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Background: The focus of most epidemiological studies has been mortality or clinical events, with less information on activity limitations related to basic daily functions and their consequences. Standardised data from multiple countries at different economic levels in different regions of the world on activity limitations and their associations with clinical outcomes are sparse. We aimed to quantify the prevalence of activity limitations and use of assistive devices and the association of limitations with adverse outcomes in 25 countries grouped by different economic levels., Methods: In this analysis, we obtained data from individuals in 25 high-income, middle-income, and low-income countries from the Prospective Urban Rural Epidemiological (PURE) study (175 660 participants). In the PURE study, individuals aged 35-70 years who intended to continue living in their current home for a further 4 years were invited to complete a questionnaire on activity limitations. Participant follow-up was planned once every 3 years either by telephone or in person. The activity limitation screen consisted of questions on self-reported difficulty with walking, grasping, bending, seeing close, seeing far, speaking, hearing, and use of assistive devices (gait, vision, and hearing aids). We estimated crude prevalence of self-reported activity limitations and use of assistive devices, and prevalence standardised by age and sex. We used logistic regression to additionally adjust prevalence for education and socioeconomic factors and to estimate the probability of activity limitations and assistive devices by age, sex, and country income. We used Cox frailty models to evaluate the association between each activity limitation with mortality and clinical events (cardiovascular disease, heart failure, pneumonia, falls, and cancer). The PURE study is registered with ClinicalTrials.gov, NCT03225586., Findings: Between Jan 12, 2001, and May 6, 2019, 175 584 individuals completed at least one question on the activity limitation questionnaire (mean age 50·6 years [SD 9·8]; 103 625 [59%] women). Of the individuals who completed all questions, mean follow-up was 10·7 years (SD 4·4). The most common self-reported activity limitations were difficulty with bending (23 921 [13·6%] of 175 515 participants), seeing close (22 532 [13·4%] of 167 801 participants), and walking (22 805 [13·0%] of 175 554 participants); prevalence of limitations was higher with older age and among women. The prevalence of all limitations standardised by age and sex, with the exception of hearing, was highest in low-income countries and middle-income countries, and this remained consistent after adjustment for socioeconomic factors. The use of gait, visual, and hearing aids was lowest in low-income countries and middle-income countries, particularly among women. The prevalence of seeing close limitation was four times higher (6257 [16·5%] of 37 926 participants vs 717 [4·0%] of 18 039 participants) and the prevalence of seeing far limitation was five times higher (4003 [10·6%] of 37 923 participants vs 391 [2·2%] of 18 038 participants) in low-income countries than in high-income countries, but the prevalence of glasses use in low-income countries was half that in high-income countries. Walking limitation was most strongly associated with mortality (adjusted hazard ratio 1·32 [95% CI 1·25-1·39]) and most consistently associated with other clinical events, with other notable associations observed between seeing far limitation and mortality, grasping limitation and cardiovascular disease, bending limitation and falls, and between speaking limitation and stroke., Interpretation: The global prevalence of activity limitations is substantially higher in women than men and in low-income countries and middle-income countries compared with high-income countries, coupled with a much lower use of gait, visual, and hearing aids. Strategies are needed to prevent and mitigate activity limitations globally, with particular emphasis on low-income countries and women., Funding: Funding sources are listed at the end of the Article., Competing Interests: Declaration of interests AR received grants from the Swedish Research Council and Swedish Heart and Lung Foundation. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background : The purpose of this study was to analyze the major cardiovascular risk (CVR) factors and their trends in the study population. Methods : The results of subjects in the Polish Prospective Urban and Rural Epidemiological Study (PURE) study group were interpreted. CVR was calculated for each participant according to the Systematic Coronary Risk Evaluation (SCORE2) scale or the Systematic Coronary Risk Evaluation-Older Persons (SCORE2-OP) scale. Data from the beginning of the analysis (2013) and nine years later (2022) were included. In addition, the use of lipid-lowering therapy (LLT) and meeting the low-density lipoprotein cholesterol (LDL-c) target criterion at the beginning and end of the study were analyzed. Results : Patients in the high and very high CVR groups who had abnormal LDL-c results accounted for 64% and 91% of their group in 2013 and 70% and 92% in 2022, respectively. Conclusions : Regardless of age, patients using LLT at the start of the analysis had a greater increase in future CVR, especially if they had lipid abnormalities at the start of the study. This may be due to reverse causality and multimorbidity in these patients, highlighting the importance of appropriate treatment of lipid abnormalities.

The aim of this study is to present data on the use of lipid-lowering therapy (LLT) in relation to calculated cardiovascular risk (CVR) and an additionally defined target LDL-C concentration. The cohort consisted of 1287 participants in the Polish edition of the Prospective Urban and Rural Epidemiological Study (PURE). CVR was calculated for each participant using the SCORE2 or SCORE2-OP scale, and for patients with diabetes mellitus (DM), chronic kidney disease (CKD) or atherosclerotic cardiovascular disease (ASCVD) according to the respective criteria. In the cohort analysed, 107 of 212 people (50.5%) in the low cardiovascular risk (CVR) group, 284 of 414 people (68.6%) in the moderate CVR group, 562 of 612 people (91.8%) in the high CVR group and 48 of 49 people (98%) in the very high CVR group did not meet the target LDL-c criterion. Of those in the low CVR group, 86% of participants were not receiving lipid-lowering therapy (LLT); in the moderate CVR group, the proportion was 77.8%; in the high CVR group, 68.1% and in the very high CVR group, 75%. In each cardiovascular risk group, participants who did not meet the target LDL-c concentration criterion and did not take LLT made up the larger group.

The aim of the study was to analyze the association between dietary patterns (DP) identified in the group of Lower Silesia (Poland) inhabitants and the prevalence of selected noncommunicable diseases, such as total cardiovascular diseases (CVD), hypertension, diabetes, impaired fasting glucose (IFG), visceral obesity, and excessive body weight. This study involved 2023 subjects aged 35-70 years, from Wroclaw and surrounding villages. The assessment of food intake in the study group was assessed using the standardized Food Frequency Questionnaire. Dietary patterns were identified using the principal components analysis (PCA) with varimax rotation. Three dietary patterns were identified in the study group: unhealthy, healthy, and traditional. The prevalence of hypertension, diabetes, IFG, and visceral obesity decreased across the quartiles of healthy DP. Prevalence of IFG increased across the quartiles of unhealthy DP, but the prevalence of hypertension decreased. When the diet was more adherent to the traditional DP the prevalence of CVD, diabetes, IFG, visceral obesity, obesity, and being overweight was higher. DP abundant in fruits, vegetables, seeds, nuts, raisins, and unrefined grains, named "healthy dietary pattern", had a beneficial association with lower prevalence of selected noncommunicable diseases. DP abundant in meat products, but poor in fruits and vegetables were positively associated with higher prevalence of total CVD, diabetes, IFG, excessive body weight, and visceral obesity.

Introduction: Despite some improvement in awareness and treatment of hypertension, blood pressure control is still below expectations in Poland. The aim of the study was to analyze the secular trend of hypertension prevalence in the PURE Poland cohort study over 9 years of observation and to analyze factors associated with controlled HT., Methods: The study group consisted of 1,598 participants enrolled in a Prospective Urban and Rural Epidemiological Study (PURE), who participated both in baseline (2007-2010) and 9-year follow-up (2016-2019). Hypertension was ascertained on the basis of (1) self-reported hypertension previously diagnosed by the physician, (2) self-reported anti-hypertensive medication, and/or (3) an average of two blood pressure measurements ≥140 mmHg systolic BP and/or ≥90 mmHg diastolic BP., Results: The prevalence of hypertension increased from 69.4% at baseline to 85.9% at 9-year follow-up. The chance of HT was 8.6-fold higher in the oldest vs. the youngest age group [OR 8.55; CI 4.47-16.1]. Male sex increased the chance for hypertension over 3-fold [OR 3.23; CI 2.26-4.73]. Obesity, according to BMI, increased the chance of HT 8-fold [OR 8.01; CI 5.20-12.8] in comparison with normal body weight. Male sex decreased the chance of controlled HT after 9 years [OR 0.68; CI 0.50-0.92]. There was no statistically significant association between controlled HT and age or place of residence. Higher and secondary education increased the chance of controlled HT over 2-fold in comparison with primary education [OR 2.35; CI 1.27-4.34, OR 2.34; CI 1.33-4.11]. Obesity significantly decreased the chance of controlled HT after 9 years in comparison with normal body weight [OR 0.54; CI 0.35-0.83]., Conclusion: Factors significantly increasing the chance for controlled hypertension after 9 years were female sex, secondary and tertiary education, normal body weight, and avoiding alcohol drinking. Changes in lifestyle, with special emphasis on maintaining normal body weight, should be the basis of prevention and control of HT., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zatońska, Basiak-Rasała, Połtyn-Zaradna, Gaweł-Dąbrowska, Wołyniec, Karczewski and Szuba.)

Chronic inflammation is involved in the pathogenesis of many non-infectious diseases, including cardiovascular diseases (CVD), a leading cause of death in Europe. The aim of the study was to assess the inflammatory potential of the diets of participants enrolled in the Polish arm of the Prospective Urban and Rural Epidemiological (PURE) study, evaluate the association between the dietary inflammatory index (DII) score with the dietary content, and to determine the correlation of DII score with selected anthropometric parameters and biochemical risk factors for CVD. Diets were assessed with the Food Frequency Questionnaire (FFQ). Among participants with pro-inflammatory diets, we reported higher mean values of triglycerides (TG), fasting glucose (FG), atherogenic index of plasma (AIP), and the Castelli's risk index (CRI) in the group of men and women, and higher waist circumference (WC) and waist-to-hip ratio (WHR) in the group of women. Pro-inflammatory diets were associated with higher intake of refined grains, sweets, juices, red meat, high-fat cheese and cream, alcohol, fats except for vegetable oils, potatoes, sugar and honey, French fries, fried fish, and processed/high-fat poultry. Moreover, study participants with pro-inflammatory diets consumed more milk, low-fat dairy, and eggs associated with unhealthy dietary habits, but this should not be considered as an independent CVD risk factor. Anthropometric and biochemical outcomes were more favorable among study participants who consumed more vegetables, fruits, nuts, seeds, raisins, pulses, low-fat poultry, and tea. However, association of beverage consumption with dietary inflammatory potential requires further study.

Medical personnel, working in medical intensive care units, are exposed to fatigue associated with alarms emitted by numerous medical devices used for diagnosing, treating, and monitoring patients. Alarm fatigue is a safety and quality problem in patient care and actions should be taken to reduce this by, among other measures, building an effective safety culture. In the present study, an adaptation of a questionnaire to assess alarm fatigue was carried out. The study obtained good reliability of the questionnaire at Cronbach's alpha level of 0.88. The Polish research team has successfully adapted the Alarm Fatigue Assessment Questionnaire so that it can be used in healthcare settings as a tool to improve patient safety.

The aim of the study was to assess the relationship between the inflammatory potential of the diets of residents of Lower Silesia, based on the Dietary Inflammatory Index (DII), with the incidence of metabolic syndrome (MetS) and its components. Diets were characterized according to DII terciles. The study group consisted of 1570 individuals enrolled in the Polish arm of the Prospective Urban and Rural Epidemiological (PURE) study. Participants’ diets in DII T1 (most anti-inflammatory diet) had the highest intake of vegetables (except for potatoes), fruits, nuts and seeds, low-calorie beverages, tea, and coffee (all p < 0.001). On the other hand, participants’ diets in DII T3 (most pro-inflammatory diet) contained a lot of whole-fat products, refined cereals, fats (except for vegetable oils), fruit juices, red meat, processed meat/meat products, sugar-sweetened beverages, sweets, sugar, and honey (all p < 0.001). Overall, we did not find an increased prevalence of MetS and its individual components in DII tercile 3 (T3) compared to DII tercile 1 (T1), except for an increased prevalence of abnormal TG in DII T3 compared to T1 (OR 1.34; 95% CI = 1.01 to 1.78) in the crude model. In the adjusted model, a lower prevalence of abnormal fasting glucose (FG) was found in DII T2 compared to DII T1 (OR 0.71; 95% CI = 00.54 to 0.94). Results of this study are informative and provide an important basis for further research on the quality of diet and nutrition.

Background: Higher intake of ultra-processed foods (UPFs) has been associated with increased risk of CVD and mortality in observational studies from Western countries but data from non-Western countries are limited., Objectives: We aimed to assess the association between consumption of UPFs and risk of mortality and major CVD in a cohort from multiple world regions., Design: This analysis includes 138,076 participants without a history of CVD between the ages of 35 and 70 y living on 5 continents, with a median follow-up of 10.2 y. We used country-specific validated food-frequency questionnaires to determine individuals' food intake. We classified foods and beverages based on the NOVA classification into UPFs. The primary outcome was total mortality (CV and non-CV mortality) and secondary outcomes were incident major cardiovascular events. We calculated hazard ratios using multivariable Cox frailty models and evaluated the association of UPFs with total mortality, CV mortality, non-CV mortality, and major CVD events., Results: In this study, 9227 deaths and 7934 major cardiovascular events were recorded during the follow-up period. We found a diet high in UPFs (≥2 servings/d compared with 0 intake) was associated with higher risk of mortality (HR: 1.28; 95% CI: 1.15, 1.42; P-trend < 0.001), CV mortality (HR: 1.17; 95% CI: 0.98, 1.41; P-trend = 0.04), and non-CV mortality (HR: 1.32; 95% CI 1.17, 1.50; P-trend < 0.001). We did not find a significant association between UPF intake and risk of major CVD., Conclusions: A diet with a high intake of UPFs was associated with a higher risk of mortality in a diverse multinational study. Globally, limiting the consumption of UPFs should be encouraged., (Copyright © 2022 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Metabolic syndrome (MetS) is a complex condition encompassing a constellation of cardiometabolic abnormalities. Oxylipins are a superfamily of lipid mediators regulating many cardiometabolic functions. Plasma oxylipin signature could provide a new clinical tool to enhance the phenotyping of MetS pathophysiology. A high-throughput validated mass spectrometry method, allowing for the quantitative profiling of over 130 oxylipins, was applied to identify and validate the oxylipin signature of MetS in two independent nested case/control studies involving 476 participants. We identified an oxylipin signature of MetS (coined OxyScore), including 23 oxylipins and having high performances in classification and replicability (cross-validated AUC ROC of 89%, 95% CI: 85-93% and 78%, 95% CI: 72-85% in the Discovery and Replication studies, respectively). Correlation analysis and comparison with a classification model incorporating the MetS criteria showed that the oxylipin signature brings consistent and complementary information to the clinical criteria. Being linked with the regulation of various biological processes, the candidate oxylipins provide an integrative phenotyping of MetS regarding the activation and/or negative feedback regulation of crucial molecular pathways. This may help identify patients at higher risk of cardiometabolic diseases. The oxylipin signature of patients with metabolic syndrome enhances MetS phenotyping and may ultimately help to better stratify the risk of cardiometabolic diseases.

This study aimed to investigate the hypothesis that brain maintenance expressed in white matter hyperintensities and brain reserves, defined as gray and white matter volumes, mediate the association between cognitive reserve (CR) and cognitive performance. A cross-sectional population-based observational study was conducted, and the final study sample consisted of 763 participants (282 men and 481 women) with a mean age of 61.11 years (±9.0). Data from different categories were collected from study participants, such as demographic, lifestyle, medical, and psycho-social characteristics. All participants underwent a detailed psychometric evaluation (MoCA and DSST) followed by a brain MRI. Volumetric measurements of the total gray matter (GMvol), total white matter (WMvol), and white matter hyperintensities (WMHvol) were performed using the Computational Anatomy Toolbox 12 (CAT12) and Statistical Parametric Maps 12 (SPM12) based on 3D T1-weighted sequence. Significant direct and indirect effects of cognitive reserve on cognitive functioning were measured with both scales-the MoCA and DSST. In each mediation model, the volumes of WMH and GM were significant mediators for the association between cognitive reserve and cognitive performance. This study confirms the importance of strengthening the cognitive reserve in the course of life through potentially modifiable effects on both cognition and the brain.

Interpersonal communication plays a key role in the treatment process. It affects not only the patient's satisfaction with the course of treatment, but also allows the achievement of the best outcome in the therapeutic process. The process of patient empowerment and putting them in the role of a partner in the therapeutic process makes it possible to build a relationship based on trust, kindness and empathy. The aim of the study is to show the relationship between a patient's sense of safety and access to health information, friendly and empathetic treatment by medical staff and a relationship based on trust. The study is conducted on patients from public hospitals in Wrocław by using the author's questionnaire. One of the five most important factors according to respondents is the sense of safety, as reported by more than half of the patients (54.4%)-this is the opinion of more than half of the patients (54.4%). The respondents assessed the quality of patient care as an average of M = 41.1/50 points. There is a strong positive correlation between the sense of security and the access to information (rho = 0.642), kind treatment (rho = 0.623), trust in medical staff (rho = 0.758) and satisfaction with hospital stay (rho = 0.758).

(1) Background: This study aims to examine changes in tobacco smoking prevalence in the PURE Poland cohort study over the 9-year follow-up period. Moreover, it attempts to identify socio-demographic factors that affect changes in attitudes towards tobacco smoking. (2) Methods: The PURE Poland cohort study-baseline was performed in 2007-2010 and covered 2036 participants, including urban (59.4%) and rural (40.6%) residents of Lower Silesia, Poland. The following study reports the results of 1690 participants who took part in both the baseline (2007-2010) study and 9-year follow-up (2016-2019). (3) Results: There was a 3.5% decrease in current smokers during the analyzed period (from 20.2% at the baseline study to 16.7% in the 9-year follow-up). Living in rural area increased the likelihood of being a current smoker by more than 1.5-fold (OR = 1.65 CI = 1.26-2.14) and decreased the likelihood of being a former smoker (OR = 0.70 CI = 0.57-0.86). In the 9-year follow-up period, more women were current smokers than men (17.2% vs. 16.0%) and women had lower chances of being former smokers than men (OR = 0.77 CI = 0.62-0.95). People with a primary education had 1.5-fold higher likelihood of being a current smoker (OR = 1.45 CI = 1.03-2.05). Nearly 11% significant increase in the percentage of current smokers was observed in the oldest age group (1.9% in the baseline study vs. 12.6% in the follow-up period). (4) Conclusions: The results obtained during 9 years of observation indicate the necessity of intensifying anti-tobacco programs especially targeting women, elderly population, people with lower level of education, rural residents, and the unemployed.

The aim of the study was to estimate the content of K1, K2 (MK-n) as well as total K vitamins and their sources in the diets of 1985 PURE Poland study participants based on the FFQ questionnaire. Due to the pleiotropic effect of K vitamins, it is important to know their food sources depending on different eating habits. Total vitamin K in the diets amounted to 331.1 ± 151.5 µg/d and 358.6 ± 181.0 µg/d for men and women, respectively. Dietary patterns (DPs) were identified in the study group, and the relationship between them and vitamin K intake was assessed. The proportion of dominant products as sources of vitamin K in the fourth quartile of each of the three identified DPs did not change significantly compared to the proportion of these products as sources of vitamin K in all subjects. In the fourth quartile of individual DPs, vitamin K1 came mainly from vegetables (56.5-76.8%); K2 mainly from processed meat and high-fat cheese and cream (70.1-77.6%); and total K mainly from vegetables and processed meat (57.6-67.8%). Intakes of K vitamins were high and similar in terms of predominant vitamin K provider products, in groups of subjects whose diets were most consistent with the particular DP. In the absence of global findings on the most appropriate dietary content of MK-n vitamins other than phylloquinone, the estimated high content of these vitamins in the diets of the subjects compared with other nations suggests that their level in diets was satisfactory. Future studies should aim to determine the need for MK-n vitamins in terms of fulfilling all their functions in the body.

Introduction: Portable spirometers are commonly used in longitudinal epidemiological studies to measure and track the forced expiratory volume in first second (FEV1) and forced vital capacity (FVC). During the course of the study, it may be necessary to replace spirometers with a different model. This raise questions regarding the comparability of measurements from different devices. We examined the correlation, mean differences and agreement between two different spirometers, across diverse populations and different participant characteristics., Methods: From June 2015 to Jan 2018, a total of 4,603 adults were enrolled from 628 communities in 18 countries and 7 regions of the world. Each participant performed concurrent measurements from the MicroGP and EasyOne spirometer. Measurements were compared by the intra-class correlation coefficient (ICC) and Bland-Altman method., Results: Approximately 65% of the participants achieved clinically acceptable quality measurements. Overall correlations between paired FEV1 (ICC 0.88 [95% CI 0.87, 0.88]) and FVC (ICC 0.84 [0.83, 0.85]) were high. Mean differences between paired FEV1 (-0.038 L [-0.053, -0.023]) and FVC (0.033 L [0.012, 0.054]) were small. The 95% limits of agreement were wide but unbiased (FEV1 984, -1060; FVC 1460, -1394). Similar findings were observed across regions. The source of variation between spirometers was mainly at the participant level. Older age, higher body mass index, tobacco smoking and known COPD/asthma did not adversely impact on the inter-device variability. Furthermore, there were small and acceptable mean differences between paired FEV1 and FVC z-scores using the Global Lung Initiative normative values, suggesting minimal impact on lung function interpretation., Conclusions: In this multicenter, diverse community-based cohort study, measurements from two portable spirometers provided good correlation, small and unbiased differences between measurements. These data support their interchangeable use across diverse populations to provide accurate trends in serial lung function measurements in epidemiological studies., Competing Interests: All authors have declared that they have no competing interests., (Copyright: © 2022 Duong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study aimed to assess the predictive value of anthropometric measurements in impaired fasting glucose progression to type 2 diabetes (T2DM) after 9 years of follow-up in the Prospective Urban and Rural Epidemiology (PURE) study run in Poland. The study group consisted of 283 patients aged 54.3 ± 8.9 years who had impaired fasting glucose at baseline and completed a 9-year-long follow-up. We analyzed body weight, height, waist (WC) and hip (HC) circumferences, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body mass index (BMI), and body adiposity index (BAI). Most individuals were overweight or obese according to BMI. Obesity occurred more often in men than women. The analysis highlighted the following three anthropometric parameters WHtR, BMI, and WC, each having equally good predictive power concerning the development of full-fledged T2DM in people with impaired fasting glucose. In conclusion, we confirmed the distinct harmfulness of obesity and pointed out the potential of easy-measured anthropometric parameters to self-control the risk of passing the impaired fasting glucose into T2DM., (© 2021. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

This study aimed to evaluate the role of risk factors included in the Framingham Risk Score for hard coronary heart disease (CHD) in the development of type 2 diabetes (DM) in patients with impaired fasting glycemia (IFG) after a 9-year follow-up. The research was part of the Polish insight into the international Prospective Urban and Rural Epidemiology (PURE) study. The cohort consisted of 283 subjects aged 54.3 ± 8.9 years who were diagnosed with IFG at baseline and then completed after a 9-year follow-up. The main risk factors for both CHD and DM evaluated were smoking, arterial hypertension, abnormal lipid profile, and family medical history. Most participants had both untreated or poorly controlled hypertension and dyslipidemia. Those who developed full-fledged DM over time were older and had significantly higher levels of fasting plasma glucose, lipid parameters, and mean blood pressure records. In conclusion, we confirmed that early diagnosis of dyslipidemia and hypertension, along with the treatment optimization of these conditions, could prevent or reduce the risk of DM and adverse cardiovascular outcomes. The study highlighted a large-scale problem of the modifiable risk factors that could jeopardize the health status in patients with IFG in the long range and pointed to targeted preventive measures., (© 2022. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

(1) Background: The objective was to investigate the association between sleep duration, bedtime, and noncommunicable diseases in the PURE Poland cohort study. (2) Methods: The baseline study was conducted in 2007-2010. The study group comprised 2023 adult inhabitants of urban and rural areas in Lower Silesia, Poland. The study protocol included questionnaires, blood pressure measurements, blood draws, and anthropometric measurements. Sleep duration and bedtime were self-reported. (3) Results: The median sleep duration of women was 30 min longer than men (8 h vs. 7.5 h; p = 0.001). The average time of sleep increased along with the age of the participants. A sleep duration of >8 h was more common in rural than in urban participants (40.2% vs. 27.1%; respectively; p < 0.001). The relative risk of diabetes, stroke, hypertension, cardiovascular diseases (CVD), and obesity was significantly higher in participants who went to bed between 6 p.m. and 10 p.m. in comparison to those who went to bed between 10 p.m. and 12 a.m. (RR 2.23, 95% CI 1.06-4.67; RR 2.52, 95% CI 1.28 to 4.97; RR 1.12, 95% CI 1.04-1.20; RR 1.36; 95% CI 1.1-1.68; RR 1.38; 95% CI 1.15-1.66, respectively). The relative risk of respiratory diseases was two-fold higher in those who went to bed after midnight in comparison to those who went to bed between 10 p.m. and 12 a.m. (RR 2.24; 95% CI 1.19-4.22). (4) Conclusions: In our study, an earlier bedtime was associated with a higher risk of diabetes, stroke, obesity, hypertension, and CVD.