Health Survey For England Research Articles

Inequality of opportunity in health: A decomposition-based approach.

This paper presents new decomposition-based approaches to measure inequality of opportunity in health that capture Roemer's distinction between circumstances and effort and are consistent with both compensation and reward principles. Our approach is fully nonparametric in the way that it handles differences in circumstances and provides decompositions of both a rank-dependent relative (the Gini coefficient) and a rank-independent absolute inequality index (the variance). The decompositions distinguish the contribution of effort from the direct and indirect (through effort) contribution of circumstances to the total inequality. Our approach is illustrated by an empirical application that uses objectively measured biomarkers as health outcomes and as proxies for relevant effort variables. Using data from the Health Survey for England from 2003 to 2012, we find that circumstances are the leading determinant of inequality in cholesterol, glycated haemoglobin, and in a combined ill-health index whereas effort plays a substantial role in explaining inequality in fibrinogen only.

Targeted lung cancer screening selects individuals at high risk of cardiovascular disease

BackgroundCardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention. MethodsThe Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55–74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score. ResultsSeventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 ± 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9–29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6–16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3–14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention. DiscussionOpportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.

Normalization of Plus Size and the Danger of Unseen Overweight and Obesity in England

ObjectiveThis study aimed to investigate trends and sociodemographic factors underlying weight misperception in adults with overweight and obesity in England.MethodsThis study used descriptive and logistic regression analyses based on a pooled nationally representative cross‐sectional survey, Health Survey for England, for the years 1997, 1998, 2002, 2014, and 2015 of individuals with BMI ≥ 25 (n = 23,459). The main outcomes were (1) weight misperception and (2) weight‐loss attempts as well as the associations with demographic and socioeconomic characteristics and health status.ResultsThe proportion of individuals with overweight and obesity misperceiving their weight status increased over time between 1997 and 2015 (37% to 40% in men; 17% to 19% in women). There were socioeconomic disparities in the misperception of weight status, with lower‐educated individuals from poorer‐income households and members of minority ethnic groups being more likely to underestimate their weight. Those underestimating their overweight and obesity status were 85% less likely to try to lose weight compared with people who accurately identified their weight status.ConclusionsThe upward trend in underassessment of overweight and obesity status in England is possibly a result of the normalization of overweight and obesity. Obesity prevention programs need to consider differential sociodemographic characteristics associated with underassessment of weight status.

PRM66 - Synthetic Sample Generation Representing the English Population Using Spearman Rank Correlation and Chomsky Decomposition

To generate a synthetic sample of 1 million individuals that reflect the characteristics of the population recorded in the Health Survey for England (HSE). We used data from the HSE to determine the age and gender-dependent distributions of continuous variable risk factors (height, weight, BMI, systolic blood pressure, total and HDL cholesterol and their ratio, number of cigarettes/day and units of alcohol/week) and prevalence of binary risk factors (smoking status, diabetes). Spearman rank correlations including age and gender were determined for these risk factors. A table of normally distributed random numbers was generated. Cholesky decomposition was used to replicate the observed Spearman rank correlations in the table of random numbers. Rank correlations that included binary variables were recalibrated to adjust for numerous tied values. The sample was then generated using a reverse look-up of the gamma distribution value using the random percentiles for continuous variables or setting a binary variable to 1 when the random percentile falls below the prevalence threshold. Differences between coefficients were no more than 0.5% for any continuous variable. The prevalence of binary factors in the SS was very well matched with the HSE sample. Smoker incidence rates were 18.8% and 16.7% in the SS versus 18.4% and 16.5% in the HSE sample, for males and females respectively. Prevalence of diabetes in the SS was 13.3% and 7.7% versus 13.2% and 7.8%, and for cardiovascular disease was 17.6% and 14.1% versus 18.2% and 14.6%. Comparing 25th, 50th and 75th quantiles, the maximum difference between the original and synthetic values for BMI and TC/HDL ratio were 0.6Kg and 0.3 respectively. Our new approach generates large synthetic samples with risk factor distributions very closely matching those of the real HSE population. This sample can be used to model the likely impact of new therapies or predict mortality.

The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study.

BackgroundThe National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation.Methods and findingsWe developed a microsimulation model to estimate the health benefits (incident ischaemic heart disease, stroke, dementia, and lung cancer) of the NHS Health Check programme in England. We simulated a population of adults in England aged 40–45 years and followed until age 100 years, using data from the Health Survey of England (2009–2012) and the English Longitudinal Study of Aging (1998–2012), to simulate changes in risk factors for simulated individuals over time. We used recent programme data to describe uptake of NHS Health Checks and of 4 associated interventions (statin medication, antihypertensive medication, smoking cessation, and weight management). Estimates of treatment efficacy and adherence were based on trial data. We estimated the benefits of the current NHS Health Check programme compared to a healthcare system without systematic health checks. This counterfactual scenario models the detection and treatment of risk factors that occur within ‘routine’ primary care. We also explored the impact of making feasible changes to implementation of the programme concerning eligibility, uptake of NHS Health Checks, and uptake of treatments offered through the programme. We estimate that the NHS Health Check programme prevents 390 (95% credible interval 290 to 500) premature deaths before 80 years of age and results in an additional 1,370 (95% credible interval 1,100 to 1,690) people being free of disease (ischaemic heart disease, stroke, dementia, and lung cancer) at age 80 years per million people aged 40–45 years at baseline. Over the life of the cohort (i.e., followed from 40–45 years to 100 years), the changes result in an additional 10,000 (95% credible interval 8,200 to 13,000) quality-adjusted life years (QALYs) and an additional 9,000 (6,900 to 11,300) years of life. This equates to approximately 300 fewer premature deaths and 1,000 more people living free of these diseases each year in England. We estimate that the current programme is increasing QALYs by 3.8 days (95% credible interval 3.0–4.7) per head of population and increasing survival by 3.3 days (2.5–4.1) per head of population over the 60 years of follow-up. The current programme has a greater absolute impact on health for those living in the most deprived areas compared to those living in the least deprived areas (4.4 [2.7–6.5] days of additional quality-adjusted life per head of population versus 2.8 [1.7–4.0] days; 5.1 [3.4–7.1] additional days lived per head of population versus 3.3 [2.1–4.5] days). Making feasible changes to the delivery of the existing programme could result in a sizable increase in the benefit. For example, a strategy that combines extending eligibility to those with preexisting hypertension, extending the upper age of eligibility to 79 years, increasing uptake of health checks by 30%, and increasing treatment rates 2.5-fold amongst eligible patients (i.e., ‘maximum potential’ scenario) results in at least a 3-fold increase in benefits compared to the current programme (1,360 premature deaths versus 390; 5,100 people free of 1 of the 4 diseases versus 1,370; 37,000 additional QALYs versus 10,000; 33,000 additional years of life versus 9,000). Ensuring those who are assessed and eligible for statins receive statins is a particularly important strategy to increase benefits. Estimates of overall benefit are based on current incidence and management, and future declines in disease incidence or improvements in treatment could alter the actual benefits observed in the long run. We have focused on the cardiovascular element of the NHS Health Check programme. Some important noncardiovascular health outcomes (e.g., chronic obstructive pulmonary disease [COPD] prevention from smoking cessation and cancer prevention from weight loss) and other parts of the programme (e.g., brief interventions to reduce harmful alcohol consumption) have not been modelled.ConclusionsOur model indicates that the current NHS Health Check programme is contributing to improvements in health and reducing health inequalities. Feasible changes in the organisation of the programme could result in more than a 3-fold increase in health benefits.

The Importance of Vigorous-Intensity Leisure-Time Physical Activity in Reducing Cardiovascular Disease Mortality Risk in the Obese

ObjectiveTo investigate the role of vigorous-intensity leisure-time physical activity in reducing cardiovascular disease (CVD) mortality risk in the obese. Participants and MethodsTrained interviewers assessed physical activity and body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) in 59,005 adult participants (mean ± SD age, 57±12 years; 46.5% male) in 2 household-based surveillance studies: Health Survey for England and Scottish Health Survey. Mortality was ascertained from death certificates. Data were collected from January 1, 1994, through March 31, 2011. Cox proportional hazards models were adjusted for age, sex, smoking habit, total physical activity, long-standing illness, prevalent CVD, and occupation. ResultsThere were 2302 CVD deaths during 532,251 person-years of follow-up (mean ± SD, 9±4 years). A total of 15,002 (25%) participants were categorized as obese (BMI ≥30). Leisure-time physical activity was inversely associated and BMI was positively associated with CVD mortality. Compared with those who reported meeting physical activity guidelines including some vigorous-intensity physical activity and who had a normal BMI (18.5-24.9) (reference group), the CVD mortality hazard ratio was not significantly different in the obese who also reported meeting physical activity guidelines including some vigorous-intensity physical activities (1.25; 95% CI, 0.50-3.12). Compared with the reference group, the CVD mortality hazard ratio was more than 2-fold in the obese who reported meeting physical activity guidelines, including only moderate-intensity physical activities (2.52; 95% CI, 1.15-2.53). ConclusionThis large, statistically powerful study suggests that vigorous-intensity leisure-time physical activity is important in reducing CVD mortality risk in the obese.

High-Density Lipoprotein Cholesterol and Mortality: Too Much of a Good Thing?

The objective of this study was to examine the shape of the association between high-density lipoprotein cholesterol (HDL-C) and mortality in a large general population sample. Adult participants (n=37 059; age=57.7±11.9 years; 46.8% men) were recruited from general population household-based surveys (Health Survey for England and Scottish Health Survey). Individual participant data were linked with the British National Health Service Central Registry to record mortality. There were 2250 deaths from all causes during 326 016 person-years of follow-up. When compared with the reference category (HDL-C=1.5-1.99 mmol/L), a U-shaped association was apparent for all-cause mortality, with elevated risk in participants with the lowest (hazard ratio=1.23; 95% confidence interval, 1.06, 1.44) and highest (1.25; 0.97, 1.62) HDL-C concentration. Associations for cardiovascular disease were linear, and elevated risk was observed in those with the lowest HDL-C concentration (1.49; 1.15, 1.94). A U-shaped association was observed between HDL-C and mortality in a large general population sample.

Associations of total and type-specific physical activity with mortality in chronic obstructive pulmonary disease: a population-based cohort study

BackgroundRegular physical activity is recommended for all people with chronic obstructive pulmonary disease (COPD), but the dose of physical activity required to gain mortality benefit in this population is not yet known. This aim of this study was to examine the associations of total and type-specific physical activity with mortality risk in people with COPD.MethodsPeople with COPD aged ≥40 years were identified from the 1997 Health Survey for England and the 1998 and 2003 Scottish Health Survey cohorts. Self-reported total physical activity, moderate-vigorous intensity physical activity (MVPA), walking, domestic physical activity, and sport/exercise were assessed at baseline. Cox proportional hazards models were used to examine the associations between physical activity and mortality risk.ResultsTwo thousand three hundred ninety-eight participants with COPD were included in the analysis and followed up for a mean 8.5 (SD 3.9) years. For both total physical activity and MVPA, we observed dose-response associations with all-cause and cardiovascular disease (CVD) mortality risk, and with respiratory mortality risk to a lesser extent. Compared to those who reported no physical activity, participants who met the physical activity guidelines demonstrated the greatest reductions in all-cause (HR 0.56, 95% CI 0.45–0.69), CVD (HR 0.48, 95% CI 0.32–0.71) and respiratory mortality risk (HR 0.40, 95% CI 0.24–0.67). Participants who reported a level of physical activity of at least half the dosage recommended by the guidelines also had a reduced risk of all-cause (HR 0.75, 95% CI 0.56–1.00) and CVD mortality (HR 0.48, 95% CI 0.26–0.88). Dose-response associations with mortality risk were demonstrated for walking and sport/exercise, but not domestic physical activity.ConclusionsWe found a dose-response association between physical activity and all-cause and CVD mortality risk in people with COPD, with protective effects appearing at levels considerably lower than the general physical activity recommendations. People with COPD may benefit from engagement in low levels of physical activity, particularly walking and structured exercise.

Obesity prevalence among healthcare professionals in England: a cross-sectional study using the Health Survey for England

ObjectiveTo estimate obesity prevalence among healthcare professionals in England and compare prevalence with those working outside of the health services.DesignCross-sectional study based on data from 5 years (2008–2012) of the...

Recruitment and Ongoing Engagement in a UK Smartphone Study Examining the Association Between Weather and Pain: Cohort Study.

BackgroundThe huge increase in smartphone use heralds an enormous opportunity for epidemiology research, but there is limited evidence regarding long-term engagement and attrition in mobile health (mHealth) studies.ObjectiveThe objective of this study was to examine how representative the Cloudy with a Chance of Pain study population is of wider chronic-pain populations and to explore patterns of engagement among participants during the first 6 months of the study.MethodsParticipants in the United Kingdom who had chronic pain (≥3 months) and enrolled between January 20, 2016 and January 29, 2016 were eligible if they were aged ≥17 years and used the study app to report any of 10 pain-related symptoms during the study period. Participant characteristics were compared with data from the Health Survey for England (HSE) 2011. Distinct clusters of engagement over time were determined using first-order hidden Markov models, and participant characteristics were compared between the clusters.ResultsCompared with the data from the HSE, our sample comprised a higher proportion of women (80.51%, 5129/6370 vs 55.61%, 4782/8599) and fewer persons at the extremes of age (16-34 and 75+). Four clusters of engagement were identified: high (13.60%, 865/6370), moderate (21.76%, 1384/6370), low (39.35%, 2503/6370), and tourists (25.44%, 1618/6370), between which median days of data entry ranged from 1 (interquartile range; IQR: 1-1; tourist) to 149 (124-163; high). Those in the high-engagement cluster were typically older, whereas those in the tourist cluster were mostly male. Few other differences distinguished the clusters.ConclusionsCloudy with a Chance of Pain demonstrates a rapid and successful recruitment of a large, representative, and engaged sample of people with chronic pain and provides strong evidence to suggest that smartphones could provide a viable alternative to traditional data collection methods.

Does Strength-Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis of Data on 11 Population Cohorts With All-Cause, Cancer, and Cardiovascular Mortality Endpoints.

Public health guidance includes recommendations to engage in strength-promoting exercise (SPE), but there is little evidence on its links with mortality. Using data from the Health Survey for England and the Scottish Health Survey from 1994-2008, we examined the associations between SPE (gym-based and own-body-weight strength activities) and all-cause, cancer, and cardiovascular disease mortality. Multivariable-adjusted Cox regression was used to examine the associations between SPE (any, low-/high-volume, and adherence to the SPE guideline (≥2 sessions/week)) and mortality. The core sample comprised 80,306 adults aged ≥30 years, corresponding to 5,763 any-cause deaths (736,463 person-years). Following exclusions for prevalent disease/events occurring in the first 24 months, participation in any SPE was favorably associated with all-cause (hazard ratio (HR) = 0.77, 95% confidence interval (CI): 0.69, 0.87) and cancer (HR = 0.69, 95% CI: 0.56, 0.86) mortality. Adhering only to the SPE guideline was associated with all-cause (HR = 0.79, 95% CI: 0.66, 0.94) and cancer (HR = 0.66, 95% CI: 0.48, 0.92) mortality; adhering only to the aerobic activity guideline (equivalent to 150 minutes/week of moderate-intensity activity) was associated with all-cause (HR = 0.84, 95% CI: 0.78, 0.90) and cardiovascular disease (HR = 0.78, 95% CI: 0.68, 0.90) mortality. Adherence to both guidelines was associated with all-cause (HR = 0.71, 95% CI: 0.57, 0.87) and cancer (HR = 0.70, 95% CI: 0.50, 0.98) mortality. Our results support promoting adherence to the strength exercise guidelines over and above the generic physical activity targets.

Detection And Management Of Diabetes In England: Results From The Health Survey For England

As part of a control strategy current guidance in the UK recommends more intense surveillance of HbA1C levels among those of South-east Asian or Chinese ethnicity above specified BMI thresholds. The objective of this study was to determine whether disparities in the identification and control of diabetes in England persisted despite these guidelines and assess current strategies in light of these findings. Data were extracted from the 2013 Health Survey for England that included ethnicity, BMI status and HbA1C levels. Descriptive statistics and logistic regression analyses were used to examine relationships among undetected diabetes, poorly controlled diabetes and a range of covariates including ethnicity and BMI. Concentration indices were used to examine the socio-economic gradient in disease detection and control among and between ethnic groups. In regression models that controlled for a range of covariates Asians were found to have a 5% point higher risk of undetected diabetes than Whites. With respect to disease management, Bangladeshis and Pakistanis were found to be at a 28% point and 21% point higher risk of poor disease control respectively than Whites. Concentration indices revealed better disease control among more affluent Whites than poor Whites, no significant pattern between income and disease management was found among Pakistanis and poorer disease control was more evident among more affluent than poorer Bangladeshis. In the UK current guidance recommends practitioners consider testing for diabetes among South-east Asians and Chinese where BMI exceeds 23. Our findings suggest that the risk experienced by Asians in disease detection is independent of BMI and may warrant a more active screening policy than currently recommended. With respect to disease management, our findings suggest that Indians and Pakistanis experience particularly high levels of poor disease control that may also be usefully reflected in guidance.

Investigating the relationship between smoking and subjective welfare

Using data from the Health Survey for England, we examine the effect of smoking behavior and smoking addiction (considering the frequency and intensity of smoking) on happiness and depression, two well-known measures of subjective wellbeing. We find that smoking and smoking addiction are associated with lower levels of happiness and higher levels of depression. This finding is robust to alternative ways of measuring smoking behavior, as well as to the methodological approach to estimation that addresses endogeneity. Specifically, comparing the Ordinary Least Squares (OLS) results with the two-stage least square (2SLS) results, we find that although the OLS results overstate the effects of smoking status and addiction on wellbeing, the emerging conclusion of a negative effect of smoking behavior is still valid in the case of 2SLS.

Alcohol and depression: Evidence from the 2014 health survey for England

BackgroundA relatively large body of literature examines the association between depression and alcohol consumption, with evidence suggesting a bidirectional causal relationship. However, the endogeneity arising from this reverse causation has not been addressed in the literature. MethodsUsing data on 5828 respondents from the Health Survey for England (HSE), this study revisits the relationship between alcohol and depression and addresses the endogenous nature of this relationship. We use information on self-assessed depression, and control for endogeneity using the Lewbel two-staged least square (2SLS) estimation technique. ResultsWe find that drinking alcohol promotes depression, and this is consistent across several measures of drinking behaviour including the amount of alcohol consumed, consumption intensity, alcohol dependence and risk of dependence. ConclusionWhile drinking may be generally accepted and in the case of England, part of the culture, this has costs in terms of both physical and mental health that ought not to be ignored. While public policy has predominantly focused on the physical aspects of excessive alcohol consumption it is possible that these policies will also have a direct positive spillover in terms of the mental health costs, through the impact of lower alcohol consumption on quality of life and wellbeing.

Estimating the variation in need for community-based social care by body mass index in England and associated cost: population-based cross-sectional study

BackgroundAdult obesity is linked to a greater need for social care because of its association with the development of long term conditions and because obese adults can have physical and social difficulties which inhibit daily living. Obesity thus has considerable social care cost implications but the magnitude of these costs is currently unknown. This paper outlines an approach to estimating obesity-related social care costs in adults aged over 65 in England.MethodsWe used univariable and multivariable logistic regression models to investigate the relation between the self-reported need for social care and potential determinants, including body mass index (BMI), using data from Health Survey for England. We combined these modelled estimates of need for social care with the mean hours of help received, conditional on receiving any help, to calculate the expected hours of social care received per adult by BMI.ResultsBMI is positively associated with self-reported need for social care. A one unit (ie 1 kg/m2) increase in BMI is on average associated with a 5% increase in the odds of need for help with social care (odds ratio 1.05, 95% CI 1.04 to 1.07) in an unadjusted model. Adjusting for long term illness and sociodemographic characteristics we estimate the annual cost of local authority funded care for those who receive it is £599 at a BMI of 23 but £1086 at a BMI of 40.ConclusionBMI is positively associated with self-reported need for social care after adjustment for sociodemographic factors and limiting long term illness. The increase in need for care with BMI gives rise to additional costs in social care provision which should be borne in mind when calculating the cost-effectiveness of interventions aimed at reducing obesity.

Weekend warrior physical activity pattern and common mental disorder: a population wide study of 108,011 British adults

BackgroundThe dose-response association between physical activity (PA) and mental health is poorly described. We explored cross-sectional associations between physical activity and common mental disorder (psychological distress) in ‘weekend warriors’ who do all their exercise in one or two sessions per week.MethodsAdult participants (n = 108,011, age = 47 ± 17 yrs., 46.5% men) were recruited from general population household-based surveys (Health Survey for England and Scottish Health Survey) from 1994 to 2004. Data were pooled and analyzed using logistic regression models. Moderate to vigorous physical activity (MVPA) was self-reported and psychological distress was measured using the 12 item General Health Questionnaire (GHQ-12).ResultsPsychological distress (GHQ-12 > 3) was prevalent in 14.5% of the sample. In healthy participants an inverse association between PA and psychological distress was optimal at the PA guideline (150 mins/wk. MVPA or 75 min/wk. Vigorous PA) regardless of whether it was accumulated in one or two bouts per week “Weekend warrior” (odd ratio = 0.68, 95% CI, 0.63, 0.73) or as more frequent daily bouts (odd ratio = 0.68, 95% CI, 0.64, 0.72) in comparison to the inactive reference group. In participants with chronic health conditions an inverse association between PA and psychological distress was also evident at lower doses (one or two sessions of PA a week below PA guideline) (OR = 0.72, 95% CI, 0.68, 0.77). Undertaking vigorous intensity PA as part of the PA guideline conferred additional benefit in women (odds ratio = 0.87, 95% CI, 0.75, 1.00), but not men.ConclusionMental health benefits may be accrued through different PA patterns, thus individual approaches to prescribing exercise should be promoted.

FORECASTING DEMENTIA CASES AND PREVALENCE: TAKING CURRENT RISK FACTOR PREVALENCE TRENDS INTO ACCOUNT

Dementia prevalence in the UK has been reported to be decreasing but this is not the case worldwide. The burden of dementia in the UK has still been forecasted to increase in the future, making it a top priority. As there is currently no cure for dementia, it will be important to prevent dementia through modifiable risk factors. The aim is to see whether the reported change in prevalence could be due to changes in risk factors and also which risk factors, with interventions, could prevent the most dementia cases in the future. Data from the second Cognitive Function and Ageing Study (CFAS II), Health Survey for England (HSE), Office for National Statistics and comprehensive systematic reviews have been collated to forecast dementia prevalence and dementia cases from 2011 to 2030. The model combined future population estimates, current age and gender specific dementia prevalence, risk associated with dementia and the changing prevalence of risk factors. The trends for midlife obesity and stroke were found to increase prevalence of dementia and dementia cases above that of population ageing alone. Education was the only protective factor for dementia and could greatly attenuate future cases of dementia. Although midlife hypertension, midlife physical inactivity and smoking are associated with increased risk of dementia, the rate that the prevalence of these risk factors is decreasing by could make up for the increase in risk. The outlook is optimistic if trends in education, midlife physical inactivity, midlife hypertension and smoking continue but further decreases in the latter three of these risk factors and the prevention of midlife obesity and stroke could further help decrease expected dementia cases in the future.

Ventilatory function as a predictor of mortality in lifelong non-smokers: evidence from large British cohort studies

BackgroundReduced ventilatory function is an established predictor of all-cause mortality in general population cohorts. We sought to verify this in lifelong non-smokers, among whom confounding by active smoking can be...

The association between leisure-time physical activity, low HDL-cholesterol and mortality in a pooled analysis of nine population-based cohorts

The objective of this study was to investigate associations between leisure-time physical activity, low high-density lipoprotein cholesterol (HDL-C) and mortality. Self-reported leisure-time physical activity, HDL-C concentration, and mortality were assessed in 37,059 adults in Health Survey for England and Scottish Health Survey. Meeting physical activity guidelines was defined as ≥150 min wk−1 of moderate-intensity activity, ≥75 min wk−1 of vigorous-intensity activity, or equivalent combinations. Low HDL-C was defined as <1.03 mmol L−1. Cox proportional hazard models were adjusted for age, sex, smoking, total cholesterol, systolic blood pressure, body mass index, longstanding illness, and socioeconomic status. There were 2250 deaths during 326,016 person-years of follow-up. Compared with those who met physical activity guidelines and whose HDL-C was normal (reference group), all-cause mortality risk was not elevated in those who met physical activity guidelines and whose HDL-C concentration was low (hazard ratio: 1.07; 95% confidence interval: 0.75, 1.53). Compared with the reference group, all-cause mortality risk was elevated in those who did not meet physical activity guidelines and whose HDL-C was normal (1.37; 1.16, 1.61), and in those who did not meet physical activity guidelines and whose HDL-C was low (1.65; 1.37, 1.98). Cardiovascular disease mortality hazard ratios were similar, although confidence intervals were wider. There was no statistically significant evidence of biological interaction between physical inactivity and low HDL-C. This novel study supports the notion that leisure-time physical activity be recommended in those with low HDL-C concentration who may be resistant to the HDL-raising effect of exercise training.

Body-weight and psychological well-being in the UK general population.

While the consequences of body weight for physical health are well explored, the evidence for psychological well-being is less straightforward. An instrumental variable approach is used to address the endogenous relationship between body weight and well-being in the UK general population. Data from the Health Survey for England (2003, 2004 and 2006) are used to fit linear and ordered probit instrument variable models for a sample of 13 862 individuals, with frequent white meat consumption instrumenting for body-weight. Non-linearities in the relationship, robustness to weak instruments and relaxation of strict exogeneity assumption are further examined. Accounting for endogeneity and conditional on health a protective effect on well-being is observed. A unit increase in body mass index (BMI) improves General Health Questionnaire (GHQ) by 0.17 (95% CI: 0.02-0.31) points and reduces the probability of reporting very low GHQ by 2.5% (95% CI: 0.01-0.05). Empirical testing showed that the instrument performs well, with increased meat consumption adding 0.58 points (95% CI: 0.42-0.74) to ones' BMI. We present support for the jolly-fat hypothesis, however, caution is recommended in drawing inferences. Further research needs to resolve the mixed findings in the literature.