Review Board Statement” section).

Results

In table 1 and the text, “below 60” should be “50-59” to avoid confusion for readers.

It is not necessary to duplicate information in the text that has been already included in tables.

Why were peptic ulcer and IBS chosen between the chronic conditions? Why “other” conditions are not included in the descriptive table?

How is it possible that n=412 have either CVD or diabetes, however only n=223 have chronic conditions?

Was the study sample representative of the Hungarian population?

Table 2 should be easier to read if % were displayed by group (Chronic condition yes/no).

Were there any difference in the responses between the phases (survey VS interviews)?

Discussion

Results included in the discussion section should already be in the methods section (i.e., lines 333-334).

Comparison of the study population and the general population is necessary to stablish external validity (i.e., results found for smokers/non-smokers) (lines 374-375), as the comparison made with IBS. In addition, knowing the prevalence in general population could help understand the importance of the study for the design of prevention measures.

How could misclassification of the smoking status could be made when is a binary variable (yes/no)?

Appendix

It is necessary to include the questionnaire as appendix.

Reviewer 3 Report

I appreciate the opportunity to revise this work about risk factors associated with age-related disorders. This topic is extremely interesting to improve the well-being of aging societies.

 1. Please revise the introduction some sentences are redundant.

Line 79

“The study aimed to examine the association between the sociodemographic factors of loneliness, employment status, educational level, urban-rural living area, BMI, dietary supplementation, and alcohol consumption, and the presence of chronic diseases, such as heart disease and diabetes, in adults aged 50 and above”.

Line 90

“Therefore, this study aims to address this gap by examining the associations between sociodemographic factors such as loneliness, employment status, educational level, urban-rural living area, BMI, dietary supplementation, tobacco use, and alcohol consumption, and the presence of chronic diseases, such as heart disease and diabetes, in adults aged 50 and above”

 

2. Please provide data regarding the statistical power of the sample.

 

3. Please provide the questionnaire. The questionnaire has been validated regarding the face and content?

 

4. Please describe only the relevant result and avoid duplication of results. Some data are simultaneously described in the text and tables.

 

5. The discussion should be improved, is too descriptive.

Reviewer 4 Report

Line 73 and 74: Dietary supplementation, including the use of  vitamins and other dietary supplements, has also been linked to chronic disease risk, with some supplements showing potential protective effects [13].

The authors should clarify this well, it is a bit contradictory.

 

Line 90-92: the objective should specify what type of association is intended to be investigated, they leave it very general.

“Therefore, this study aims to address this gap by examining the associations between 90 sociodemographic factors such as loneliness, employment status, educational level, urban-rural living area, BMI, dietary supplementation, tobacco use and alcohol consumption, and the presence of chronic diseases…”

 Participants and sampling;

Hungarian adults aged 50 years and above were allowed to participate in a survey which was conducted in two stages. How were they selected?

It lacks important aspects such as inclusion and exclusion criteria related to sex, and if the first contacts were the response to a questionnaire, did they take into account the presence of mild dementia or other psychiatric pathologies??

 

Strengths and limitations: Among other strong limitations that influence the lack of scientific strength of this study is the lack of aspects as important as the fact that the diagnosis is based only on the verbal test, they do not provide a clinical report with the diagnoses of chronic pathologies, the anamnesis is not taken into account. family to determine the genetic association of some chronic pathologies studied and an important factor such as sedentary lifestyle or regular physical activity performed.

 

Doubts: all the participants have some chronic disease, if they have cardiovascular disease or diabetes are they already chronic?

 

This is not well understood and leads to confusion, they should clarify this aspect. Or the participants may or may not have chronic diseases other than cardiovascular or diabetic disease????