Philip McLoone

Deprivation and mortality in Scotland 1981 and 1991.

Abstract Objective: To compare the mortality experience of Scottish postcode sectors characterised by socioeconomic census variables (Carstairs scores) in 1980-2 and 1990-2. Methods: Variables derived from the 1981 and 1991 censuses were combined according to the method devised by Carstairs and Morris*RF 6* to obtain Carstairs scores for 1010 postcode sectors in Scotland in 1981 and 1001 sectors in 1991. For most analyses, these scores were grouped into seven deprivation categories ranging from affluent (category 1) to deprived (category 7) localities. Main outcome measures: Death rates and standardised mortality ratios for localities according to deprivation category. Results: Postcode sectors in Scotland that were categorised as deprived in 1981 were relatively more deprived at the time of the 1991 census; the mortality experience of deprived localities relative to either Scotland or affluent neighbourhoods worsened over this period, with a 162% difference between the most affluent and most deprived categories in 1991-2. Although the age and sex standardised mortality for ages 0-64 in Scotland declined by 22% during the 1980s, the reduction in the deprived categories was only about half that of the affluent groups. Increases in the death rate for men (29%) and women (11%) aged 20-29 in the deprived groups were largely attributable to an increase in the rates of suicide. Death rates from ischaemic heart disease and carcinoma of the lung and bronchus at ages 40-69 were lower in all deprivation categories in 1990-2, but the reduction was greater in more affluent areas; the difference in rates for these conditions between affluent and deprived groups therefore increased over the decade. The observed worsening of the standardised mortality ratio for Glasgow relative to Scotland could be explained on the basis of these mortality differentials and the concentration of deprived postcode sectors in Glasgow. Conclusions: Differences in mortality experience linked to relative poverty increased in the 10 years between 1981 and 1991 censuses. Although mortality for Scotland as a whole is improving, the picture is one of an increasing distinction between the experience of the majority and that of a substantial minority of the population.

Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study.

BackgroundSocioeconomic inequalities in mortality have increased in recent years in many countries. We examined age-, sex-, and cause-specific mortality rates for social groups in and regions of Scotland to understand the patterning of inequalities and the causes contributing to these inequalities.MethodsWe used death records for 1980–82, 1991–92 and 2000–02 together with mid-year population estimates for 1981, 1991 and 2001 covering the whole of Scotland to calculate directly standardised mortality rates. Deaths and populations were coded to small areas (postcode sectors and data zones), and deprivation was assessed using area based measures (Carstairs scores and the Scottish Index of Multiple Deprivation). We measured inequalities using rate ratios and the Slope Index of Inequality (SII).ResultsSubstantial overall decreases in mortality rates disguised increases for men aged 15–44 and little change for women at the same ages. The pattern at these ages was mostly attributable to increases in suicides and deaths related to the use of alcohol and drugs. Under 65 a 49% fall in the mortality of men in the least deprived areas contrasted with a fall of just 2% in the most deprived. There were substantial increases in the social gradients for most causes of death. Excess male mortality in the Clydeside region was largely confined to more deprived areas, whilst for women in the region mortality was in line with the Scottish experience. Relative inequalities for men and women were greatest between the ages of 30 and 49.ConclusionGeneral reductions in mortality in the major causes of death (ischaemic heart disease, malignant neoplasms) are encouraging; however, such reductions were socially patterned. Relative inequalities in mortality have increased and are greatest among younger adults where deaths related to unfavourable lifestyles call for direct social policies to address poverty.

Changing patterns of hospital admission for asthma, 1981-97

BACKGROUND Hospital admission rates for asthma have stopped rising in several countries. The aim of this study was to use linked hospital admission data to explore recent trends in asthma admissions in Scotland. METHODS Linked Scottish Morbidity Records (SMR1) for asthma (ICD-9 493 and ICD-10 J45–6) from 1981 to 1997 were used to describe rates of first admissions and readmissions by age and sex. As a measure of resource use, annual trends in bed days used were also explored by age and sex. RESULTS There were 160 039 hospital admissions for asthma by 82 421 individuals in Scotland during the study period. The overall hospital admission rate increased by 122% (from 106.7 to 236.7 per 100 000 population) but this varied by sex, age, and admission type. First admissions rose by 70% from 73.2 per 100 000 in 1986 to 124.8 per 100 000 in 1997 while readmissions fell. Children (<15 years) experienced a decline in overall admissions after 1992 due to falls in both new admissions and readmissions. By 1997 the ratio of female to male admissions was 0.57 in children, but 1.50 above 14 years of age. Mean lengths of stay fell from 10.7 days to 3.7 days between 1981 and 1997 and bed days used showed little change except for a decline after 1992 in children. CONCLUSIONS After a period of increasing hospitalisation for asthma in Scotland, rates of admission among children have begun to fall but among adults admissions continue to rise.

Coffee consumption and prostate cancer risk: further evidence for inverse relationship

BackgroundHigher consumption of coffee intake has recently been linked with reduced risk of aggressive prostate cancer (PC) incidence, although meta-analysis of other studies that examine the association between coffee consumption and overall PC risk remains inconclusive. Only one recent study investigated the association between coffee intake and grade-specific incidence of PC, further evidence is required to understand the aetiology of aggressive PCs. Therefore, we conducted a prospective study to examine the relationship between coffee intake and overall as well as grade-specific PC risk.MethodsWe conducted a prospective cohort study of 6017 men who were enrolled in the Collaborative cohort study in the UK between 1970 and 1973 and followed up to 31st December 2007. Cox Proportional Hazards Models were used to evaluate the association between coffee consumption and overall, as well as Gleason grade-specific, PC incidence.ResultsHigher coffee consumption was inversely associated with risk of high grade but not with overall risk of PC. Men consuming 3 or more cups of coffee per day experienced 55% lower risk of high Gleason grade disease compared with non-coffee drinkers in analysis adjusted for age and social class (HR 0.45, 95% CI 0.23-0.90, p value for trend 0.01). This association changed a little after additional adjustment for Body Mass Index, smoking, cholesterol level, systolic blood pressure, tea intake and alcohol consumption.ConclusionCoffee consumption reduces the risk of aggressive PC but not the overall risk.

Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity

BACKGROUND There is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) > 40 kg/m(2). AIM This programme aimed to generate weight losses of ≥15 kg at 12 months, within routine primary care. DESIGN AND SETTING Feasibility study in primary care. METHOD Patients with a BMI ≥40 kg/m(2) commenced a micronutrient-replete 810-833 kcal/day low-energy liquid diet (LELD), delivered in primary care, for a planned 12 weeks or 20 kg weight loss (whichever was the sooner), with structured food reintroduction and then weight-loss maintenance, with optional orlistat to 12 months. RESULT Of 91 patients (74 females) entering the programme (baseline: weight 131 kg, BMI 48 kg/m(2), age 46 years), 58/91(64%) completed the LELD stage, with a mean duration of 14.4 weeks (standard deviation [SD] = 6.0 weeks), and a mean weight loss of 16.9 kg (SD = 6.0 kg). Four patients commenced weight-loss maintenance omitting the food-reintroduction stage. Of the remaining 54, 37(68%) started and completed food reintroduction over a mean duration of 9.3 weeks (SD = 5.7 weeks), with a further mean weight loss of 2.1 kg (SD = 3.7 kg), before starting a long-term low-fat-diet weight-loss maintenance plan. A total of 44/91 (48%) received orlistat at some stage. At 12 months, weight was recorded for 68/91 (75%) patients, with a mean loss of 12.4 kg (SD = 11.4 kg). Of these, 30 (33% of all 91 patients starting the programme) had a documented maintained weight loss of ≥15 kg at 12 months, six (7%) had a 10-15 kg loss, and 11 (12%) had a 5-10 kg loss. The indicative cost of providing this entire programme for wider implementation would be £861 per patient entered, or £2611 per documented 15 kg loss achieved. CONCLUSION A care package within routine primary care for severe obesity, including LELD, food reintroduction, and weight-loss maintenance, was well accepted and achieved a 12-month-maintained weight loss of ≥15 kg for one-third of all patients entering the programme.

Changes in BMI and waist circumference in Scottish adults: use of repeated cross-sectional surveys to explore multiple age groups and birth-cohorts

Objective:To document changes in body mass index (BMI) and waist circumference (WC) over a 10-year period 1998–2008, in representative surveys of adults.Subjects:Adults aged 18–72 in the Scottish Health Surveys conducted in 1998, 2003 and 2008 were divided, separately for men and women, into eleven 5-year age bands. ‘Synthetic birth-cohorts’ were created by dividing participants into thirteen 5-years-of-birth bands (n=20 423). Weight, height and WC were objectively measured by trained observers.Results:Subjects with data available on BMI/WC were 7743/6894 in 1998, 5838/4437 in 2003 and 4688/925 in 2008 with approximately equal gender distributions. Mean BMI and waist were both greater in successive surveys in both men and women. At most specific ages, people were consistently heavier in 2008 than in 1998 by about 1–1.5 BMI units, and WCs were greater by about 2–6 cm in men and 5–7 cm in women. Greater increases were seen at younger ages between 1998 and 2003 than between 2003 and 2008, however increases continued at older ages, particularly in waist. All birth-cohorts observed over the 10 years 1998–2008 showed increases in both BMI and waist, most marked in the younger groups. The 10-year increases in waist within birth-cohorts (mean 7.4 cm (8.1%) in men and 8.6 cm (10.9%) in women) were more striking than in BMI (mean 1.8 kg m−2 (6.6%) in men and 1.5 kg m−2 (6.4%) in women) were particularly steep in older women.Conclusion:People were heavier and fatter in 2003 than those of the same age in 1998, with less marked increases in WC between 2003 and 2008 than between 1998 and 2003. There were proportionally greater increases in WC than in BMI, especially in older women. This suggests a disproportionate increase in body fat, compared with muscle, particularly among older women.

Risk of Critical Illness Among Patients With Solid Cancers: A Population-Based Observational Study

IMPORTANCE Critical illness may be a potential determinant of cancer outcomes and geographic variations, but its role has not been described before. OBJECTIVE To determine the incidence of admission to intensive care units (ICUs) within 2 years following cancer diagnosis. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective observational study using cancer registry data in 4 datasets from 2000 to 2009 with linked ICU admission data from 2000 to 2011, in the West of Scotland region of the United Kingdom (population, 2.4 million; all 16 ICUs within the region). All 118,541 patients (≥16 years) diagnosed as having solid (nonhematological) cancers. Their median age was 69 years, and 52.0% were women. MAIN OUTCOMES AND MEASURES Demographic and clinical variables associated with admission to an ICU and death in an ICU. RESULTS A total of 118,541 patients met the study criteria. Overall, 6116 patients (5.2% [95% CI, 5.0%-5.3%]) developed a critical illness and were admitted to an ICU within 2 years. Risk of critical illness was highest at ages 60 to 69 years and higher in men. The cumulative incidence of critical illness was greatest for small intestinal (17.2% [95% CI, 13.3%-21.8%]) and colorectal cancers (16.5% [95% CI, 15.9%-17.1%]). The risk following breast cancer was low (0.8% [95% CI, 0.7%-1.0%]). The percentage who died in ICUs was 14.1% (95% CI, 13.3%-15.0%), and during the hospital stay, 24.6% (95% CI, 23.5%-25.7%). Mortality was greatest among emergency medical admissions and lowest among elective surgical patients. The risk of critical illness did not vary by socioeconomic circumstances, but mortality was higher among patients from deprived areas. CONCLUSIONS AND RELEVANCE In this study, about 1 in 20 patients experienced a critical illness resulting in ICU admission within 2 years of cancer diagnosis. The associated high mortality rate may make a significant contribution to overall cancer outcomes.

Diet, exercise, obesity, smoking and alcohol consumption in cancer survivors and the general population: a comparative study of 16 282 individuals

Background:Cancer survivors may be particularly motivated to improve their health behaviours.Methods:We compared health behaviours and obesity in cancer survivors with the general population, using household survey and cancer registry data.Results:Cancer survivors were more likely than those with no history of cancer to eat fruit and vegetables (ORadj 1.41, 95% CI 1.19–1.66), less likely to engage in physical activity (ORadj 0.79, 95% CI 0.67–0.93) and more likely to have stopped smoking (ORadj 1.25, 95% CI 1.09–1.44).Conclusions:Most health-related behaviours were better in cancer survivors than the general population, but low physical activity levels may be amenable to health promotion interventions.

The implementation of the Counterweight Programme in Scotland, UK

BACKGROUND The Counterweight Programme is a proven model for the management of obesity in the UK, evaluated over 5 years (2000-05) and demonstrating clinical and cost effectiveness. The Scottish Government commissioned three phases of Counterweight implementation during the period 2006-08. The first two phases linked the Counterweight Programme to a primary care cardiovascular disease prevention programme; the third phase was commissioned independent of other interventions. Aim. To assess the implementation of the Counterweight Programme in 13 Health Boards in Scotland and compare 12-month outcomes with published Counterweight data. METHODS Patients with a body mass index (BMI) ≥ 30 kg/m(2) or BMI ≥ 28 kg/m(2) with at least one co-morbidity were screened for the Counterweight Programme. Patients were asked to attend nine structured appointments with a trained Counterweight Programme practitioner over 12 months. RESULTS Six thousand seven hundred and fifteen patients from 184 general practices, 16 pharmacies and one centralized community-based service in 13 Health Boards, with a mean BMI of 37 kg/m(2) were enrolled in the Counterweight Programme. Twenty-six per cent had a BMI ≥ 40 kg/m(2). Attendance for patients at 3, 6 and 12 months follow-up was 55%, 37% and 28%. Of those who attended at 12 months, 35.2% had maintained a weight loss of ≥5% compared to 30.7% in the original evaluation. CONCLUSIONS Evaluation of the Counterweight Programme in Scotland demonstrated consistency in characteristics of patients enrolled into the programme. There was evidence of higher loss to follow-up in a population not routinely engaging with primary care but evidence of greater weight losses among those who attended.

Tea consumption and the risk of overall and grade specific prostate cancer: a large prospective cohort study of Scottish men

Tea may be a potentially modifiable and highly prevalent risk factor for the most common cancer in men, prostate cancer. However, associations between black tea consumption and prostate cancer in epidemiological studies have been inconsistent, limited to a small number of studies with small numbers of cases and short follow-up periods and without grade-specific information. We conducted a prospective cohort study of 6,016 men who were enrolled in the Collaborative Cohort Study between 1970 and 1973 and followed up to December 31, 2007. We used Cox proportional hazards models to investigate the association between tea consumption and overall as well as grade-specific risk of prostate cancer incidence. Three hundred and eighteen men developed prostate cancer in up to 37 years of follow-up. We found a positive association between consumption of tea and overall risk of prostate cancer incidence (P = 0.02). The association was greatest among men who drank ≥7 cups of tea per day (HR: 1.50, 95% CI: 1.06 to 2.12), compared with the baseline of 0–3 cups/day. However, we did not find any significant association between tea intake and low- (Gleason <7) or high-grade (Gleason 8–10) prostate cancer incidence. Men with higher intake of tea are at greater risk of developing prostate cancer, but there is no association with more aggressive disease. Further research is needed to determine the underlying biological mechanisms for the association.