Manual Social Class Research Articles

Trajectories of social class and adult self-perceived oral health.

To determine the effect of social mobility on self-perceived oral health (SPOH) by: (i)characterizing patterns of social mobility from birth to adulthood and (ii)assessing their influence on SPOH among British adults. A secondary data analysis of the 1970 British Cohort Study. Data were collected at birth and at 5, 10, 16, 26, 30, 34, 38, 42 and 46 years of age. Social class (SC) was indicated by parental SC from birth to age 16 and own SC from ages 26 to 42. At age 46, SPOH was measured using a single question. Sex, ethnicity, country and residence area were included as potential confounders. Latent class growth analysis (LCGA) was used to identify trajectories of exposure to non-manual SC over time, instead of predetermined categories. LCGA identified four social mobility patterns: stable high, stable low, upwardly mobile and downwardly mobile; the time for the change in SC happening between 16 and 26 years. A total of 9657 participants were included. In the crude model, stable high had lower odds (OR: 0.67, 95% CI: 0.59-0.76), while downward mobility and stable low had higher odds (OR: 1.36, 95% CI: 1.15-1.61 and OR: 1.57, 95% CI: 1.40-1.77) of poor SPOH than upward mobility. These results were corroborated in the fully adjusted model; being female and living in rural areas was also associated with lower odds (OR: 0.64, 95% CI: 0.59-0.71 and OR: 0.90, 95%CI: 0.80-1.00) of poor SPOH. Social mobility significantly affects SPOH in British adults. Those in non-manual SC have better SPOH than those in manual SC. When compared to upward mobility, downwardly mobile individuals report bad SPOH more frequently, evidencing that current SC influences oral health in a slightly greater measure than early years SC.

Hospital admissions and mortality over 20 years in community-dwelling older people: findings from the Hertfordshire Cohort Study

BackgroundDemographic changes worldwide are leading to pressures on health services, with hospital admissions representing an important contributor. Here, we report admission types experienced by older people and examine baseline risk factors for subsequent admission/death, from the community-based Hertfordshire Cohort Study.Methods2997 participants (1418 women) completed a baseline questionnaire and clinic visit to characterize their health. Participants were followed up from baseline (1998–2004, aged 59–73 years) until December 2018 using UK Hospital Episode Statistics and mortality data, which report clinical outcomes using ICD-10 coding. Baseline characteristics in relation to the risk of admission/death during follow-up were examined using sex-stratified univariate logistic regression.ResultsDuring follow-up, 36% of men and 26% of women died and 93% of men and 92% of women had at least one hospital admission; 6% of men and 7% of women had no admissions and were alive at end of follow-up. The most common types of admission during follow-up were cardiovascular (ever experienced: men 71%, women 68%) and respiratory (men 40%, women 34%). In both sexes, baseline risk factors that were associated (p < 0.05) with admission/death during follow-up were older age, poorer SF-36 physical function, and poorer self-rated health. In men, manual social class and a history of smoking, and in women, higher BMI, not owning one’s home, and a minor trauma fracture since age 45, were also risk factors for admission/death.ConclusionsSociodemographic factors were related to increased risk of admission/death but a small proportion experienced no admissions during this period, suggesting that healthy ageing is achievable.

Prevalence of Undiagnosed Diabetes in 2004 and 2012: Evidence From the English Longitudinal Study of Aging

In light of recent publicity campaigns to raise awareness of diabetes, we investigated changes in the prevalence of diabetes and undiagnosed diabetes in adults age 50 and older in England between 2004 and 2012, and explored risk factors for undiagnosed diabetes. In total, 7666 and 7729 individuals were from Wave 2 (2004-2005, mean age 66.6) and Wave 6 (2012-2013, mean age 67.6) of the English Longitudinal Study of Ageing. Diagnosed diabetes was defined as either self-reported diabetes or taking diabetic medications. Undiagnosed diabetes was defined as not self-reporting diabetes and not taking diabetic medications, but having a glycated hemoglobin measurement ≥48 mmol/mol (6.5%). There were increases in both diagnosed diabetes (7.7%-11.5%) and undiagnosed diabetes (2.4%-3.4%) between 2004 and 2012. However, a small decrease in the proportion of people with diabetes who were unaware of this condition (24.5%-23.1%, p < .05) was observed. Only men aged 50-74 showed a stable prevalence of undiagnosed diabetes, with better recognition of diabetes. Age, non-white ethnicity, manual social class, higher diastolic blood pressure, and cholesterol level were factors associated with higher risks of undiagnosed diabetes, whereas greater depressive symptoms were related to lower risks. This study suggests that the greater awareness of diabetes in the population of England has not resulted in a decline in undiagnosed cases between 2004 and 2012. A greater focus on people from lower socioeconomic groups and those with cardiometabolic risk factors may help early diagnosis of diabetes for older adults.

Life-course social class is associated with later-life diabetes prevalence in women: evidence from the Irish Longitudinal Study on Ageing

This study aimed to investigate the independent and synergistic effects of childhood and adult social class, as well as the effect of social mobility, on type 2 diabetes (T2D) risk in later life. Cross-sectional data from The Irish Longitudinal Study of Ageing (TILDA) (n = 4,998), a nationally representative probability sample of adults aged 50 and older, were analysed. Prevalent diabetes was defined using subjective (self-reported doctor’s diagnosis) and objective data (medications usage and glycated haemoglobin testing). Social class was classified as a three-level variable based on fathers’ occupation in childhood and respondents’ primary occupation in adulthood. A five-level social mobility variable was created from cross-classification of childhood and adulthood social class. Logistic regression was employed to assess the relationship between social class variables and T2D. Mean (SD) age of the sample was 63.8y (9.9) and 46.4% were male. Incidence of T2D was 11.6% of men and 7.7% of women. Some 57.4% of the sample were classified as Manual social class in childhood. Compared to those in Professional/Managerial occupations, belonging to the Manual social class in childhood was associated with an increased risk of T2D in men (Odds Ratio (OR): 1.36, 95% CI: 0.88, 2.10) and women (OR: 2.16, 95% CI: 1.21, 3.85). This association was attenuated in women when controlled for adulthood social class (OR: 1.84, 95% CI: 1.00–3.37), suggesting that the effect of childhood social class may be modified by improving social circumstance over the life course.

Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland

ObjectivesTo assess the association between multiple indicators of socioeconomic position and dementia-related death, and to estimate the contribution of dementia to socioeconomic differences in overall mortality at older ages.DesignProspective population-based...

Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort

ObjectivesTo investigate whether residential area deprivation index predicts subsequent admissions to hospital and time spent in hospital independently of individual social class and lifestyle factors.DesignProspective population-based study.SettingThe European Prospective Investigation...

Maternal and Perinatal Outcomes in women with Hepatitis B Carrier State

Introduction Hepatitis B is the most common form of viral hepatitis. Much has been done for the prevention of Hepatitis B transmission from mother to child. However, there is still very limited evidence looking at maternal obstetrics and perinatal outcomes, such as gestational diabetes, antepartum haemorrhage and preterm labour, hypertensive disorders in pregnancy and small for gestational age, with Hepatitis B infected women. These adverse pregnancy outcomes, if significant, may affect future antenatal care and have a negative impact on public health. This study aims to determine the association between these adverse pregnancy and neonatal outcomes with maternal Hepatitis B carrier state. Methods This is a retrospective cohort study comparing adverse pregnancy and neonatal outcomes in primigravid women who delivered singleton babies after 24 completed weeks of gestation and are carrier for Hepatitis B virus with those who are non-carrier for Hepatitis B virus, between 1992 and 2013 in Aberdeen Maternity Hospital. The adverse pregnancy and neonatal outcomes studied include hypertensive disorders in pregnancy, antepartum haemorrhage, preterm birth &lt;37 weeks, induction of labour, caesarean delivery, low birth weight and admission to neonatal unit. Data was extracted from the Aberdeen Maternity and Neonatal Databank (AMND), which was established in 1950 to record all pregnancy-related events occurring in Aberdeen city and district in the northeast of Scotland. Statistical analysis was done with SPSS version 21 using independent samples t-test for normally distributed continuous variables and chi-squared test for categorical variables. Multivariate logistic regression analysis using a multilevel random effects regression model was also conducted to adjust for confounding factors. Results The data set contained a sample size of 35116 primigravid women with singleton pregnancies, with 59 being carrier for Hepatitis B virus (represented by positive HBsAg status). HBsAg-positive women had significantly lower mean Body Mass Index and were more likely to be from the manual social class (registrar general’s occupation-based social class). On unadjusted analysis, there were no significant differences in the prevalence of all maternal and perinatal outcomes in both groups. However, after adjusting for confounding factors, HBsAg-positive women were more likely to have smaller babies (aOR 4.28; 95% CI 1.57-11.66). Conclusion Our study suggested higher frequencies of low birth weight babies in women with hepatitis B infection. We found no statistically significant differences in other adverse pregnancy and perinatal outcomes. As current evidence still shows inconsistent results, further research evaluating the possible effects of Hepatitis B viraemia on pregnancy outcomes is justified.

Inequalities in health and health behaviours between couple and lone mothers before and during the financial crisis in Spain (2003-2012).

Lone mothers report worse health and adopt more risky health behaviours than couple mothers, as largely documented in several European countries, but not deeply in Spain. The primary aim of this study was to identify the possible existence of inequalities in health and health behaviours between couple and lone mothers in Spain by occupational social class and employment status. A second aim was to explore whether any inequalities were influenced by the economic crisis beginning in 2008, analysing changes in inequalities between 2003–2004 and 2011–2012.Two waves of the cross-sectional Spanish National Health Survey data were used. Analyses were restricted to mothers aged 16–64 years, with at least one child aged 18 years or younger. The sample consisted of 2982 mothers in 2003–2004 and 3070 in 2011–2012, representing more than 80% of couple mothers. Two health outcomes and two health behaviour measurements were used. Robust Poisson regression was run to estimate inequalities between couple and lone mothers, calculating prevalence ratios adjusted by age and stratified by social class and employment status.We found inequalities in health and health behaviours between couple and lone mothers in Spain amongst the manual social class, with lone mothers reporting a more than 30% higher prevalence of poor self-perceived health and being smoker in both time points of study compared with couple mothers. Furthermore, lone mothers were at 50% higher risk of having at least one selected chronic condition and 86% higher probability of sleeping less than 6 hours/day in 2011–2012 This study could not confirm that inequalities between couple and lone mothers changed in Spain during the study period, although some patterns were noticeable. Inequalities pointed towards an increase amongst mothers in the manual social class with paid employment, while inequalities amongst unemployed mothers (both manual and non-manual social class) pointed towards a decrease.

Exposure and health risks perception of extremely low frequency and radiofrequency electromagnetic fields and the effect of providing information

Given that regardless of actual exposure levels, high-risk perceptions of electromagnetic fields of non-ionizing radiation (EMF-NIR) may cause health effects, it is important to understand the mechanisms behind perceptions in the general population. The aims of this study were to assess perceptions of both exposure and health-risk among mothers of the INMA (Environment and childhood)-Gipuzkoa child cohort; to explore possible determinants that explain such perceptions; and to evaluate whether providing information on exposure levels has any effect on perceptions. Overall, 387 mothers completed a questionnaire composed of four questions on perceived exposure and perceived health-risk of exposure to extremely low frequency (ELF) and radiofrequency (RF) fields answered on a Likert-type scale from 0 to 10. Later, measurements of ELF and RF fields were conducted in the houses of a subsample of 104 participants. All measured levels were far below the levels established by the European Council recommendation. This was explained in the individual reports sent to the families. After reading the results, mothers completed the aforementioned questionnaire a second time, plus two additional questions regarding the role of public health bodies in risk communication.The association between perceived and measured levels as categorical variables was assessed with a chi-square test. Multiple linear regressions were conducted for each of the questions related to perceived exposure and health-risk perceptions. Wilcoxon signed-rank test was conducted to assess the effect of receiving information.Both exposure and health risk were perceived to be very high for both ELF and RF fields, with mean and medians of 7 on a 10-point scale. Reporting higher perception levels was not associated with higher levels of exposure measured at home. Variables that were repeatedly associated with higher perceptions included: manual social class, not having the feeling of living in a good neighborhood, difficulty getting by financially, not having a television antenna within 600 m, being younger and having fewer devices at home. Providing information on EMF-NIR exposure levels at home did not alter health-risk perceptions, but mean perceived RF exposure decreased significantly (by 0.7 points). Most of the participants claimed to have received no or insufficient information regarding exposure and health-risks of EMF-NIR from public bodies and considered it very important that they should.

Association of adverse childhood experiences with educational attainment and adolescent health, and the role of socioeconomic factors: analysis of a prospective cohort study

BackgroundThere is increasing policy emphasis on adverse childhood experiences (ACEs). We aimed to assess the relative contributions of these experiences and socioeconomic factors to educational attainment and health. MethodsUsing data collected between 1991 and 2014, from a UK cohort (ALSPAC), we assessed associations of having had ACEs between birth and 16 years of age (sexual, physical, emotional abuse; emotional neglect; parental substance abuse, mental illness, criminal conviction, or separation; violence between parents; and bullying) with obtaining five or more good GCSEs (grades A* to C, n=9959, assessed through linkage to the National Pupil Database) and health at age 17 (depression, obesity, harmful alcohol use, smoking, and illicit drug use, n=4917, assessed through research clinic measurements and self-completed computer questionnaires). ACEs were assessed using both prospective (reports by main caregiver at time of ACE occurrence or very soon afterwards) and retrospective (reports by 23 year old adults looking back at their childhood) questionnaires and an ACE score was calculated by summing the number of ACE an individual experienced. We adjusted for a wide range of socioeconomic and family factors. We calculated population attributable fractions (PAF) for each outcome for four or more ACEs and key socioeconomic and demographic indicators. FindingsMost participants (84%) experienced at least one adverse experience (24% ≥4). ACE score was associated with lower educational attainment and worse adolescent health. The association with educational attainment reduced by about half after adjustment for socioeconomic and family factors; associations with adolescent health also attenuated, but to a lesser degree. We assessed PAF for each outcome according to experiencing four or more ACEs (24%), low maternal education (30%), manual social class (24%), and maternal smoking during pregnancy (27%). For depression and illicit drug use, PAFs were highest for four or more ACEs (14% and 15%, respectively). For these outcomes, the PAF for maternal smoking during pregnancy was also high (both 10%). For all other outcomes, PAFs were higher for socioeconomic factors or maternal smoking than for ACEs. InterpretationA key limitation of our study is that it is restricted to families in a population-based cohort; vulnerable groups are under-represented. Nevertheless, our analysis suggests that interventions targeted at children experiencing four or more ACEs will not necessarily focus on the groups at highest risk of adverse outcomes. Our results underline the importance of the broader socioeconomic context for policies focused on ACEs. FundingSupported by a grant from the UK Economic and Social Research Council (ES/N000382/1).

Combined Impact of Smoking and Early-Life Exposures on Adult Lung Function Trajectories.

Both adverse early-life exposures and adult smoking can negatively influence adult lung function trajectory, but few studies consider how the impact of early-life exposures may be modified by subsequent smoking. The Medical Research Council National Survey of Health and Development is a nationally representative cohort, initially of 5,362 individuals, followed since enrollment at birth in March 1946. Using data collected prospectively across life and multilevel modeling, we investigated how the relationships between early-life exposures (infant lower respiratory infection, manual social class, home overcrowding, and pollution exposure) and FEV1 and FVC trajectories between ages 43 and 60-64 years were influenced by smoking behavior. Among 2,172 individuals, there were synergistic interactions of smoking with infant respiratory infection (P = 0.04) and early-life home overcrowding (P = 0.009), for FEV1 at 43 years. Within smoker-stratified models, there were FEV1 deficits among ever-smokers associated with infant lower respiratory infection (-108.2 ml; P = 0.001) and home overcrowding (-89.2 ml; P = 0.002), which were not evident among never-smokers (-15.9 ml; P = 0.69 and -13.7 ml; P = 0.70, respectively). FVC modeling, including 1,960 individuals, yielded similar results. FEV1 decline was greater in smokers (P < 0.001), but there was no effect of any early-life exposure on FEV1 decline. Neither smoking nor early-life exposures were associated with FVC decline. Besides accelerating adult FEV1 decline, cigarette smoking also modifies how early-life exposures impact on both midlife FEV1 and FVC. These findings are consistent with smoking impairing pulmonary development during adolescence or early adulthood, thereby preventing catch-up from earlier acquired deficits.

Desigualdades en la realización de mamografías y citologías cervicales en las mujeres españolas según las encuestas nacionales de salud

ObjectiveTo analyse the frequencies of mammographic screening, mammographic follow-up through a population-based screening programme, and cytological screening by autonomous community and social class in Spanish women aged 25 to 69 years. MethodsObservational study. The information source was the National Health Surveys (NHS) for 2003, 2006 and 2011. The study population consisted of women aged 25 to 69 years (N=7,844 for NHS-2003, N=12,845 for NHS-2006 and N=7,695 for NHS-2011). The dependent variables were periodic mammographic screening, periodic mammographic screening through a population-based programme, and periodic cervical screening. The independent variables were age, social class (manual/non-manual), autonomous community, the number of years since the start of the programme, and year of the NHS. Prevalence ratios with their 95% confidence intervals (95% CI) were calculated. ResultsIn 2006, participation in periodic population-based mammographic screening was 49.2% among women from a non-manual social class versus 61.5% among those from a manual social class (prevalence ratios NHS-2006: 0.81; 95% CI 0.75-0.88). In NHS-2011, participation was 53.6% among women from a non-manual social class versus 68.0% among those from a manual social class. For NHS-2003, participation in periodic cytological screening was 90.2% among women from a non-manual social class versus 86.7% among those from a manual social class (prevalence ratios NHS-2003: 1.04; 95% CI 1.01-1.06). ConclusionsNo differences were observed by social class in periodic mammographic screening. Population-based breast cancer screening programmes compensate for differences in social class in mammographic follow-up. Cytological screening was more frequent among women from a non-manual social class.

Child Maltreatment and Adult Living Standards at 50 Years.

Child maltreatment (abuse and neglect) has established effects on mental health. Less is known about its influence on adult economic circumstances. We aimed to establish associations of child maltreatment with such outcomes and explore potential pathways. We used 1958 British birth cohort data (N = 8076) to examine associations of child neglect and abuse with adult (50 years) long-term sickness absence, not in employment, education or training (NEET), lacking assets, income-related support, poor qualifications, financial insecurity, manual social class, and social mobility. We assessed mediation of associations by 16-year cognition and mental health. Abuse prevalence varied from 1% (sexual) to 10% (psychological); 16% were neglected. A total of 21% experienced 1 maltreatment type, 10% experienced ≥2 types. Sexual and nonsexual abuse were associated with several outcomes; eg, for sexual abuse, adjusted odds ratio (aOR) of income-related support was 1.75 (95% confidence interval [CI], 1.12-2.72). Associations were little affected by potential mediating factors. Neglect was associated with several adult outcomes (eg, aOR of NEET was 1.43 [95% CI, 1.10-1.85]) and associations were mediated by cognition and mental health (primarily by cognition): percent explained varied between 4% (NEET) to 70% (poor qualifications). In general, the risk of poor outcome increased by number of maltreatment types (eg, aOR for long-term sickness absence increased from 1.0 [reference] to 1.76 [95% CI, 1.32-2.35] to 2.69 [95% CI, 1.96-3.68], respectively, for 0, 1, and ≥2 types of maltreatment. Childhood maltreatment is associated with poor midadulthood socioeconomic outcomes, with accumulating risk for those experiencing multiple types of maltreatment. Cognitive ability and mental health are implicated in the pathway to outcome for neglect but not abuse.

Family socioeconomic position in early life and onset of depressive symptoms and depression: a prospective cohort study

PurposeTo investigate whether low parental socioeconomic position (SEP) at birth is associated only with early-onset depressive symptoms in offspring.MethodsThis prospective cohort study used data on 9193 individuals (4768 females, 4425 males) from the Avon Longitudinal Study of Parents and Children. Depressive symptoms during three age periods (10–12, 12–16, 16–20 years) were assessed using the Short Mood and Feelings Questionnaire, and ICD-10 depression at age 18 was assessed using the Clinical Interview Schedule-Revised.ResultsLow SEP was associated with increased incidence rates of depressive symptoms in all age periods, with indicators of low standard of living showing the strongest associations. For instance, incidence rate ratios for material hardship were 1.75 (95% CI [1.42–2.15]) at 10–12 years, 1.36 (1.16–1.61) at 12–16 years and 1.39 (1.21–1.59) at 16–20 years. Low SEP was also associated with increased odds of ICD-10 depression at 18 years, ranging from OR = 1.20 (95% CI [0.94–1.52]) for manual social class to 1.74 (1.35–2.24) for material hardship.ConclusionsThere was no evidence that depressive symptoms can be “subtyped” by the age of onset, because the association with low SEP was evident for early- and later-onset symptoms. If socioeconomic inequalities in early life have long-term adverse impacts on mental health, policies addressing these inequalities could benefit the mental health of the population.

Child maltreatment and living standards in adulthood: findings from a prospective birth cohort

BackgroundChild maltreatment (abuse and neglect) has well-established effects on mental health, but less is known about its influence on adult life economic circumstances. We aimed to establish associations of child maltreatment with such outcomes in mid-life. MethodsWe used data from the 1958 British birth cohort (n=8076) on child neglect and abuse (physical, sexual, psychological, and witnessing abuse) and adult (at age 50 years) long-term sickness absence, not in employment, education, or training (NEET), lacking assets, income-related support, poor educational qualifications, financial insecurity, manual social class, and social mobility. Logistic regression was used to assess associations with maltreatment separately and combined as a score (0, 1, ≥2) with and without adjustment for potential confounding factors (maternal age, birthweight, birth order, social class at birth, parental education, household amenities, crowding, and tenure at age 7 years). Missing values were imputed with multiple imputation chained equations. FindingsAbuse prevalence varied from 1% (n=115) for sexual abuse to 10% (776) for psychological abuse; 1208 (16%) were defined as neglected. 1506 (19%) of the population experienced one type of maltreatment, and 585 (7%) experienced two or more. All maltreatments were associated with most outcomes (eg, for physical abuse, adjusted odds ratio [OR] of long-term sickness absence was 2·33, 95% CI 1·62–3·35). There was a trend across multiple types of maltreatment and unfavourable outcomes—eg, adjusted OR for NEET increased for one and two or more maltreatments compared with no maltreatment (1·30 [1·02–1·65] and 1·72 [1·28–2·33], respectively; ptrend<0·0001). Likewise, adjusted OR for three or more unfavourable adult outcomes increased with more maltreatment compared with none (1·94 [1·59–2·37] for one and 2·23 (1·75–2·84] for two or more; ptrend<0·0001). Children who were sexually abused or neglected were less likely than those not sexually abused or neglected, respectively, to be upwardly mobile from birth to mid-adulthood (unadjusted OR 0·49 [0·30–0·81] and 0·45 [0·39–0·53]). InterpretationChild abuse was reported retrospectively in adulthood, although child neglect and potential confounding factors were ascertained prospectively and we examined a wide range of adult socioeconomic outcomes that are important because of their costs to individuals and society. That childhood maltreatments were associated with most unfavourable outcomes in mid-adulthood, has implications for the broader field of health equity. The increasing risk of poor adult outcome associated with multiple types of maltreatment suggests that they have an accumulating burden. FundingThis work was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health.

Self-Reported Sleep Duration, Napping, and Incident Heart Failure: Prospective Associations in the British Regional Heart Study.

ObjectivesTo examine the associations between self‐reported nighttime sleep duration and daytime sleep and incident heart failure (HF) in men with and without preexisting cardiovascular disease (CVD).DesignPopulation‐based prospective study.SettingGeneral practices in 24 British towns.ParticipantsMen aged 60–79 without prevalent HF followed for 9 years (N = 3,723).MeasurementsInformation on incident HF cases was obtained from primary care records. Assessment of sleep was based on self‐reported sleep duration at night and daytime napping.ResultsSelf‐reported short nighttime sleep duration and daytime sleep of longer than 1 hour were associated with preexisting CVD, breathlessness, depression, poor health, physical inactivity, and manual social class. In all men, self‐reported daytime sleep of longer than 1 hour duration was associated with significantly greater risk of HF after adjustment for potential confounders (adjusted hazard ratio (aHR) = 1.69, 95% CI = 1.06–2.71) than in those who reported no daytime napping. Self‐reported nighttime sleep duration was not associated with HF risk except in men with preexisting CVD (<6 hours: aHR = 2.91, 95% CI = 1.31–6.45; 6 hours: aHR = 1.89, 95% CI = 0.89–4.03; 8 hours: aHR = 1.29, 95% CI = 0.61–2.71; ≥9 hours: aHR = 1.80, 905% CI = 0.71–4.61 vs nighttime sleep of 7 hours). Snoring was not associated with HF risk.ConclusionSelf‐reported daytime napping of longer than 1 hour is associated with greater risk of HF in older men. Self‐reported short sleep (<6 hours) in men with CVD is associated with particularly high risk of developing HF.

Predicting admissions and time spent in hospital over a decade in a population-based record linkage study: the EPIC-Norfolk cohort

ObjectiveTo quantify hospital use in a general population over 10 years follow-up and to examine related factors in a general population-based cohort.DesignA prospective population-based study of men and women.SettingNorfolk, UK.Participants11...

Social class based on occupation is associated with hospitalization for A(H1N1)pdm09 infection. Comparison between hospitalized and ambulatory cases.

This study aimed to analyse the existence of an association between social class (categorized by type of occupation) and the occurrence of A(H1N1)pmd09 infection and hospitalization for two seasons (2009-2010 and 2010-2011). This multicentre study compared ambulatory A(H1N1)pmd09 confirmed cases with ambulatory controls to measure risk of infection, and with hospitalized A(H1N1)pmd09 confirmed cases to asses hospitalization risk. Study variables were: age, marital status, tobacco and alcohol use, pregnancy, chronic obstructive pulmonary disease, chronic respiratory failure, cardiovascular disease, diabetes, chronic liver disease, body mass index >40, systemic corticosteroid treatment and influenza vaccination status. Occupation was registered literally and coded into manual and non-manual worker occupational social class groups. A conditional logistic regression analysis was performed. There were 720 hospitalized cases, 996 ambulatory cases and 1062 ambulatory controls included in the study. No relationship between occupational social class and A(H1N1)pmd09 infection was found [adjusted odds ratio (aOR) 0·97, 95% confidence interval (CI) 0·74-1·27], but an association (aOR 1·53, 95% CI 1·01-2·31) between occupational class and hospitalization for A(H1N1)pmd09 was observed. Influenza vaccination was a protective factor for A(H1N1)pmd09 infection (aOR 0·41, 95% CI 0·23-0·73) but not for hospitalization. We conclude that manual workers have the highest risk of hospitalization when infected by influenza than other occupations but they do not have a different probability of being infected by influenza.

Diet quality in older age: the influence of childhood and adult socio-economic circumstances.

Socio-economic gradients in diet quality are well established. However, the influence of material socio-economic conditions particularly in childhood, and the use of multiple disaggregated socio-economic measures on diet quality have been little studied in the elderly. In the present study, we examined childhood and adult socio-economic measures, and social relationships, as determinants of diet quality cross-sectionally in 4252 older British men (aged 60-79 years). A FFQ provided data on daily fruit and vegetable consumption and the Elderly Dietary Index (EDI), with higher scores indicating better diet quality. Adult and childhood socio-economic measures included occupation/father's occupation, education and household amenities, which combined to create composite scores. Social relationships included social contact, living arrangements and marital status. Both childhood and adult socio-economic factors were independently associated with diet quality. Compared with non-manual social class, men of childhood manual social class were less likely to consume fruit and vegetables daily (OR 0.80, 95% CI 0.66, 0.97), as were men of adult manual social class (OR 0.65, 95% CI 0.54, 0.79), and less likely to be in the top EDI quartile (OR 0.73, 95% CI 0.61, 0.88), similar to men of adult manual social class (OR 0.66, 95 % CI 0.55, 0.79). Diet quality decreased with increasing adverse adult socio-economic scores; however, the association with adverse childhood socio-economic scores diminished with adult social class adjustment. A combined adverse childhood and adulthood socio-economic score was associated with poor diet quality. Diet quality was most favourable in married men and those not living alone, but was not associated with social contact. Diet quality in older men is influenced by childhood and adulthood socio-economic factors, marital status and living arrangements.

Intergenerational mobility and adult oral health in a British cohort.

This study aimed to characterize trajectories of intergeneration mobility from birth to age 33 years and to assess the influence of these trajectories on adult oral health. Repeated data on occupational social class (birth and 7, 11, 16, 23 and 33 years) and two subjective oral health indicators (lifetime and past-year prevalence of persistent trouble with gums or mouth) measured at age 33 years, from the 1958 National Child Development Study, were used for this analysis. Latent class growth analysis (LCGA) was used to identify different trajectories of exposure to manual social class over time. Binary logistic regression was then used to explore the association between these trajectories and each oral health indicator, adjusting for participants' sex. Latent class growth analysis showed that a four trajectory model provided the best fit to the data. The four trajectories that emerged were identified as stable manual, stable nonmanual, late steep increase (those who were likely to be in the manual social class until age 16 years but ended up in the nonmanual social class afterwards) and steady increase (those whose likelihood of leaving the manual social class increased gradually over time). Lifetime and past-year prevalence of persistent trouble with gums or mouth was significantly higher in the stable manual trajectory than in all other trajectories. No differences were found between the stable nonmanual, late steep increase and steady increase trajectories. Although four distinctive trajectories were identified in the 1958 NCDS, only those who remained in the manual social class over time reported worse oral health by age 33 years. Proximal socioeconomic experiences may be more relevant to adult oral health than early life experiences.