Antonia C Hardcastle

The Effects of Flavonoids on Bone

Osteoporosis and fragility fractures are a growing problem for our aging population with around 1 in 2 women and 1 in 5 men suffering from an osteoporotic fracture during their lifetime. Although there are established factors that can reduce the risk of fracture such as maintaining physical activity, ceasing smoking, and adequate vitamin D status, and intakes of calcium; dietary mechanisms are less well established. The relevance of the flavonoid group of bioactive compounds found in fruits and vegetables has been less investigated. Two human epidemiologic studies in women found positive associations between total dietary flavonoid intake and bone mineral density. Flavonoids may protect against bone loss by upregulating signaling pathways that promote osteoblast function, by reducing the effects of oxidative stress or chronic low-grade inflammation. The limitations of the existing research are explored in the manuscript and it is concluded that further research is needed, in this promising area.

Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study

Objective We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment. Design The English Longitudinal Study of Ageing, a panel study of 12 765 participants aged 50 years and older in four waves from 2004 to 2011, selected using a stratified random sample of households in England. Distribution of illness burden, diagnosis and treatment by wealth was estimated using regression analysis. Outcome measures The main outcome measures were ORs for the illness burden, diagnosis and treatment, respectively, adjusted for age, sex and wealth. We estimated the illness burden for angina with the Rose Angina scale, diabetes with fasting glycosylated haemoglobin, depression with the Centre for Epidemiologic Studies Depression Scale, osteoarthritis with self-reported pain and disability and cataract with self-reported poor vision. Medical diagnoses were self-reported for all conditions. Treatment was defined as β-blocker prescription for angina, surgery for osteoarthritis and cataract, and receipt of predefined effective interventions for diabetes and depression. Results Compared with the wealthiest, the least wealthy participant had substantially higher odds for illness burden from any of the five conditions at all four time points, with ORs ranging from 4.2 (95% CI 2.6 to 6.8) for diabetes to 15.1 (11.4 to 20.0) for osteoarthritis. The ORs for diagnosis and treatment were smaller in all five conditions, and ranged from 0.9 (0.5 to 1.4) for diabetes treatment to 4.5 (3.3 to 6.0) for angina diagnosis. Conclusions The substantially higher illness burden in less wealthy participants was not matched by appropriately higher levels of diagnosis and treatment.

OP32 Symptoms, Diagnosis and Treatment in Socio-Economic Inequalities of Health

Background Ill health and relative poverty are connected. This study aimed to determine first whether the worse health experienced by poorer participants was matched by appropriately greater receipt of healthcare, and second whether any inequalities in receipt occurred at the stage of diagnosis or treatment. Methods The English Longitudinal Study of Ageing is a cohort of participants aged 50 years or older. The relative distributions by wealth of symptoms, diagnosis and treatment of five common chronic conditions (angina, diabetes, depression, osteoarthritis, and cataract) were analysed in four waves of data collected from 2002 to 2010. Symptoms were defined for angina using the Rose Angina scale, diabetes using fasting HbA1c level, depression using the Centre for Epidemiologic Studies Depression Scale, osteoarthritis as self-reported pain and disability, and cataract as self-reported poor vision. Doctors’ diagnoses for all conditions were self-reported. Treatment was defined for angina as beta-blocker prescription, osteoarthritis and cataract as surgery, and diabetes and depression as receiving treatment described in quality indicators. Binomial regression models tested variations between the hypothetically poorest and richest individuals for age and sex adjusted symptoms, diagnosis and treatment across the waves, using a slope index of inequality. Results Symptoms were commoner in poorer participants in all 5 conditions at all 4 timepoints, with ORs ranging from 2.5 to 7.0. In angina, depression and diabetes, receipt of diagnosis and treatment was similarly higher in poorer participants, with ORs ranging from 1.9 to 5.6. In osteoarthritis and cataract, receipt of diagnosis and treatment did not show substantial matching variations by wealth, with ORs ranging from 0.8 to 1.9. For example, ORs for diabetes in 2008 were broadly similar for symptoms (2.5 [95% CI 1.5, 4.0], diagnosis (3.8 [3.0, 4.9]) and treatment (3.1 [2.4, 4.0]). In contrast, osteoarthritis ORs were substantially larger for symptoms (6.9 [5.2, 9.1]) than for diagnosis (1.4 [1.2, 1.7]) or treatment (0.8 [0.5, 1.3]). Conclusion Poorer participants were much more likely to have symptoms of osteoarthritis and cataract, but not much more likely to receive a diagnosis. The block in equitable receipt of healthcare was at the stage of diagnosis rather than treatment, and so interventions to reduce inequalities in osteoarthritis and cataract should focus on the diagnostic process. The same relative inequalities in diagnosis were not seen in angina, depression and diabetes, which have all been the target of multiple quality improvement initiatives. These patterns remained consistent over 8 years.