Ao Papacosta

Evidence of an accelerating increase in prevalence of diagnosed Type 2 diabetes in British men, 1978-2005

Background  The prevalence of Type 2 diabetes is increasing worldwide; predictions suggest that the disease will reach epidemic proportions this century. This study aims to estimate the extent of the increase in prevalence of diagnosed Type 2 diabetes in British men between 1978 and 2005.

The influence of neighbourhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men

Background Evidence from longitudinal studies on the influence of neighbourhood socioeconomic factors in older age on cardiovascular disease (CVD) mortality is limited. We aimed to investigate the prospective association of neighbourhood-level deprivation in later life with CVD mortality, and assess the underlying role of established cardiovascular risk factors. Methods A socially representative cohort of 3924 men, aged 60–79 years in 1998–2000, from 24 British towns, was followed up until 2012 for CVD mortality. Quintiles of the national Index of Multiple Deprivation (IMD), a composite score of neighbourhood-level factors (including income, employment, education, housing and living environment) were used. Multilevel logistic regression with discrete-time models (stratifying follow-up time into months) were used. Results Over 12 years, 1545 deaths occurred, including 580 from CVD. The risk of CVD mortality showed a graded increase from IMD quintile 1 (least deprived) to 5 (most deprived). Compared to quintile 1, the age-adjusted odds of CVD mortality in quintile 5 were 1.71 (95% CI 1.32 to 2.21), and 1.62 (95% CI 1.23 to 2.13) on further adjustment for individual social class, which was attenuated slightly to 1.44 (95% CI 1.09 to 1.89), but remained statistically significant after adjustment for smoking, body mass index, physical activity and use of alcohol. Further adjustment for blood pressure, high-density lipoprotein cholesterol and prevalent diabetes made little difference. Conclusions Neighbourhood-level deprivation was associated with an increased risk of CVD mortality in older people independent of individual-level social class and cardiovascular risk factors. The role of other specific neighbourhood-level factors merits further research.

Burden of poor oral health in older age: findings from a population-based study of older British men

Objectives Evidence of the extent of poor oral health in the older UK adult population is limited. We describe the prevalence of oral health conditions, using objective clinical and subjective measures, in a population-based study of older men. Design Cross-sectional study. Setting and participants A representative sample of men aged 71–92 years in 2010–2012 from the British Regional Heart Study, initially recruited in 1978–1980 from general practices across Britain. Physical examination among 1660 men included the number of teeth, and periodontal disease in index teeth in each sextant (loss of attachment, periodontal pocket, gingival bleeding). Postal questionnaires (completed by 2147 men including all participants who were clinically examined) included self-rated oral health, oral impacts on daily life and current perception of dry mouth experience. Results Among 1660 men clinically examined, 338 (20%) were edentulous and a further 728 (43%) had <21 teeth. For periodontal disease, 233 (19%) had loss of attachment (>5.5 mm) affecting 1–20% of sites while 303 (24%) had >20% sites affected. The prevalence of gingival bleeding was 16%. Among 2147 men who returned postal questionnaires, 35% reported fair/poor oral health; 11% reported difficulty eating due to oral health problems. 31% reported 1–2 symptoms of dry mouth and 20% reported 3–5 symptoms of dry mouth. The prevalence of edentulism, loss of attachment, or fair/poor self-rated oral health was greater in those from manual social class. Conclusions These findings highlight the high burden of poor oral health in older British men. This was reflected in both the objective clinical and subjective measures of oral health conditions. The determinants of these oral health problems in older populations merit further research to reduce the burden and consequences of poor oral health in older people.

OP25 Socioeconomic factors associated with frailty: results from two studies of older british populations

Background Frailty is a state of increased vulnerability to stressors in older age, which increases risks of disability, falls and mortality. Prevalence of frailty is very high in older populations. The extent to which socioeconomic factors are associated with frailty is less well studied. We investigated the extent to which socioeconomic factors at individual and area level are associated with frailty in two studies of older populations in the UK. Methods Data are from two studies of older populations: the British Regional Heart Study (BRHS) comprised a socially representative sample of men (n=1622) from 24 British towns aged 71–92 years in 2010–12; the English Longitudinal Study of Ageing (ELSA) comprised a representative sample of older men and women (n=5344) aged ≥60 years in 2004 from England. Using the Fried phenotype, frailty was defined by the presence of ≥3 of the following components: unintentional weight loss, low grip strength, low physical activity, slow walking pace and exhaustion. Socioeconomic measures included occupational social class and area-level deprivation was based on the Index of Multiple Deprivation (IMD). Logistic regressions models were used. Results Prevalence of frailty was 19% and 9% in the BRHS and ELSA populations respectively. In the BRHS sample, the risk of frailty increased from the highest (social class I) to lowest social class V; age-adjusted odds ratio was 1.18 (95% confidence interval (CI)=1.07–1.31) for each category from social class I to V, which remained significant on adjustment for smoking, history of cardiovascular disease (CVD) or diabetes, body mass index (BMI) and alcohol consumption. The risk of frailty also increased from the least (quintile 1) to most deprived IMD quintile (quintile 5); OR per quintile=1.19 (95% CI 1.08 to 1.30). This increased risk remained significant on further adjustment for covariates. Similarly, in the ELSA population of older men and women, frailty risk was greater in lower social classes (OR=1.21 (95% CI 1.16 to 1.27) for each group from highest to lowest social classes. Frailty risk was greater also in deprived quintiles (OR=1.35, 95% CI 1.28 to 1.43, for every increase in quintile of deprivation). These associations remained significant on adjustment for covariates. Conclusion Adverse socioeconomic factors are associated with risk of frailty in older populations. These associations were independent of lifestyle factors and comorbidities, and were observed both for individual and area-level socioeconomic factors. Socioeconomic factors are potentially important in reducing the burden of frailty in older people. These findings merit further investigation prospectively.

OP44 The influence of life-course socioeconomic factors on oral health in older age: findings from a longitudinal study of older British men

Background The influence of socioeconomic disadvantage in early life and later life on oral health in older ages is not established. Studies are mostly in middle-aged populations or have limited oral health measures. We examined the relationships between socioeconomic factors in childhood, middle-age and older age with clinical and self-reported oral health measures in older ages, and tested which conceptual life-course model (sensitive period, accumulation of risk or social mobility) explains the relationships between socioeconomic factors across the life-course and adverse oral health outcomes in older age. Methods The study comprised a socially representative cohort of 1,903 British men aged 71–92 years in 2010–12 drawn from general practices across Britain. Socioeconomic factors were available for childhood (father’s occupational social class); middle-age (longest-held occupation at 40–59 years); and older age at 60–79 years (socioeconomic deprivation). Oral health examination at 71–92 years included number of teeth, and periodontal disease measures in index teeth in each sextant (loss of attachment, periodontal pocket, gingival bleeding), and self-rated oral health (excellent, good, fair and poor). Life-course models, adjusted for age and town, were compared with a saturated model using Likelihood-ratio tests. Results Socioeconomic disadvantage in childhood, middle-age and older ages was associated with edentulism at 71–92 years – age-adjusted odds ratios (95% CI:) were 1.39 (1.02–1.90), 2.26 (1.70–3.01), 1.83 (1.35–2.49) respectively. Poor self-rated oral health was associated with socioeconomic disadvantage in childhood and middle-age; age-adjusted odds ratios (95% CI:) were 1.48 (1.19–1.85), 1.45 (1.18–1.78) respectively. Comparing competing life-course hypotheses, the sensitive period model for socioeconomic disadvantage in middle-age showed the best fit for edentulism (complete loss of natural teeth) and having <21 teeth at 71–92 years. Accumulation of risk across the life span model was strongest for poor self-rated oral health at 71–92 years. Periodontal disease measures were not significantly associated with socioeconomic disadvantage at any time-point and none of the life-course models fitted the data. Conclusion Socioeconomic disadvantage in middle-age has a particularly strong influence on tooth loss in older age. Overall self-rated oral health is influenced by socioeconomic disadvantage across the life-course.

OP26 Self-reported frailty components predict incident disability, falls and all-cause mortality in later life: results from a prospective study of older British men

Background Frailty is an established state of increased vulnerability for disability, falls, and mortality. Assessments of frailty components including grip strength, weight loss, physical activity and gait speed are complex or require objective measurements which are challenging in primary care. In this study we examined the ability of self-reported frailty components to predict known adverse outcomes of frailty including disability, falls and mortality and compared it to that of an established frailty phenotype. Methods The British Regional Heart Study is a cohort study comprising a socially and geographically representative sample of older British men, initially examined in 1978–80. In 2010–12, 1622 participants attended a physical examination (55% response rate) and completed a questionnaire (68% response rate). Frailty was based on weight loss, grip strength, exhaustion, slowness, and low physical activity. Single self-reported measures of the frailty components were selected from the questionnaire. Information on disability (problems walking 400 yards/taking stairs) and falls were collected through a postal questionnaire in 2014 after a 3-year follow-up. Data on mortality were obtained through the NHS Central Register. The discriminative ability of models with up to three single subjective measures were compared to the frailty phenotype for incident disability and falls using receiver operating characteristic-area under the curve (ROC-AUC). The predictive ability of these models for all-cause mortality was assessed using age-adjusted Cox proportional hazard models. Results A model including single items of self-reported slow walking speed, physical inactivity and exhaustion had a significantly increased ROC-AUC (0.68, 95% CI 0.63–0.72) for incident disability compared with the frailty phenotype (0.63, 95% CI 0.59–0.68; p-value of ΔAUC = 0.003) and was a significant predictor of all-cause mortality (hazard ratio = 1.65, 95% CI 1.34–2.03). A second model including self-reported slow walking speed, physical inactivity and weight decrease had a higher ROC-AUC (0.64, 95% CI 0.59–0.68) for incident falls compared to the frailty phenotype (0.57, 95% CI 0.53–0.61; p-value of ΔAUC < 0.001) and was also a significant predictor of all-cause mortality (hazard ratio = 2.13, 95% CI 1.71–2.66). Conclusion Simple self-report questions on walking speed, physical activity, feelings of exhaustion and weight-loss improve the risk stratification provided by an established frailty phenotype for incident disabilities and falls in older people, and are predictive of all-cause mortality. Developing such a simple assessment tool has potential implications for care pathways of older people to reduce the adverse consequences associated with frailty.

OP42 Socioeconomic inequalities in poor oral health in older age: influence of neighbourhood and individual level factors in a cross-sectional study of older british men

Background Socioeconomic inequalities in oral health are well-established. However, evidence on the influence of neighbourhood or area-level socioeconomic factors on poor oral health in older populations is limited. Therefore, we examined the extent to which area-level deprivation is associated with poor oral health (number of teeth, periodontal/gum disease and self-rated oral health) in older age, and whether this association is independent of individual-level socioeconomic position. Methods The investigation is based on a cross-sectional study of a representative cohort of men aged 71–92 years in 2010–12 drawn from general practices across Britain. A dental examination of 1622 men included number of teeth, and periodontal disease measures of loss of attachment (cumulative marker of periodontal disease) and periodontal pocket (active disease). Self-rated oral health (excellent, good, fair and poor) was assessed through postal questionnaires in 2147 men. Neighbourhood deprivation was based on the national Index of Multiple Deprivation (IMD), a composite score based on neighbourhood-level factors including income, employment, housing and access to services. Individual socioeconomic position was based on longest-held occupational social class. Multilevel logistic regression was used to obtain odds ratios according to IMD quintiles (quintile 1 being least deprived and used as a reference group). Results The risk of deep periodontal pockets and loss of teeth increased from IMD quintile 1 to 5; age-adjusted odds ratios (OR) for quintile 5 were 3.25 (95% CI 2.05–5.17) and 3.58 (95% CI 2.38–5.39) respectively, compared to quintile 1. These associations were attenuated only slightly by adjustment for individual social class, smoking and BMI and remained statistically significant. Age-adjusted odds of severe periodontal disease (based on loss of attachment and pocket depth) were increased only in quintile 5 compared to quintile 1 (OR = 1.90, 95% CI 1.07–3.35) and were not significant after adjustment for individual social class. The odds of self-reported fair/poor oral health was greater in more deprived IMD quintiles (OR for most deprived compared to least deprived quintile = 1.73, 95% CI 1.28–2.35), and remained statistically significant after adjustment for individual social class. Conclusion Marked differences in poor oral health in relation to neighbourhood-level factors were observed in this study of older men. Neighbourhood deprivation was associated with increased risks of loss of teeth, periodontal disease and poor self-rated oral health in older age, independent of individual social class. Neighbourhood level factors are likely to play an important role in reducing inequalities in oral health in older populations, and merit further research.

OP14 Neighbourhood-level socio-economic deprivation and cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men

Background Studies have shown associations between area or neighbourhood-level deprivation and cardiovascular disease (CVD) risk in middle age. However, there is little evidence on the longitudinal influence of neighbourhood-level socio-economic factors on CVD risk in older age. Therefore, we aimed to investigate the prospective association between neighbourhood level socio-economic deprivation and CVD mortality, and to assess the role of individual socio-economic position and established cardiovascular risk factors underlying these associations. Methods The investigation is based on a cohort of 3648 men, aged 60–79 years in 1998–2000, drawn from 24 British towns and followed-up for CVD (myocardial infarction and stroke) mortality over 12 years. Neighbourhood deprivation was based on the national Index of Multiple Deprivation (IMD), a composite score based on neighbourhood-level factors including income, employment, housing and access to services. IMD scores for Scotland and Wales were adjusted to that of England using the income and employment scores which are comparable in the IMD scores for England, Scotland and Wales. Quintiles based on the overall IMD score were created (quintile 1 being least deprived). Individual socio-economic position was based on longest-held occupational social class. Multilevel discrete-time models were applied using logistic regression to obtain odds ratios according to IMD quintiles for CVD mortality over the 12 year follow-up by dividing survival time in discrete time periods of 1 month. Results Over the 12 year follow-up 516 CVD deaths occurred. The relative risk of CVD mortality showed a graded increase from IMD quintile 1 to 5. Compared to quintile 1, the age-adjusted odds of CVD mortality in quintile 5 was 1.75 (95% CI 1.31–2.34), and 1.69 (95% CI 1.24–2.30) on further adjustment for individual social class. These estimates attenuated slightly, but remained significant on adjustment for smoking, body mass index (BMI), physical activity and alcohol (odds ratio for quintile 5 was 1.50; 95% CI 1.10, 2.05). Further adjustment for blood pressure and lipids made little difference. Conclusion Neighbourhood-level deprivation is associated with an increased risk of CVD mortality in older people independent of individual-level social class. Individual-level behavioural risk factors (smoking, BMI and physical activity) contribute to this association to some extent. The role of neighbourhood-level factors (such as access to health services, air pollution) merits further research.