Marilyn A. Roth

The contribution of active travel (walking and cycling) in children to overall physical activity levels: a national cross sectional study

OBJECTIVE To assess the contribution of active travel to and from school to childrens overall physical activity levels in England. METHOD Logistic regression models examining associations between active travel (walked, or cycled, to/from school at least once in the last week) and achievement of physical activity recommendations (≥60 min/d daily) in 4,468 children aged 5-15y (303 with valid accelerometry data) participating in the nationally-representative Health Survey for England 2008. RESULTS The 64% of children who walked and the 3% who cycled to/from school were more active than the 33% who did neither. Typical walkers came from a deprived area and were less likely to have a limiting illness; typical cyclists were older, male, and most likely to meet the recommendations. For self-reported activity, time spent cycling to/from school contributed more to meeting the recommendations (OR1.31, 1.09-1.59) than time spent walking to/from school (OR1.08, 1.02-1.15) or in sports (OR1.17, 95% CI 1.14-1.20). Time spent walking to school (OR1.80, 1.41-2.30) and in sports (OR1.10, 1.01-1.20) were significantly associated with being in the highest tertile actigraph-measured activity. CONCLUSION Children who reported walking or cycling to school were more active. Longitudinal studies are required to ascertain whether encouraging active travel affects less active children.

Chronic kidney disease, albuminuria and socioeconomic status in the Health Surveys for England 2009 and 2010

BACKGROUND Renal replacement therapy rates are inversely related to socioeconomic status (SES) in developed countries. The relationship between chronic kidney disease (CKD) and SES is less clear. This study examined the relationships between SES and CKD and albuminuria in England. METHODS Data from the Health Survey for England 2009 and 2010 were combined. The prevalence of CKD 3-5 and albuminuria was calculated, and logistic regression used to determine their association with five individual-level measures and one area-level measure of SES. RESULTS The prevalence of CKD 3-5 was 5.2% and albuminuria 8.0%. Age-sex-adjusted CKD 3-5 was associated with lack of qualifications [odds ratio (OR) 2.27 (95% confidence interval 1.40-3.69)], low income [OR 1.50 (1.02-2.21)] and renting tenure [OR 1.36 (1.01-1.84)]. Only tenure remained significant in fully adjusted models suggesting that co-variables were on the causal pathway. Albuminuria remained associated with several SES measures on full adjustment: low income [OR 1.55 (1.14-2.11)], no vehicle [OR 1.38 (1.05-1.81)], renting [OR 1.31 [1.03-1.67)] and most deprived area-level quintile [OR 1.55 (1.07-2.25)]. CONCLUSIONS CKD 3-5 and albuminuria were associated with low SES using several measures. For albuminuria this was not explained by known measured causal factors.

Under-reporting of tobacco use among Bangladeshi women in England

BACKGROUND This study investigates the prevalence of under-reported use of tobacco among Bangladeshi women and the characteristics of this group. METHODS The 1999 and 2004 Health Survey for England included 996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without. The main outcome measure was the prevalence of under-reported tobacco use. RESULTS Fifteen per cent of Bangladeshi women with a saliva sample under-reported their personal tobacco use. Under-reporters were very similar to self-reported users except for being much more likely to report chewing paan without tobacco (47% versus 9%, P < 0.001). Under-reporters differed significantly from cotinine-validated non-users in most respects. Regression analyses confirmed that under-reporters and self-reported users were similar in age, education level and exposure to passive smoking. Under-reporters were older and less educated than cotinine-validated non-users. Both self-reported users [odds ratio (OR): 0.11, 95% confidence interval (CI): 0.04-0.30] and cotinine-validated non-users (OR: 0.42, 95% CI: 0.20-0.89) were far less likely to report chewing paan without tobacco compared with under-reporters. CONCLUSIONS Contrary to our a priori hypothesis, under-reporters were not young, British-born, English-speaking women likely to be concealing smoking but resembled self-reported tobacco users except for being much more likely to report chewing paan without tobacco.

Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England

Background The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants. Method Using HSE 2003–2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28 470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models. Results Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a lower risk of age-adjusted pSRH (0.66, 0.43 to 1.00 (p=0.048)) and LLI (0.45, 0.28 to 0.72), which were significant in every model. Likewise, Chinese men had a lower risk of age-adjusted pSRH (0.51, 0.26 to 1.00 (p=0.048)) and LLI (0.22, 0.10 to 0.48). Except in Black Caribbean women, adjustment for SEP rendered raised age-adjusted associations for pSRH among Pakistani (2.51, 1.99 to 3.17), Bangladeshi (1.85, 1.08 to 3.16), Black Caribbean (1.78, 1.44 to 2.21) and Indian women (1.37, 1.13 to 1.66) insignificant. Adjustment for health behaviours had the largest effect for South Asian women. By contrast, Irish women reported better age-adjusted SRH (0.70, 1.51 to 0.96). Conclusions SEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them.

P35 Objective and subjective method of physical activity measurement in a cross-section of English adults: health survey for England 2008

Objective To describe and compare physical activity levels, sedentary and moderate-to-vigorous physical activity (MVPA) behaviour in HSE2008 in a representative sample of the adult population, using both objective (accelerometry) and subjective (self-report via questionnaire) methods of measurement. Design Nationally representative cross-sectional population data from Health Survey for England, 2008. Setting Random sample of the general population living in private households in England. Participants Subsample of 4507 adults aged 16+ were selected for accelerometry wear, of whom 2115 adults had valid accelerometry data wear (with at least 600 min per day). Main Outcome Measure Prevalence of those adults who meet the current physical activity (PA) recommendations by accelerometry data. Mean sedentary (minutes) and MVPA minutes (accelerometry). Results Based on accelerometry data, 6% of men and 4% of women met the Chief Medical Officers current minimum recommendations for PA by achieving at least 30 min of moderate or vigorous activity on at least 5 days in the week of accelerometer wear. Men and women aged 16–34 were most likely to have met the recommendations (11% and 8%, respectively). In contrast, based on self-report measures, 39% of men and 29% of women were said to have met the PA recommendations. Only 10% of men and 8% of women whose self-reported activity level corresponded with meeting the recommendations also met the recommendations based on accelerometry. Overall, men had significantly longer periods of sedentary time per day than women (595 min and 584 min, respectively), (p=0.003). While men spent an average of 31 min in MVPA in total per day, and women an average of 24 min, most of this was sporadic activity. Those who were not overweight or obese spent few minutes on average in sedentary time (591 min for men and 577 min for women) than those who were obese (612 min for men and 585 for women). Similarly, adults not overweight or obese spent more MVPA minutes than those who were overweight or obese. This pattern was similar with each BMI category. Conclusion Subjective self-reported method of assessing physical activity resulted in higher levels of activity than objective accelerometry data. Despite this, the results from objective accelerometer data corroborate self-report findings across age and sex. Objective measures provide more accurate data and should be used where available. Comparison between objective and subjective methods indicates that people over estimate their actual physical activity levels.

Under-reporting of tobacco use among Bangladeshi women in England; a cross-sectional study

To investigate the prevalence of under-reported use of tobacco among Bangladeshi women and the characteristics of this group. Cross-sectional surveys. Private households in England. 996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without, in the 1999 and 2004 Health Surveys for England. Prevalence of under-reported tobacco use (estimated using self-reported tobacco …

PP55 Socioeconomic Status and Chronic Kidney Disease: Further Findings from the Health Surveys for England 2009 and 2010

Background Renal replacement therapy rates are higher in more deprived populations in developed countries. The relationship between population-level prevalence of chronic kidney disease (CKD) and socio-economic status (SES) is less clear. Albuminuria is also recognised as an independent risk factor for poor CKD outcomes but again little is known about its relationship with SES. The nationally representative Health Surveys for England (HSE) 2009 and 2010 showed mixed evidence for variation of CKD prevalence by area deprivation defined by ‘Spearhead Primary Care Trust’ status. The present study aimed to examine the relationship between CKD and SES in more detail, and to include investigation of associations of albuminuria. Methods Data from the 2009 and 2010 HSEs were combined, giving a total of 5,799 individuals with kidney function data. Prevalence of moderate to severe CKD (stage 3–5), using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) estimating equation, and albuminuria were calculated. Multivariate logistic regression models were used to determine the associations of SES measures with CKD and albuminuria, adjusted for demographic, lifestyle and clinical factors. Results Prevalence of CKD Stage 3–5 was 5.2%, and any albuminuria 8.0%. After accounting for age-sex interaction, age-sex adjusted CKD 3–5 prevalence was associated with lack of qualifications (OR 2.27 [95% CI 1.40, 3.69]), low income (1.50 [1.02, 2.21]) and household tenure (1.36 [1.01, 1.84]) for rented vs. ownership). Only tenure remained significant after further adjustment for lifestyle and clinical factors (smoking, body mass index, hypertension, diabetes and ethnicity). Age-sex adjusted albuminuria prevalence was associated with low income (1.79 [1.35, 2.36]) most deprived quintile of index of multiple deprivation (1.72 [1.24, 2.41]), vehicle ownership (1.59 [1.25, 2.02]) and tenure (1.46 [1.18, 1.81]); these associations persisted after full adjustment. Conclusion There was little evidence of socioeconomic variation in CKD 3-5 prevalence in these HSE participants. By contrast, albuminuria prevalence varied by several measures of SES. This suggests a higher risk of CKD progression in lower SES groups. When combined with the higher prevalence of Type 2 diabetes in lower socioeconomic groups, this may contribute to the inverse gradient of renal replacement therapy rates by SES. This has implications for the early detection of CKD and albuminuria, and for equity of care in managing CKD.

OP84 Explaining Ethnic Inequalities in Health: Data from a National Cross-Sectional Survey

Background Although ethnic health inequalities remain a worldwide problem, underlying factors remain contested. Theories include genetic differences, culturally-patterned behavioural disparities, disadvantageous environmental exposures, and discrimination – as a psychosocial stressor and barrier to community and remunerative resources. A conceptual model was designed to explore the association between such factors and ethnic inequalities in self-rated health (SRH). Methods Data: The Health Survey for England 2004, a nationally representative, random general population sample of 4445 men and 5682 women, including boost samples from major minority ethnic groups in England. SRH was dichotomised into very good/good health versus fair/bad/very bad health, the latter classified as poor SRH (pSRH). Inequalities in the odds of pSRH were compared across seven ethnic groups relative to the White British population. Analyses: Potential correlates were grouped and tested separately using age-adjusted logistic regression models. These groups included demographic (religion, marital status, household size), socio-economic (education, equivalised family income, economic activity), psychosocial (anxiety/depression, social/emotional support), and health behaviour variables (fruit/vegetable intake, smoking status, frequency of alcohol consumption and physical activity), plus community characteristics (community participation, social capital, perceived neighbourhood quality). Analyses were stratified by sex, with final models created using backward selection. Results Indian (OR 1.80 [95% CI 1.36, 2.37], Pakistani (1.81 [1.34, 2.43]) and Bangaldeshi (2.49 [1.92, 3.24]) men had raised age-adjusted odds of pSRH. These were attenuated by adjustment for psychosocial and community factors, and rendered non-significant following adjustment for demographic factors. Black African men showed lower odds of pSHR after adjustment for socio-economic (0.57 [0.39, 0.85]) and lifestyle (0.57 [0.37, 0.86]) factors. The final model adjusted for age, education, equivalised income, household size, economic activity, anxiety/depression, smoking, and physical activity. Black African men showed lower odds (0.64 [0.42, 0.98]) while Indian men had higher odds (1.78 [1.25, 2.53]) of pSRH relative to White British men. Ethnic health inequalities were greater among women. Irish women reported better age-adjusted SRH (0.70 [0.96, 1.51]) but black Caribbean (2.19 [1.72, 2.78]), Indian (1.47 [1.15, 1.87]), Pakistani (2.46 [1.87, 3.24]) and Bangladeshi (3.07 [2.35, 4.01]) women had worse SRH than White British women. The final model (adjusted as for men, plus marital status, social capital, and neighbourhood quality) attenuated risks among Pakistani (1.57 [1.06, 2.33]) and Bangladeshi (1.63 [1.09, 2.43]) women, but had little effect on pSRH in Irish, Black Caribbean or Indian women. Conclusion Inequality in pSRH was greatest among ethnic minority women, while differences in demographic, socio-economic and health behaviour variables accounted for most ethnic health inequalities among Indian, Pakistani and Bangladeshi men.

P57 Persistent regional variation in treatment of hypertension

Objective To investigate risk factors for treatment for hypertension in people with survey-defined hypertension in England. Design Cross-sectional health examination surveys. Setting Three, nationally representative random samples of the general population living in private households in England—the Health Survey for England (HSE) in 2005, 2006, and 2007. Participants A new, nationally representative sample is selected each year. A random sample of the free-living general population (HSE 2005 (n=5321), 2006 (n=10 213), 2007 (n=4848)) were visited by an interviewer then a nurse; the interview was supplemented by physical measurements using standardised protocols. Blood pressure was measured three times with an Omron HEM207 after a 5-min rest. Mean of second and third readings in participants who had not eaten, drunk alcohol, smoked, or exercised in the preceding 30 min were used. Main Outcome Measures Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, and/or taking prescribed medication to lower blood pressure. Results A higher proportion of participants in London than elsewhere in England with survey-defined hypertension were on treatment (2005–2007 average: 61% men, 66% women in London; 43% men, 55% women in England, (p for London vs rest of England <0.001 for each sex). Regression analysis showed this regional effect for odds of treatment persisted after adjustment for demographic, socio-economic, and health behaviours (OR 1.48, 95% CI 1.04 to 2.10, p=0.029) and was strengthened (OR1.87 (1.25 to 2.81), p=0.003) by including self-reported health, long-standing illness, diabetes, and cardiovascular disease in the model. Apart from the regional differences, treatment for hypertension increased with age and was more likely among women (OR 1.59 (1.29 to 1.97), p=0.001); former smokers (OR 1.44 (1.05 to 1.99), p=0.026); and people who were married; were overweight (OR 1.40 (1.03 to 1.89), p=0.033) or obese (OR 1.80 (1.32 to 2.42), p<0.001); reported limiting (OR 2.49 (1.93 to 3.20), p<0.001) or non-limiting (OR 3.25 (2.48 to 4.24), p<0.001) long-term illness; or reported diabetes (OR 2.36 (1.60 to 3.47), p<0.001) or cardiovascular disease (OR 1.54 (1.18 to 22.02), p=0.002). Treatment was 39% and 61% less likely in widowed (p=0.004) and co-habiting participants (p<0.001), respectively, and 40% less likely in binge-drinkers (p=0.014). Conclusion The proportion of people in London being treated for hypertension is above the national average even after adjustment for sociodemographic and health-related factors. This may be due to greater population mobility in London with more people having new Patient Health checks. Education and financial incentives for improvements in detection, treatment and control of hypertension in primary care in England have been beneficial but remain inadequate.