Faiza Tabassum

Socioeconomic differences in physical disability at older age

Background: This study aims to investigate the association between socioeconomic position (SEP) and physical disability at older age, using a framework that incorporates education, social class and wealth. Wave One data from the English Longitudinal Study of Ageing are used. Methods: Self-reported difficulties with activities of daily living, instrumental activities of daily living and motor skills were combined and categorised into “no disability”, “mild disability” and “severe disability”. The indicators of SEP used were wealth, education and social class. Multinomial regression was used to assess the associations between SEP and physical functioning reflecting the temporal relationship between education, social class and wealth. Results: Men and women who had the highest levels of wealth, education and social class also had the lowest disability rates. The association was stronger in younger age groups and in men. The association of education with disability, which was found to be significant in the unadjusted models, was attenuated when adjusted for other factors such as occupation or wealth. This supports a temporal model of education feeding into occupation and then wealth. The association of SEP with disability was stronger for men and for men and women in the younger age group. Conclusions: Socioeconomic circumstances affect the prevalence and scale of physical disability even at older ages. In particular, wealth appears more important as a socioeconomic factor for physical disability than social class or education. Socioeconomic gradients in physical disability are greater for men than for women and for those in the younger age groups.

Social differences in insulin-like growth factor-1: findings from a British birth cohort.

PURPOSE Insulin-like growth factor-1 (IGF-1) is related to factors that are socially patterned and may play a role in social differences in the development of morbidities including disability. Our aim is to examine whether there are social differences in IGF-1 in a cohort of participants between 44 and 45 years of age. METHODS We examine the association of IGF-1 with social position measured by fathers or own occupational class at three time points in childhood and adulthood, in a cohort of individuals born in one month in 1958 (N = 3,374 men and 3,302 women). RESULTS Lower IGF-1 levels were associated with lower social position measured with fathers occupational class at birth (p < 0.0001) and own occupational class aged 42 years (p < 0.001). Adult social position was associated with IGF-1 independently of social position at birth (p < 0.001) or any covariates examined. CONCLUSIONS IGF-1 secretion is associated with social position such that low social position is associated with lower levels of IGF-1. This biomarker may play a role in the development of social differences in morbidities associated with aging, such as the development of disability.

Association of volunteering with mental well-being: a lifecourse analysis of a national population-based longitudinal study in the UK

Objectives The association of volunteering with well-being has been found in previous research, but mostly among older people. The aim of this study was to examine the association of volunteering with mental well-being among the British population across the life course. Design British Household Panel Survey, a population-based longitudinal study. Setting UK. Participants 66 343 observations (person-years). Main outcome measures Mental well-being was measured by using the General Health Questionnaire (GHQ-12 or GHQ); high values denote high mental disorder. Four groups of volunteering participation were created: frequent (once a week), infrequent (once a month/several times a year), rare (once or less a year) and never. Multilevel linear models were used to analyse variations in mental well-being over the life course by levels of volunteering. Results When not considering age, those who engaged in volunteering regularly appeared to experience higher levels of mental well-being than those who never volunteered. To explore the association of volunteering with the GHQ across the life course, interaction terms were fitted between age and volunteering. The interactions were significant, demonstrating that these associations vary by age. The association between volunteering and well-being did not emerge during early adulthood to mid-adulthood, instead becoming apparent above the age of 40 years and continuing up to old age. Moreover, in early adulthood, the absence of engagement in voluntary activity was not related to mental well-being, but GHQ scores for this group increased sharply with age, levelling off after the age of 40 and then increasing again above the age of 70 years. The study also indicates variation in GHQ scores (65%) within individuals across time, suggesting evidence of lifecourse effects. Conclusions We conclude that volunteering may be more meaningful for mental well-being at some points of time in the life course.

Socio-economic inequalities in physical functioning: a comparative study of English and Greek elderly men

ABSTRACT The associations between socio-economic position (SEP) and physical functioning have frequently been investigated but little is known about which measures of SEP are the best to use for older people. This study examined how different SEP indicators related to the physical functioning of men aged 50 or more years in England and Greece. The data derived from Wave 1 of the English Longitudinal Study of Ageing (ELSA) and from the Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported physical functioning limitations and mobility difficulties were combined and categorised into ‘no disability’, ‘mild disability’ and ‘severe disability’. The SEP indicators studied were: wealth, educational level and occupational class. The findings indicate that respondents with less wealth, fewer educational qualifications and lower occupational class were more likely to experience mild or severe physical disability than those of high SEP. When all three measures of SEP were adjusted for each other, in both samples wealth maintained a strong association with mild and severe disability, while education was associated with severe disability but only among English men. Occupational class was not strongly associated with physical disability in either case. Hence, among English and Greek older men, wealth was a more important predictor of physical functioning difficulties than either occupational class or education.

Cohort Profile: The Flu Watch Study

Influenza is a common, highly contagious respiratory virus which infects all age groups, causing a range of outcomes from asymptomatic infection and mild respiratory disease to severe respiratory disease and death.1 If infected, the adaptive immune system produces a humoral (antibody) and cell-mediated (T cell) immune response to fight the infection.2 Influenza viruses continually evolve through antigenic drift, resulting in slightly different ‘seasonal’ influenza strains circulating each year. Population-level antibody immunity to these seasonal viruses builds up over time, so in any given season only a proportion of the population is susceptible to the circulating strains. Occasionally, influenza A viruses evolve rapidly through antigenic shift by swapping genes with influenza viruses usually circulating in animals. This process creates an immunologically distinct virus to which the population may have little to no antibody immunity. The virus can result in a pandemic if a large portion of the population is susceptible and the virus is easily spread.

Are Current UK National Institute for Health and Clinical Excellence (NICE) Obesity Risk Guidelines Useful? Cross-Sectional Associations with Cardiovascular Disease Risk Factors in a Large, Representative English Population

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35–97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women.

Coronary heart disease risk factors and regional deprivation in England: does age matter?

SIR—The potential influence of regional deprivation in the development of coronary heart disease (CHD) has rarely been addressed among the older population in England. Most studies on geographical variations have focused on mortality [1, 2] rather than morbidity or concentrated only on particular areas [3–5]. Inequalities in CHD by geographical regions or area of residence are well recognised [6–8]. Given that the risk of CHD increases with age [9, 10] and that the relationship between socioeconomic factors and health varies among different age groups [11, 12], we separately examined the associations of regional deprivation with CHD risk factors accounting for individual measures of social position and health behaviours in late middle age (52–65 years) and older (>65 years). The following biological CHD risk factors were used: body mass index (BMI), waist–hip ratio (WHR), systolic blood pressure, high-density lipoprotein (HDL) cholesterol and triglycerides.