Health

Response to 'The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study', published in the Lancet

We conducted a retrospective study of breast feeding in the years 2005 and 2010, comparing breast feeding incidence rates by day of week of birth.

Longitudinal Trends in Hypertension Management and Mortality Among Octogenarians: Prospective Cohort Study

BACKGROUND: Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes including falls, disability and death. The underlying pathophysiological pathways of frailty are not known but the hypothalamic-pituitary-adrenal axis and heightened chronic systemic inflammation appear to be major contributors.

The rise in obesity has largely been attributed to an increase in calorie consumption. We show that official government household survey data indicate that calories have declined in England between 1980 and 2013; while there has been an increase in calories from food out at restaurants, fast food, soft drinks and confectionery, overall there has been a decrease in total calories purchased.

This paper studies the effects of a randomized intervention in rural Malawi that provided mothers of young infants with information on child nutrition. The intervention improved child nutrition, household food consumption and consequently health. We find evidence that labor supply also increased.

This paper deals with the relationship between family formation and employment in older cohorts of the English population born between 1916 and 1957. Based on retrospective life history data of the English Longitudinal Study of Ageing (ELSA) and using sequence and cluster analyses, we explore three dimensions in particular: employment, marital status, and having children, and the extent to which individuals’ life course trajectories on these three dimensions vary across cohorts, gender, and level of education. While the majority of men followed a trajectory of marriage and family formation with a (relatively) continuous career, the family-work trajectories of women varied noticeably from one cohort to the next, including increased labour market participation combined with fewer and shorter breaks from work to care for children. While the current perception is that the so-called ‘baby boomer’ generation born soon after World War Two was path-breaking in terms of life course innovations, our findings are not compatible with the assumption of a single cohort being particularly pioneering.

Authors reply: Duration of depressive symptoms significantly related to increase in mortality

Abstract OBJECTIVE: Scant evidence is available on the discordance between loneliness and social isolation among older adults. We aimed to investigate this discordance and any health implications that it may have. METHOD: Using nationally representative datasets from ageing cohorts in Ireland (TILDA) and England (ELSA), we created a metric of discordance between loneliness and social isolation, to which we refer as Social Asymmetry. This metric was the categorised difference between standardised scores on a scale of loneliness and a scale of social isolation, giving categories of: Concordantly Lonely and Isolated, Discordant: Robust to Loneliness, or Discordant: Susceptible to Loneliness. We used regression and multilevel modelling to identify potential relationships between Social Asymmetry and cognitive outcomes. RESULTS: Social Asymmetry predicted cognitive outcomes cross-sectionally and at a two-year follow-up, such that Discordant: Robust to Loneliness individuals were superior performers, but we failed to find evidence for Social Asymmetry as a predictor of cognitive trajectory over time. CONCLUSIONS: We present a new metric and preliminary evidence of a relationship with clinical outcomes. Further research validating this metric in different populations, and evaluating its relationship with other outcomes, is warranted. Copyright © 2016 John Wiley & Sons, Ltd.

Anti-smoking policies can in theory make smokers better off, by helping smokers with time-inconsistent preferences commit to giving up or reducing the amount they smoke. We use almost 20 years of British individual-level panel data to explore the impact on self-reported psychological well-being of two policy interventions: large increases in tobacco excise taxes and bans on smoking in public places. We use a difference-in-differences approach to compare the effects on well-being for likely smokers and non-smokers. We find robust evidence that increases in tobacco taxes raise the relative well-being of likely smokers. Exploiting regional variation in the timing of the smoking ban across Britain, we find no evidence that it raised smoker well-being. Our findings give some support to the view that tobacco taxes are at least partly justifiable because of the benefits they have for smokers themselves.

Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses

Trajectories of the healthy ageing phenotype among middle-aged and older Britons, 2004-2013

The impact of a cancer diagnosis on health and well-being: a prospective, population-based study

We examined the little-tested associations between general cognitive function in middle and older age and later risk of death from chronic diseases. In the English Longitudinal Study of Ageing (2002-2012), 11,391 study participants who were 50-100 years of age at study induction underwent a battery of cognitive tests and provided a range of collateral data. In an analytical sample of 9,204 people (4,982 women), there were 1,488 deaths during follow-up (mean duration, 9.0 years). When we combined scores from 4 cognition tests that represented 3 acknowledged key domains of cognitive functioning (memory, executive function, and processing speed), cognition was inversely associated with deaths from cancer (per each 1-standard-deviation decrease in general cognitive function score, hazard ratio = 1.21, 95% CI: 1.10, 1.33), cardiovascular disease (hazard ratio = 1.71, 95% CI: 1.55, 1.89), other causes (hazard ratio = 2.07, 95% CI: 1.79, 2.40), and respiratory illness (hazard ratio = 2.48, 95% CI: 2.12, 2.90). Controlling for a range of covariates, such as health behaviors and socioeconomic status, and left-censoring to explore reverse causality had very little impact on the strength of these relationships. These findings indicate that cognitive test scores can provide relatively simple indicators of the risk of death from an array of chronic diseases and that these associations appear to be independent of other commonly assessed risk factors.

BACKGROUND: Despite the importance of socioeconomic position for survival, total wealth, which is a measure of accumulation of assets over the life course, has been underinvestigated as a predictor of mortality. We investigated the association between total wealth and mortality at older ages. METHODS: We estimated Cox proportional hazards models using a sample of 10 305 community-dwelling individuals aged ≥50 years from the English Longitudinal Study of Ageing. RESULTS: 2401 deaths were observed over a mean follow-up of 9.4 years. Among participants aged 50-64 years, the fully adjusted HRs for mortality were 1.21 (95% CI 0.92 to 1.59) and 1.77 (1.35 to 2.33) for those in the intermediate and lowest wealth tertiles, respectively, compared with those in the highest wealth tertile. The respective HRs were 2.54 (1.27 to 5.09) and 3.73 (1.86 to 7.45) for cardiovascular mortality and 1.36 (0.76 to 2.42) and 2.53 (1.45 to 4.41) for other non-cancer mortality. Wealth was not associated with cancer mortality in the fully adjusted model. Similar but less strong associations were observed among participants aged ≥65 years. The use of repeated measurements of wealth and covariates brought about only minor changes, except for the association between wealth and cardiovascular mortality, which became less strong in the younger participants. Wealth explained the associations between paternal occupation at age 14 years, education, occupational class, and income and mortality. CONCLUSIONS: There are persisting wealth inequalities in mortality at older ages, which only partially are explained by established risk factors. Wealth appears to be more strongly associated with mortality than other socioeconomic position measures.