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Challenging times ahead for the NHS regardless of who wins the election

Comment

The Conservative, Labour and Liberal Democrat manifestos all contained commitments to increase NHS spending over the next parliament. In this observation we set out what these commitments are likely to mean for the path of health spending in England going forwards, and put this in the context of the pressures faced by the health service from an ageing population. All three parties are proposing real increases in health spending over the next parliament, but at a rate well below the long run historical average. The next parliament will therefore continue to be an incredibly challenging period for the NHS, regardless of who wins the election. In the long run the NHS would be better served by a serious attempt to address long run funding pressures in a coherent and systematic fashion, than by the government just announcing further short term funding fixes.

30 May 2017

Journal graphic

Socioeconomic position and mortality risk of smoking: evidence from the English Longitudinal Study of Ageing (ELSA).

Journal article

Background: It is not clear whether the harm associated with smoking differs by socioeconomic status. This study tests the hypothesis that smoking confers a greater mortality risk for individuals in low socioeconomic groups, using a cohort of 18 479 adults drawn from the English Longitudinal Study of Ageing. Additive hazards models were used to estimate the absolute smoking-related risk of death due to lung cancer or Chronic Obstructive Pulmonary Disease (COPD). Smoking was measured using a continuous index that incorporated the duration of smoking, intensity of smoking and the time since cessation. Attributable death rates were reported for different levels of education, occupational class, income and wealth. Smoking was associated with higher absolute mortality risk in lower socioeconomic groups for all four socioeconomic indicators. For example, smoking 20 cigarettes per day for 40 years was associated with 898 (95% CI 738, 1058) deaths due to lung cancer or COPD per 100 000 person-years among participants in the bottom income tertile, compared to 327 (95% CI 209, 445) among participants in the top tertile. Smoking is associated with greater absolute mortality risk for individuals in lower socioeconomic groups. This suggests greater public health benefits of smoking prevention or cessation in these groups.

7 May 2017

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English Longitudinal Study of Aging (ELSA). In: Nancy A Pachana (ed.). Encyclopedia of Geropsychology. Springer, Singapore.

Book Chapter
Abstract: Definition The English Longitudinal Study of Ageing (ELSA) [1] is a multidisciplinary panel study that collects a comprehensive array of measures on a representative sample of men and woman aged 50 and over who are living in England. Repeated measures covering health, economics, psychology, lifestyle and social connections are collected from the same individuals over time, allowing researchers to study the dynamics of the ageing process. The ELSA sample and study design ELSA is sampled from the Health Survey for England (HSE), a large annual cross-sectional survey on the health of the population of England [2]. Sample members recruited at wave 1 (2002/2003) were individuals who had previously taken part in one of three years of the HSE (1998, 1999 and 2001), and were aged 50 or over at the time of the wave 1 interview. Subsequent ELSA data collection waves have taken place biennially, in 2004/05 (Wave 2), 2006/07 (Wave 3), 2008/09 (Wave 4), 2010/11 (Wave 5), 2012/13 (Wave 6) and 2014/15 (Wave 7). The eighth and ninth waves of data collection are planned for 2016/17 and 2018/2019, respectively. New study participants are recruited during some waves in order to compensate for the ageing sample population and to refresh the younger age groups. This serves to maintain representation of all ages 50 and over in ELSA. Refreshment sampling to date has recruited members aged 50-52 at wave 3 (HSE 2001-04); aged 50-74 at wave 4 (HSE 2006), aged 50-55 at wave 6 (HSE 2009 -11) and aged 50-51 at Wave 7 (HSE 2011-12), with plans to continue to recruit new sample members aged 50-51 at future waves. The “core members” of the ELSA sample are individuals aged 50 and over, living in private residences, who were recruited through HSE at either the first Wave of ELSA or at any of the subsequent refreshment samples. The data also includes interviews with “young partners”, who are individuals under the age of 50 whose partners are core members and “new partners” in the correct age range who entered relationships with core members after those members were recruited to ELSA. Mode of interview Data are collected from respondents in their own home, every two years and by means of a computer assisted personal interview (CAPI) that is delivered by a trained interviewer. The CAPI includes questions on the respondents’ demographics, household membership, work and retirement activities, economic circumstances, health and behaviour. A self-completion questionnaire includes questions on wellbeing, social participation, quality of life and social networks, along with questions considered to be sensitive. The main interview takes approximately 85 minutes to complete for an individual interview and around two hours when two people within the same household are interviewed concurrently. At waves 2, 4 and 6, core members who completed a main interview were offered a visit from a qualified nurse, where a blood sample was taken and a series of performance and biomedical tests were conducted. The nurse visits took place soon after the main interviews and were of similar duration to the main interviews.

1 May 2017

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Positive and Negative Experiences of Social Support and Risk of Dementia in Later Life: An Investigation Using the English Longitudinal Study of Ageing

Journal article

BACKGROUND: Having a network of close relationships may reduce the risk of developing dementia. However, social exchange theory suggests that social interaction entails both rewards and costs. The effects of quality of close social relationships in later life on the risk of developing dementia are not well understood.

25 April 2017

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Social capital, deprivation and self-rated health: does reporting heterogeneity play a role? Results from the English Longitudinal Study of Ageing.

Journal article

Self-rated health (SRH) is commonly assessed in large surveys, though responses can be influenced by different individuals' perceptions of and beliefs about health. Therefore, instead of providing evidence of 'true' health disparities across groups, findings may actually reflect reporting heterogeneity. Using data from participants aged 50 years and older from the English Longitudinal Study of Ageing (ELSA) Wave 3 (2006/07; participation rate = 73%), associations between three dimensions of social capital (local area & trust, social support and social networks), deprivation and SRH were examined using the vignette methodology in 2341 individuals who completed both the self-report and at least one of the 18 vignettes. Analysis employed a hierarchical probit model (HOPIT). Individuals expressing low local area & trust social capital (beta = -0.276, p < 0.001) and those with poor social networks (beta = -0.280, p < 0.001) were more likely to report poor SRH in HOPIT models accounting for reporting heterogeneity, but unadjusted ordered probit analyses still correctly show a negative relationship between low local area & trust social capital (beta = -0.243, p < 0.001) and those with poor social networks (beta = -0.210, p < 0.01), though they somewhat tend to underestimate its strength. Neither social support nor deprivation appeared to have any effect on SRH regardless of reporting heterogeneity. Anchoring vignettes offer a relatively uncomplicated and cost-effective way of identifying and correcting for reporting heterogeneity to improve comparative validity of self-report measures of health. This analysis underlines the need for caution when using unadjusted self-reported measures to study the effects of social capital on health.

12 April 2017

Publication graphic

The effects of banning advertising in junk food markets

Report

There have been calls for restrictions on junk food advertising to tackle rising rates of obesity around the world. This column examines the likely effect of a ban on potato crisp advertising. Results suggest that the total quantity of crisps sold would fall by around 15% in the presence of a ban, or by 10% if firms respond with price cuts. The welfare benefits from this would depend on whether current advertising is persuasive, informative or complementary.

31 March 2017