Limiting Longstanding Illness Research Articles

Cardiorespiratory Fitness And Incident Use Of Sedative-hypnotics: A Longitudinal Population-based Study

PURPOSE: Population-based and clinical studies suggest that higher cardiorespiratory fitness (CRF) is associated with better mental health and less sleep complaints. However, in these studies mental health and sleep are assessed through questionnaires. The increased use of sedatives and hypnotics coupled with their known adverse health associations raises potential public health concerns. So far no studies have assessed if CRF is associated with incident use of sedative-hypnotics in the general population. METHODS: This prospective study included 30,481 participants (52.2% women, mean age 51.0 years) from the third survey of the Norwegian Nord-Trøndelag Health Study in 2006-08. Data on psychotropic drugs were retrieved from the Norwegian Prescription Database and incident sedative-hypnotics was measured as first registered prescription with code N05C in the Anatomical Therapeutic Chemical Classification System. Participants using any psychotropic drugs three months prior to participation and three months after participation were excluded. The participants were followed from three months after participation until incident use of sedative-hypnotics, emigration, death or study end 1st of January 2018. Baseline CRF (ml/kg/min) was determined using non-exercise algorithms based on sex, age, waist circumference, physical activity, and resting heart rate (eCRF). Baseline eCRF was further grouped into age- and sex-specific tertiles. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between baseline eCRF and incident use of sedative-hypnotics. The multivariable analyses were adjusted for age, sex, education, symptoms of anxiety and depression, limiting-longstanding illness, and sleep problems. RESULTS: During follow-up, 4,632 (15.2 %) of the participants used sedative-hypnotics. In fully adjusted models comparing with the lowest tertile of eCRF, those in the middle and upper eCRF tertiles had 8% (HR: 0.92, 95% CI: 0.84-1.00) and 24% (HR: 0.86, 95% CI: 0.77, 0.62-0.94) lower risk of incident use of sedative-hypnotics. CONCLUSION: Higher CRF is associated with less prescribed sedative-hypnotics in the general population. This effect seems to be more pronounced for those with highest CRF. Characters no space (max 2000): 1967.

Inequalities in employment rates among older men and women in Canada, Denmark, Sweden and the UK

BackgroundIn most developed countries, governments are implementing policies encouraging older persons to work past 65 years to reduce the burden on societies related to disability benefits and pension payments. Despite this push to extend working lives, we know little about who already works past this age and any inequalities that may exist. Our study investigates the employment rates of those aged 65–75 years of age by educational level, health status and sex in Canada (CAN), Denmark (DK), Sweden (SE) and the United Kingdom (UK). Secondly, we aim to relate findings on employment rates to prevailing policies in the different countries, to increase the understanding on how to further extend working lives.MethodsWe used nationally representative cross-sectional survey data from the 2012–2013 Canadian Community Health Survey, 2013/14 Survey of Health, Ageing and Retirement in Europe for Denmark and Sweden and the 2013 English Longitudinal Study of Ageing to examine employment rates for those aged 65–75 years by sex, educational level and health status (having limiting longstanding illness (LLI) or not).ResultsEmployment rates decline by age, but we see a linear decline in CAN and the UK compared to an initial decline then a plateau of employment rates from 66 to 68 years in DK and SE. Employment rates among persons aged 65–75 years were lower in the UK than in CAN, DK and SE. Among women, employment rates were highest in SE. Women with low education and a LLI had considerably lower employment rates than men with low education and a LLI (employment rates for men ranged from 27% to 12% compared with employment rates for women which ranged from 12% to 0%).ConclusionsOur results suggest that educational level, sex and health all play a role in extending working lives. The variation in employment rates between the four countries implies that policies do matter, but that social differentials show that policies cannot be ‘one size fits all’. Policy-makers must consider different groups (i.e. low-educated women with a LLI) when designing policies to extend working lives.

Effect of pro-social behaviour and conduct problems on the relationship between limiting longstanding illness and negative emotional symptoms in children

PurposeThe purpose of this paper is to explore direct and moderating effects of pro-social behaviour and conduct problems on the link between limiting longstanding illness (LL-I) and negative emotional symptoms in children.Design/methodology/approachThe Welsh Health Survey variables: LL-I, emotional symptoms, conduct problems, pro-social behaviour, gender, age and socio-economic status were entered into regression models to assess the relationships outlined above. Cross-sectional data from several years were combined.FindingsIn the cohort of 627 children aged 4–12 years who had LL-I, 601 (95.9 per cent) had complete data for analysis. Children with LL-I scored a mean of 1.8 points higher on negative emotional symptoms than children without LL-I, with LL-I accounting for 6 per cent of the variance in emotional symptoms in a regression model. In children with LL-I, highly pro-social children had lower levels of negative emotional symptoms compared to those with low pro-social levels (1.1 points on emotional symptoms scale, 95% CI=0.55–1.70;p<0.001). In children with LL-I, high levels of conduct problems were associated with increased negative emotional symptoms compared to those with low levels of conduct disorder (2.1 points on emotional symptoms scale, 95% CI=1.3–2.5;p<0.001).Research limitations/implicationsPotential improvements include a longitudinal design, and use of multi-informant Strengths and Difficulties Questionnaire scores.Practical implicationsAssessment of children with LL-I could usefully include pro-social behaviours.Social implicationsNational policy could consider the value of promoting pro-social responses.Originality/valueEmotional symptoms in children with LL-I are associated with pro-social behaviour and conduct problems, primarily as a direct effect. Pro-social interventions could promote emotional wellbeing in children with LL-I.

Ageing, health inequalities and the welfare state: A multilevel analysis

Comparative studies of health inequalities have largely neglected age and ageing aspects, while ageing research has often paid little attention to questions of social inequalities. This article investigates cross-country differences in gradients in self-rated health and limiting long-standing illness (LLSI) in middle-aged and in older people (aged 50–64 and 65–80 years) linked to social class, and degrees to which the social health gradients are associated with minimum pension levels and expenditure on elderly care. For these purposes, data from the European Social Survey (2002–2010) are analysed using multilevel regression techniques. We find significant cross-level interaction effects between class and welfare policies: higher expenditure on elderly care and particularly more generous minimum pensions are associated with smaller health inequalities in the older age group (65–80 years). It is concluded that welfare policies moderate the association between social class and health, highlighting the importance of welfare state efforts for older persons, who are strongly reliant on the welfare state and welfare state arrangements such as pensions and care policies.

Have health inequalities changed during childhood in the New Labour generation? Findings from the UK Millennium Cohort Study

ObjectivesTo examine how population-level socioeconomic health inequalities developed during childhood, for children born at the turn of the 21st century and who grew up with major initiatives to tackle health...

Are housing tenure and car access still associated with health? A repeat cross-sectional study of UK adults over a 13-year period

BackgroundIt is usually assumed that housing tenure and car access are associated with health simply because they are acting as markers for social class or income and wealth. However, previous...

Material deprivation and health: a longitudinal study.

BackgroundDoes material deprivation affect the consequences of ill health? Answering this question requires that we move beyond the effects of income. Longitudinal data on material deprivation, longstanding illness and limiting longstanding illness enables investigations of the effects of material deprivation on risk of limiting longstanding illness. This study investigates whether a shift from affording to not affording a car predicts the probability of limiting longstanding ill (LLSI).MethodsThe 2008–2011 longitudinal panel of Statistics on Income, Social Inclusion and Living Conditions (EU-SILC) is utilised. Longitudinal fixed effects logit models are applied, using LLSI as dependent variable. Transition from affording a car to not affording a car is used as a proxy for material deprivation. All models are controlled for whether the person becomes longstanding ill (LSI) as well as other time-variant covariates that could affect the results.ResultsThe analysis shows a statistically significant increased odds ratio of LLSI when individuals no longer can afford a car, after controlling for confounders and LSI in the previous year (1.129, CI = 1.022–1.248). However, when restricting the sample to observations where respondents report longstanding illness the results are no longer significant (1.032, CI = 0.910–1.171).ConclusionThe results indicate an individual level effect of material deprivation on LLSI, suggesting that material resources can affect the consequences of ill health.

Worsening of health and a cessation or reduction in alcohol consumption to special occasion drinking across three decades of the life course.

BackgroundEx-drinkers suffer from worse health than drinkers; however, whether a worsening of health is associated with a change in drinking status from early adulthood has not been previously investigated. We assess whether a worsening of health is associated with a cessation in consumption or reduction to special occasion drinking from early adulthood to middle age.MethodsMultinomial logistic regression assessing whether a change in self-reported limiting longstanding illness (LLI) was associated with ceasing alcohol consumption, or a reduction to special occasion drinking compared with being a persistent drinker from age 23 in separate models at ages 33, 42, and 50. All models adjusted for sex, poor psychosocial health, education, marital status, and children in the household. Sample included participants from Great Britain followed longitudinally in the National Child Development Study from ages 23 to 33 (N = 5,529), 42 (N = 4,787), and 50 (N = 4,476).ResultsDeveloping an LLI from the previous wave was associated with ceasing alcohol consumption at ages 33 (odds ratio [ORs] = 2.71, 95% confidence interval [CI] = 1.16–4.93), 42 (OR = 2.44, 95%CI = 1.24–4.81), and 50 (OR = 3.33, 95%CI = 1.56–7.12) and a reduction to special occasion drinking at ages 42 (OR = 2.04, 95%CI = 1.40–2.99) and 50 (OR = 2.04, 95%CI = 1.18–3.53). Having a persistent LLI across 2 waves increased the odds of ceasing consumption at ages 42 (OR = 3.22, 95%CI = 1.06–9.77) and 50 (OR = 4.03, 95%CI = 1.72–9.44) and reducing consumption to special occasion drinking at ages 33 (OR = 3.27, 95%CI = 1.34–8.01) and 42 (OR = 2.25, 95%CI = 1.23–4.50). Persistent drinkers at older ages had the best overall health suffering less from previous poor health compared with those who reduced or ceased consumption at an earlier time point.ConclusionsDeveloping an LLI was associated with a cessation in alcohol consumption and a reduction in consumption to special occasion drinking from early adulthood. Persistent drinkers who drank at least till 50 were the healthiest overall. Health selection is likely to influence nondrinking across the life course.

Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England

BackgroundThe objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health...

Increasing health inequalities between women in and out of work--the impact of recession or policy change? A repeated cross-sectional study in Stockholm county, 2006 and 2010.

IntroductionThe social insurance system in Sweden underwent extensive change between 2006 and 2010, with the overall aim of making people enter the labour market. At the same time, economic recession hit Sweden. Previous studies suggest that the economic recession particularly affected women. In light of these changes, the aim of this study is to investigate whether health inequalities between employed women and groups outside the labour market changed between 2006 and 2010. A second aim is to examine the explanatory weight of socio-demographic factors vs social and economic conditions.MethodsData consists of the Stockholm Public Health Surveys (SPHS) for 2006 and 2010. Women aged 18–64 were studied. Through logistic regression, levels of mental distress and limiting longstanding illness (LLI), were compared between four labour market groups; employed and unemployed, sickness absentees and disability pension recipients, at the two time points.ResultsMental distress increased among women in all four labour market groups between 2006 and 2010. Differences in mental distress between those employed and groups outside the labour market also increased. These were explained primarily by social and economic conditions. Levels of LLI were unchanged except among the unemployed. The difference in LLI between the unemployed and the employed was mostly explained by social and economic conditions. In the other groups socio-demographic factors were more salient. For both health outcomes, the weight of social and economic conditions had increased in 2010 compared to 2006.ConclusionsResults indicate that levels of mental distress increased in all groups, but more so among groups outside the labour market, possibly due to stricter eligibility criteria and lower benefit levels, which particularly affected their social and economic conditions.

Association between limiting longstanding illness in mothers and their children: findings from the UK Millennium Cohort Study

ObjectiveTo explore the association between maternal disability as measured by the presence of a limiting longstanding illness (LLI) 9 months postpartum and subsequent child health at the age of 7...

Persistent long-standing illness and non-drinking over time, implications for the use of lifetime abstainers as a control group

BackgroundNon-drinkers are shown to have worse health than moderate drinkers in later life. We examine the preceding health status of non-drinkers in early adulthood, and secondly whether persistent poor health...

Trends in poverty risks among people with and without limiting-longstanding illness by employment status in Sweden, Denmark, and the United Kingdom during the current economic recession – a comparative study

BackgroundPrevious studies have found higher employment rates and lower risk of relative poverty among people with chronic illness in the Nordic countries than in the rest of Europe. However, Nordic countries have not been immune to the general rise in poverty in many welfare states in recent decades. This study analysed the trends in poverty risks among a particularly vulnerable group in the labour market: people with limiting-longstanding illness (LLSI), examining the experience of those with and without employment, and compared to healthy people in employment in Sweden, Denmark and the United Kingdom.MethodsCross-sectional survey data from EU-SILC (European Union Statistics on Income and Living Conditions) on people aged 25–64 years in Sweden, Denmark and the United Kingdom (UK) were analysed between 2005 and 2010. Age-standardised rates of poverty risks (<60% of national median equalised disposable income) were calculated. Odds ratios (ORs) of poverty risks were estimated using logistic regression.ResultsIn all three countries, non-employed people with LLSI had considerably higher prevalence of poverty risk than employed people with or without LLSI. Rates of poverty risk in the UK for non-employed people with LLSI were higher than in Sweden and Denmark. Over time, the rates of poverty risk for Swedish non-employed people with LLSI in 2005 (13.8% CI=9.7-17.8) had almost doubled by 2010 (26.5% CI=19.9-33.1). For both sexes, the inequalities in poverty risks between non-employed people with LLSI and healthy employed people were much higher in the UK than in Sweden and Denmark. Over time, however, the odds of poverty risk among British non-employed men and women with LLSI compared with their healthy employed counterparts declined. The opposite trend was seen for Swedish men: the odds of poverty risk for non-employed men with LLSI compared with healthy employed men increased from OR 2.8 (CIs=1.6-4.7) in 2005 to OR 5.3 (CIs=3.2-8.9) in 2010.ConclusionsThe increasing poverty risks among the non-employed people with LLSI in Sweden over time are of concern from a health equity perspective. The role of recent Swedish social policy changes should be further investigated.

Increasing poverty risks among non-employed people with limiting-longstanding illness in Sweden

Background Previous studies have found higher employment rates and lower risk of relative poverty among people with chronic illness in the Nordic countries than in the rest of Europe. However, Nordic countries have not been immune to the general rise in poverty in many welfare states in recent decades. This study analysed the trends in poverty risks among a particularly vulnerable group in the labour market: people with limiting-longstanding illness (LLSI), examining the experience …

Cross-national differences in the gender gap in subjective health in Europe: Does country-level gender equality matter?

Multiple studies have found that women report being in worse health despite living longer. Gender gaps vary cross-nationally, but relatively little is known about the causes of comparative differences. Existing literature is inconclusive as to whether gender gaps in health are smaller in more gender equal societies. We analyze gender gaps in self-rated health (SRH) and limiting longstanding illness (LLI) with five waves of European Social Survey data for 191,104 respondents from 28 countries. We use means, odds ratios, logistic regressions, and multilevel random slopes logistic regressions. Gender gaps in subjective health vary visibly across Europe. In many countries (especially in Eastern and Southern Europe), women report distinctly worse health, while in others (such as Estonia, Finland, and Great Britain) there are small or no differences. Logistic regressions ran separately for each country revealed that individual-level socioeconomic and demographic variables explain a majority of these gaps in some countries, but contribute little to their understanding in most countries. In yet other countries, men had worse health when these variables were controlled for. Cross-national variation in the gender gaps exists after accounting for individual-level factors. Against expectations, the remaining gaps are not systematically related to societal-level gender inequality in the multilevel analyses. Our findings stress persistent cross-national variability in gender gaps in health and call for further analysis.

Prevalence and impact of disability in women who had recently given birth in the UK

BackgroundMaternity services should take into account the needs of all women, including those related to disability. No reliable information, however, exists on the extent and characteristics of disability in this population in the UK. This brief report provides an overview of the prevalence of disability in women giving birth in the UK as measured by the presence of a limiting longstanding illness (LLI). The demographic, socio-economic, lifestyle and pregnancy related characteristics and child health outcomes are summarised to inform maternity and postnatal care service planning, and policy development.MethodsSecondary analysis of data on 18,231 mother-child pairs from the nationally representative UK Millennium Cohort Study. The baseline interviews with families were carried out in 2001-2002. The LLI prevalence in women who had recently delivered was estimated, and relevant characteristics and differences in outcomes compared using descriptive statistics taking into account the study design and non-response.Results9.4% (95% CI 8.7-10.0) of women who had recently given birth reported having an LLI. Musculoskeletal, respiratory and mental disorders accounted for most of the health problems. A significantly higher proportion of women with an LLI received means-tested financial benefits, had no educational qualifications and suffered from intimate partner violence compared to women who did not have an LLI (49.3% vs 35.3%, 20.4% vs 15.0%, 6.0% vs 3.3%, respectively). They were also more likely to smoke throughout pregnancy than women without an LLI (29.2% vs 20.8%), have a preterm birth (10.9% vs 6.8%) and be lone parents (19.5% vs 13.9%). Only 25.6% of children of mothers with an LLI were breastfed for more than three months compared to 33.4% of infants of mothers who did not have an LLI. At the age of seven years, 12.0% of children of mothers with an LLI had an activity limiting health problem themselves compared to 6.2% of children of mothers without an LLI.ConclusionsDisability in women who had recently delivered is relatively common. It is associated with social and economic inequalities and worse pregnancy and child related outcomes. Apart from condition-specific support during and after pregnancy, disabled women may require extra help from health professionals to quit smoking, continue breastfeeding, and reduce intimate partner violence.

Social Inequalities in “Sickness”: Does Welfare State Regime Type Make a Difference? A Multilevel Analysis of Men and Women in 26 European Countries

In comparative studies of health inequalities, public health researchers have usually studied only disease and illness. Recent studies have also examined the sickness dimension of health, that is, the extent to which ill health is accompanied by joblessness, and how this association varies by education within different welfare contexts. This research has used either a limited number of countries or quantitative welfare state measures in studies of many countries. In this study, the authors expand on this knowledge by investigating whether a regime approach to the welfare state produces consistent results. They analyze data from the European Union Statistics on Income and Living Conditions (EU-SILC); health was measured by limiting longstanding illness (LLSI). Results show that for both men and women reporting LLSI in combination with low educational level, the probabilities of non-employment were particularly high in the Anglo-Saxon and Eastern welfare regimes, and lowest in the Scandinavian regime. For men, absolute and relative social inequalities in sickness were lowest in the Southern regime; for women, inequalities were lowest in the Scandinavian regime. The authors conclude that the Scandinavian welfare regime is more able than other regimes to protect against non-employment in the face of illness, especially for individuals with low educational level.

Disability‐free life expectancy: comparison of sources and small area estimates in England, 2006–08

Health expectancies (HEs) at sub-national geographies or by clusters of areas defined by relative deprivation are important tools to monitor inequalities in health. Previously, analyses have had limited usefulness due to a lack of timeliness or local relevance caused by limitations on the frequency or coverage of survey data. Here we explore the potential of the Annual Population Survey (APS) to provide robust estimates of disability-free life expectancy (DFLE) for men and women by clusters of area deprivation, English regions and local authority districts (LAs) in the period 2006-08. DFLE estimates for the UK were compared using the prevalence of limiting long-standing illness (LLSI) calculated using data from the APS and from the General Lifestyle Survey (GLF) covering Great Britain and equivalent data from the Continuous Household Survey (CHS) covering Northern Ireland, aggregated over the period 2006-08. The further use of APS data for England enabled the calculation of estimates of DFLE at age 16 and at age 65 for men and women by area deprivation quintiles (each quintile comprises a fifth of areas ranked according to their relative deprivation), English regions and LAs in order to measure inequality in DFLE between these population groupings. The prevalence of LLSI and estimates of DFLE at national level were broadly comparable using APS and GLF/CHS data. Substantial inequality in DFLE was present between clusters of areas defined by relative deprivation and between English regions and LAs. The scale of inequality increased markedly with each finer geographical scale analysed. The APS is a viable data source to provide LLSI data for use in DFLE estimation across a range of areas and clusters of area deprivation. While increasingly fine-grained analysis decreases statistical precision, it is possible to detect clear differences between areas within regions and in making comparisons with the England average. The estimates presented here provide scope to set benchmarks for assessing the impact of interventions designed to reduce inequality in DFLE beyond the period 2006-08.

Subjective social status and health in young people

Health inequalities according to objective socioeconomic position (SEP), have been well-documented. Yet, in young people the associations are negligible. Recently, research on the association of subjective social status (SSS), and adult health has begun to accumulate. Studies on young people are rare and describe societies with large income inequalities. Here, we investigated the association between SSS and health, while controlling for own and familial SEP. The study population consisted of 15-year-olds (N = 2369) who have grown up in a context of low social inequalities. Data were derived from surveys carried out in 2004 in 29 secondary schools in Helsinki. The SSS was measured with an indicator specific to and validated for adolescents (a societal ladder). Outcome measures were self-rated health, health complaints, presence of limiting longstanding illness (LLI) and GHQ-12 caseness (indicating psychiatric morbidity). The SSS associated strongly with all health measures. Adjusting for objective socioeconomic measures attenuated the associations; although they all remained statistically significant apart from LLI among girls. The subjective assessment contributes to health inequalities in young people largely independent of objective SEP. Subjective ratings most probably capture aspects of social hierarchy that are more subtle and less well represented than in conventional measures.

P58 The death of social fragmentation: a secondary analysis of health survey data

BackgroundSocial Fragmentation is the idea that isolation and disorganisation within an area influences individual health. Some, but not all, studies have shown it to be related to suicide and parasuicide...