R. Somerville

Longitudinal follow-up of the relationship between dietary intake and growth and development in the Lifeways cross-generation cohort study 2001-2013.

In this paper we will review evidence on the early life and familial influences on childhood growth and development, with particular reference to the Lifeways cross-generation cohort study in the Republic of Ireland. The Lifeways cross-generation cohort study was established in 2001-2013 through two maternity hospitals in the Republic of Ireland and was one of many new cohort studies established worldwide in the millennium period. Mothers were recruited at first booking visit, completing a self-administered questionnaire, which included a 147 item semi-quantitative FFQ. Longitudinal follow-up is ongoing in 2013, with linkage data to hospital and general practice records and examination of children when aged 5 and 9 years. The study is one of very few containing data on grandparents of both lineages with at least one grandparent recruited at baseline. There have been consistent associations between parental and grandparental health status characteristics and childrens outcomes, including infant birth-weight, BMI when child was aged 5 years and childhood wheeze or asthma when child was aged 3 and aged 5 years. In conclusion, empirical evidence to date shows consistent familial and cross-generational patterns, particularly in the maternal line.

PP30 Primary Care Utilisation and its Socio-Economic Determinants: findings from the Lifeways Cross-Generation Cohort Study During the Recession Period in the Republic of Ireland

Background Worldwide there is a well-established association between rates of primary and secondary health care utilisation and socio-economic deprivation. The collapse of the Celtic Tiger economy and recession in 2006/7 may have had a significant impact on health care utilisation. Aim: To examine patterns of primary care utilisation rates in the Irish adult population and its determinants over a 10 year period. Setting: Lifeways is a Cross-Generation Cohort Study of 1082 families recruited initially in the East and West of Ireland. Data were collected by self-administered questionnaire at baseline 2001-3, in 2007 and 2011/12, and from general practitioners in 2003. At the fourth phase of follow-up in 2011 1588 adults in 592 families responded. Methods Respondents provided data on health care utilisation (HCU), morbidity and socio-economic status at three time points and through GP notes. Recession impact was measured by standard questions and a composite economy score calculated (1–15, higher score indicating bigger impact). Rates of HCU were defined as ‘Less frequent’ < = 2 consultations/yr and ‘More frequent’ > = 3 consultations/yr. HCU was compared according to lineage, General Medical Services (GMS) means-tested eligibility to free health care, morbidity and various socio-economic indicators across the 4 time points. We subsequently fit a linear mixed effects model where family id and personal id were modelled as random effects with random intercepts for each family and random intercepts and slopes over time for each individual. Results At each time point, a strong, significant age gradient was noted, with women (mothers and grandmothers) being the more frequent users than men. Grandparents showed an average of 15% higher utilisation than parents (Chi-sq, p < 0.0001). GMS eligibility remained the strongest predictor of HCU at all time points (Chi-sq 172.468, p < 0.0001). At baseline, those with difficulty getting by had significantly higher HCU rates 53.7% vs. 46.3% (Chi-sq 10.212, p < 0.0001). In the final mixed model, economy score, time, GMS eligibility and co-morbidity were all highly significant predictors of healthcare utilisation adjusted for age, sex and region. Significantly higher odds of healthcare utilisation at 10yr follow-up were demonstrated for those who are GMS eligible (OR 6.9 [95% CI 2.5, 19.1], p<0.0001). A significant decrease in the odds of utilisation with increasing economic stress was also evident (6.9 [0.5, 0.9], p=0.02). Conclusion This analysis suggests persistent effects of morbidity characteristics on healthcare utilisation patterns. Exacerbated by the recent recession in adults in the Republic of Ireland.

P43 The Healthy Worker Effect? Socio-economic and health status determinants of changing self-rated health in older people in the Lifeways Cross-Generation Study of a Thousand Families

Background There has been renewed interest in the self-rated health (SRH) of older people. Many cohorts, including the Lifeways Cross Generation Cohort Study, have confirmed the role of SRH in predicting mortality. Many have also examined cross-sectional determinants, but few have described the determinants of change in SRH using the same measures 10 years apart, with a particular interest in assessing the relative contributions of change in physical and psychological morbidity and socio-demographic changes. Methods Using generalised estimating equations (GEE), we examine predictors of SRH in Lifeways grandparents who participated in the baseline (n = 710) and year 10 follow-up (n = 843) questionnaire surveys. Morbidity score was determined from summing 6 physician-diagnosed conditions that were self-reported at both time-points. For the cross sectional measures, a binomial distribution with logit link was specified, examining predictors of excellent/very good/good SRH versus fair or poor. For the predictors of change in SRH (range −2 to +2) a linear distribution with identity link was specified and two multivariable GEE models were constructed, firstly with only baseline variables, and secondly with variables reflecting change in morbidity or socioeconomic variables measured at both time-points. Each term in the model was examined conditional on the baseline value of SRH. Results Cross sectional results at both baseline and year 10 confirm that measures of both physical and psychological morbidity, as well as a measure of socio-economic deprivation (eligibility for means-tested General Medical Services – GMS), are predictive of SRH in this cohort. Of the 288 respondents with SRH measured at both time-points the following were significant predictors in the baseline GEE model (B, p): age (−0.018, 0.017), Eastern (urban) region (−0.223, 0.011) and baseline SRH (0.411, <0.001). In the final GEE model, the following were significant (B, p): age (−0.018, 0.011), Eastern region (−0.196, 0.023), baseline SRH (0.337, <0.001), change in morbidity score (0.203, <0.001), developing an activity limiting health condition (−0.701, <0.001), becoming GMS eligible (−0.239, 0.012) and change in employment status from working to other (0.234, 0.011). Conclusion The results of this on-going analysis show some interesting and novel findings. Change in SRH is related to initial level of SRH, but not initial level of morbidity. Even after accounting for change in objective and subjective morbidity, certain socio-economic factors (region and GMS eligibility) are influencing change in SRH. Of particular interest and meriting further investigation is the finding that leaving employment is associated with a positive change in SRH.

P58 Trajectories of Body Mass Index By Age 9 in The Lifeways Cross Generation Cohort Study Children in The Republic Of Ireland

Background The global childhood obesity epidemic poses great challenges in understanding how growth trajectories are determined from early life and across generations. It is increasingly clear that factors causing intra-uterine growth retardation and macrosomia may place children on adverse growth trajectories that lead to overweight and obesity. The Lifeways study was established to study the influence of familial and lifestyle factors including diet on long-term outcomes for children. Methods Of 1082 mother-child pairs recruited antenatally in 2001–3, after exclusion of twins, data were available for 981 children with at least one body mass index (BMI) measurement available at one of 3 waves of follow-up to age of 9 years old. Infants were categorised into low (<2.5 kg, N = 48), normal (2.5–4 kg, N = 761) and high (≥4 kg, N = 172) birth weight categories. We examined a variety of maternal and child characteristics at univariate level in relation to the trajectory groups. A linear mixed model was fitted with wave and birth weight category as factors with a fixed intercept and allowing correlated residuals over time with an unstructured covariance matrix (selected by BIC) and with an interaction term to allow for different trajectories over time, both adjusted and unadjusted for gestational age. Results There was a positive association for maternal age (p < 0.001), pre-pregnancy BMI (p < 0.001), and an inverse association for maternal smoking status (p < 0.001) with these trajectory groups. Maternal fat intake (% Energy Intake) was higher and carbohydrate intake (% Energy Intake) was lower during pregnancy in the low birth-weight group, p = 0.004 and p = 0.008 respectively. There was a statistically significant interaction (p < 0.001), indicating a different pattern of change in trajectory over time in the three groups, whether adjusted for gestational age or not. The low birth weight group showed a rapid catch-up response by age 5, before overtaking the normal weight group by age 9. The high birth weight group continued to track higher than the normal weight group over time. Conclusion These novel prospective cohort data confirm the adverse influence of birth-weight outcomes on subsequent growth trajectories in this cohort of children, in turn associated with maternal characteristics during gestation and pregnancy.