Seeromanie Harding

Occupational class and ischemic heart disease mortality in the United States and 11 European countries.

OBJECTIVES Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments.

Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979–2003: slow declines notable for some groups

Objective: To examine trends in coronary heart disease and stroke mortality in migrants to England and Wales. Design: Cross-sectional. Outcome measures: Age-standardised and sex-specific death rates and rate ratios 1979–83, 1989–93 and 1999–2003. Results: Coronary mortality fell among migrants, more so in the second decade than the first. Rate ratios for coronary mortality remained higher for men and women from Scotland, Northern Ireland, Republic of Ireland and South Asia, and lower for men from Jamaica, other Caribbean countries, West Africa, Italy and Spain. Rate ratios increased for men from Jamaica (1979–83: 0.45, 0.40 to 0.50; 1999–2003: 0.81, 0.73 to 0.90), Pakistan (1979–83: 1.14, 1.04 to 1.25; 1999–2003: 1.93, 1.81 to 2.06), Bangladesh (1979–83: 1.36, 1.15 to 1.60; 1999–2003: 2.11, 1.90 to 2.34), Republic of Ireland (1979–1983: 1.18, 1.15 to 1.21; 1999–2003: 1.45, 1.39 to 1.52) and Poland (1979–83: 1.17, 1.09 to 1.25; 1999–2003: 1.97, 1.57 to 2.47), and for women from Jamaica (1979–83: 0.63, 0.52 to 0.77; 1999–2003: 1.23, 1.06 to 1.42) and Pakistan (1979–83: 1.14, 0.88 to 1.47; 1999–2003: 2.45, 2.19 to 2.74), owing to smaller declines in death rates than those born in England and Wales. Rate ratios for stroke mortality remained higher for migrants. As a result of smaller declines, rate ratios increased for men from Pakistan (1979–1983: 0.99, 0.76 to 1.29; 1999–2003: 1.58, 1.35 to 1.85), Scotland (1979–1983: 1.11, 1.04 to 1.19; 1999–2003: 1.30, 1.19 to 1.42) and Republic of Ireland (1979–1983: 1.27, 1.19 to 1.36; 1999–2003: 1.67, 1.52 to 1.84). Conclusion: For groups with higher mortality than people born in England and Wales, mortality remained higher. Smaller declines led to increasing disparities for some groups and to excess coronary mortality for women from Jamaica. Maximising the coverage of prevention and treatment programmes is critical.

A systematic review of the effect of retention methods in population-based cohort studies

BackgroundLongitudinal studies are of aetiological and public health relevance but can be undermined by attrition. The aim of this paper was to identify effective retention strategies to increase participation in population-based cohort studies.MethodsSystematic review of the literature to identify prospective population-based cohort studies with health outcomes in which retention strategies had been evaluated.ResultsTwenty-eight studies published up to January 2011 were included. Eleven of which were randomized controlled trials of retention strategies (RCT). Fifty-seven percent of the studies were postal, 21% in-person, 14% telephone and 7% had mixed data collection methods. A total of 45 different retention strategies were used, categorised as 1) incentives, 2) reminder methods, repeat visits or repeat questionnaires, alternative modes of data collection or 3) other methods. Incentives were associated with an increase in retention rates, which improved with greater incentive value. Whether cash was the most effective incentive was not clear from studies that compared cash and gifts of similar value. The average increase in retention rate was 12% for reminder letters, 5% for reminder calls and 12% for repeat questionnaires. Ten studies used alternative data collection methods, mainly as a last resort. All postal studies offered telephone interviews to non-responders, which increased retention rates by 3%. Studies that used face-to-face interviews increased their retention rates by 24% by offering alternative locations and modes of data collection.ConclusionsIncentives boosted retention rates in prospective cohort studies. Other methods appeared to have a beneficial effect but there was a general lack of a systematic approach to their evaluation.

Mortality of migrants from the indian subcontinent to England and Wales: Effect of duration of residence

Background. Few studies have examined mortality of migrants by duration of residence in the country of destination. Methods. I examined mortality of South Asian migrants by duration of residence in England and Wales. The cohort (N = 2,272, age 25–54 years in 1971) was followed from 1971 to 2000. Results. All-cause mortality of South Asian migrants increased with increasing duration of residence in England and Wales. A yearly increase in duration of residence was associated with a hazard ratio of 1.07 (95% confidence interval [CI] = 1.02–1.13) among persons ages 25–34 years in 1971, 1.03 (1.00–1.07) among those ages 35–44 years, and 1.02 (1.00–1.05) among those ages 45–54. Cardiovascular disease mortality was the main component of this trend. Yearly increases in duration of residence were associated with cardiovascular disease mortality hazard ratios of 1.09 (1.03–1.16), 1.04 (1.00–1.09) and 1.02 (1.00–1.05) for the youngest, middle and oldest age groups, respectively. Comparable results were seen for coronary heart disease and for cancer mortality. Age at migration was positively related to mortality independent of duration of residence but the confidence intervals were wide. Adjusting for socioeconomic position did not alter these patterns. Conclusions. Cardiovascular and cancer mortality of South Asian migrants increased with duration of residence in England and Wales.

Patterns of mortality in second generation Irish living in England and Wales: longitudinal study.

Abstract Objective: To examine the mortality of second generation Irish living in England and Wales. Design: Longitudinal study of 1% of the population of England and Wales (longitudinal study by the Office of Population Censuses and Surveys (now the Office for National Statistics)) followed up from 1971 to 1989. Subjects: 3075 men and 3233 women aged 15 and over in 1971. Main outcome measures: Age and sex specific standardised mortality ratios for all causes, cancers, coronary heart disease, cerebrovascular diseases, respiratory diseases, and injuries and poisonings. Deaths were also analysed by socioeconomic indicators. Results: 786 deaths were traced to men and 762 to women. At working ages (men, aged 15-64; women, 15-59) the mortality of men (standardised mortality ratio 126) and women (129) was significantly higher than that of all men and all women. At ages 15-44, relative disadvantages were even greater both for men (145) and for women (164). Mortality was raised for most major causes of death. Significant excess mortality from cancers was seen for men of working age (132) and for women aged 60 and over (122). At working ages mortality of the second generation Irish in every social class and in the categories of car access and housing tenure was higher than that of all men and all women in the corresponding categories. Adjusting for these socioeconomic indicators did not explain the excess mortality. Conclusion: Mortality of second generation Irish men and women was higher than that of all men and all women and for most major causes of death. While socioeconomic factors remain important, cultural and lifestyle factors are likely to contribute to this adverse mortality. Key messages Mortality is raised for most major causes of death, with a significant excess from cancers Adjustment for social class, car access, and housing tenure did not explain the excess in all cause mortality With over two million second generation Irish and growing numbers of a third generation, their health needs special consideration

Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle

BACKGROUND Ethnicity is a consistent correlate of excess weight in youth. We examine the influence of lifestyles on ethnic differences in excess weight in early adolescence in the UK. METHOD Data were collected from 6599 pupils, aged 11-13 years in 51 schools, on dietary practices and physical activity, parental smoking and overweight, and on overweight and obesity (using International Obesity Task Force criteria). RESULTS Skipping breakfast [girls odds ratio (OR) 1.74, 95% confidence interval (CI) 1.30-2.34; boys OR 2.06; CI 1.57-2.70], maternal smoking (girls OR 2.04, CI 1.49-2.79; boys OR 1.63, CI 1.21-2.21) and maternal overweight (girls OR 2.01, CI 1.29-3.13; boys OR 2.47, CI 1.63-3.73) were associated with obesity. Skipping breakfast, more common among girls, was associated with other poor dietary practices. Compared with White UK peers, Black Caribbeans (girls OR 1.62, CI 1.24-2.12; boys OR 1.49, CI 1.15-1.95) and Black Africans (girls OR 1.96, CI 1.52-2.53; boys OR 2.50, CI 1.92-3.27) were more likely to skip breakfast and engage in other poor dietary practices, and Indians were least likely. White Other boys reported more maternal smoking (OR 1.37, CI 1.03-1.82). All these reports were more common among those born in the UK than those born elsewhere. Black Caribbean girls were more likely to be overweight (OR 1.38, CI 1.02-1.87) and obese (OR 1.65, CI 1.05-2.58), Black African girls to be overweight (OR 1.35, CI 1.02-1.79) and White Other boys to be overweight (OR 1.37, CI 1.00-1.88) and obese (OR 1.86, CI 1.15-3.00). Adverse dietary habits and being born in the UK contributed to these patterns. CONCLUSION These findings signal a potential exacerbating effect on ethnic differences in obesity if adverse dietary habits persist. Combined adolescent and parent-focused interventions should be considered.

Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis

Objective To quantify the effect of strategies to improve retention in randomised trials. Design Systematic review and meta-analysis. Data sources Sources searched: MEDLINE, EMBASE, PsycINFO, DARE, CENTRAL, CINAHL, C2-SPECTR, ERIC, PreMEDLINE, Cochrane Methodology Register, Current Controlled Trials metaRegister, WHO trials platform, Society for Clinical Trials (SCT) conference proceedings and a survey of all UK clinical trial research units. Review methods Included trials were randomised evaluations of strategies to improve retention embedded within host randomised trials. The primary outcome was retention of trial participants. Data from trials were pooled using the fixed-effect model. Subgroup analyses were used to explore the heterogeneity and to determine whether there were any differences in effect by the type of strategy. Results 38 retention trials were identified. Six broad types of strategies were evaluated. Strategies that increased postal questionnaire responses were: adding, that is, giving a monetary incentive (RR 1.18; 95% CI 1.09 to 1.28) and higher valued incentives (RR 1.12; 95% CI 1.04 to 1.22). Offering a monetary incentive, that is, an incentive given on receipt of a completed questionnaire, also increased electronic questionnaire response (RR 1.25; 95% CI 1.14 to 1.38). The evidence for shorter questionnaires (RR 1.04; 95% CI 1.00 to 1.08) and questionnaires relevant to the disease/condition (RR 1.07; 95% CI 1.01 to 1.14) is less clear. On the basis of the results of single trials, the following strategies appeared effective at increasing questionnaire response: recorded delivery of questionnaires (RR 2.08; 95% CI 1.11 to 3.87); a ‘package’ of postal communication strategies (RR 1.43; 95% CI 1.22 to 1.67) and an open trial design (RR 1.37; 95% CI 1.16 to 1.63). There is no good evidence that the following strategies impact on trial response/retention: adding a non-monetary incentive (RR=1.00; 95% CI 0.98 to 1.02); offering a non-monetary incentive (RR=0.99; 95% CI 0.95 to 1.03); ‘enhanced’ letters (RR=1.01; 95% CI 0.97 to 1.05); monetary incentives compared with offering prize draw entry (RR=1.04; 95% CI 0.91 to 1.19); priority postal delivery (RR=1.02; 95% CI 0.95 to 1.09); behavioural motivational strategies (RR=1.08; 95% CI 0.93 to 1.24); additional reminders to participants (RR=1.03; 95% CI 0.99 to 1.06) and questionnaire question order (RR=1.00, 0.97 to 1.02). Also based on single trials, these strategies do not appear effective: a telephone survey compared with a monetary incentive plus questionnaire (RR=1.08; 95% CI 0.94 to 1.24); offering a charity donation (RR=1.02, 95% CI 0.78 to 1.32); sending sites reminders (RR=0.96; 95% CI 0.83 to 1.11); sending questionnaires early (RR=1.10; 95% CI 0.96 to 1.26); longer and clearer questionnaires (RR=1.01, 0.95 to 1.07) and participant case management by trial assistants (RR=1.00; 95% CI 0.97 to 1.04). Conclusions Most of the trials evaluated questionnaire response rather than ways to improve participants return to site for follow-up. Monetary incentives and offers of monetary incentives increase postal and electronic questionnaire response. Some strategies need further evaluation. Application of these results would depend on trial context and follow-up procedures.

Ethnic differences in adolescent lung function: anthropometric, socioeconomic, and psychosocial factors.

RATIONALE The relative contribution of body proportion and social exposures to ethnic differences in lung function has not previously been reported in the United Kingdom. OBJECTIVES To examine ethnic differences in lung function in relation to anthropometry and social and psychosocial factors in early adolescence. METHODS The subjects of this study were 3,924 pupils aged 11 to 13 years, of whom 80% were ethnic minorities with satisfactory lung function measures. Data were collected on economic disadvantage, psychological well-being, tobacco exposure, height, FEV(1), and FVC. MEASUREMENTS AND MAIN RESULTS The lowest FEV(1) was observed for Black Caribbean/African children after adjusting for standing height (SH) (white boys: 2.475 L; 95% confidence interval [CI], 2.442-2.509; white girls: 2.449 L; 95% CI, 2.464-2.535]; Black Caribbean boys: -14% [95% CI, -16 to -12]; Black Caribbean girls: -13% [95% CI, -16 to -11]; Black African boys: -15% [95% CI, -17 to -13]; Black African girls: -17% [95% CI, -19 to -14]; Indian boys: -13% [95% CI, -16 to -11]; Indian girls: -11% [95% CI, -14 to -8]; Pakistani/Bangladeshi boys: -7% [95% CI, -9 to -5]; Pakistani/Bangladeshi girls: -9% [95% CI, -11 to -6]). Adjustment for upper body segment instead of SH achieved a further reduction in ethnic differences of 41 to 51% for children of Black African origin and 26 to 39% for the other groups. Overcrowding (boys) and poor psychological well-being (boys and girls) were independent correlates of FEV(1), explaining up to a further 10% of ethnic differences. Similar patterns were observed for FVC. Social exposures were also related to height components. CONCLUSIONS Differences in upper body segment explained more of the ethnic differences in lung function than SH, particularly among Black Caribbeans/African subjects. Social correlates had a smaller but significant impact. Future research needs to consider how differential development of lung capacity is compromised by the social patterning of growth trajectories.

Cancer incidence among first generation Scottish, Irish, West Indian and South Asian migrants living in England and Wales.

OBJECTIVES To examine the incidence of cancers among persons born in Scotland, Northern Ireland, the Irish Republic, Caribbean Commonwealth and Indian subcontinent and living in England and Wales. METHODS Longitudinal Study of 1% of population of England and Wales followed from 1971 to 1989. Standardised incidence ratios (SIRs) were derived for commonly occurring cancers and all cancers using the age-sex-specific rates for all females and all males in the Longitudinal Study. RESULTS The incidence of all malignant neoplasms among West Indians (females SIR = 67, male SIR = 70) and Indians (female SIR = 32, male SIR = 52) was low. Among South Asians, this pattern was consistent for Hindus, Sikhs and Moslems. Scottish females showed raised incidence of lung cancer (SIR = 149) and those from the Irish Republic of oral cavity and pharynx (SIR = 321), oesophageal (SIR = 219) and liver (SIR = 373) cancers. Among Northern Irish females, incidence of lung cancer (SIR = 193) was raised. West Indian and South Asian females showed low incidence of breast cancer (SIR = 55 and 45, respectively). High incidence of laryngeal (SIR = 229) and renal (SIR = 203) cancers was observed for Scottish males and of oral cancer (SIR = 259) for males from the Irish Republic. At ages 15-64, raised incidence of prostate cancer (SIR = 129) and of leukaemia (SIR = 252) was also observed for men from the Irish Republic. Northern Irish males showed raised incidence of stomach cancer (SIR = 200). CONCLUSION This study describes patterns of cancer incidence among migrant groups, most of which reflect environmental influences. This has challenging implications for sensitive targeting of primary interventions. It is important not to be complacent about lower risks of main cancers among West Indians and South Asians. In all Longitudinal Study members, breast cancer was the most common malignancy among females and lung cancer among males. This was also true for all migrant groups with the exception of Northern Irish women for whom lung cancer was the most common.

Overweight, obesity and high blood pressure in an ethnically diverse sample of adolescents in Britain: the Medical Research Council DASH study

Objectives:To examine the impact of overweight on mean, high normal and high blood pressure in early adolescence, and how this relates to ethnicity and socio-economic status.Design:Cross-sectional study with anthropometric and blood pressure measurements.Setting:A total of 51 secondary schools in London.Sample:A total of 6407 subjects, 11–13 years of age, including 1204 White UK, 698 Other Whites, 911 Black Caribbeans, 1065 black Africans, 477 Indians and 611 Pakistanis/Bangladeshis.Main outcome measures:Mean, high normal (gender, age and height-percentile-specific 90–94th percentile) and high (⩾95th percentile) blood pressure.Results:Based on the International Obesity Task Force age-specific thresholds, 19% of boys and 23% of girls were overweight, and 8% of each were obese. Overweight and obesity were associated with large increases in the prevalence of high normal and high blood pressures compared with those not overweight. The increases in the prevalence of high systolic pressure associated with overweight were as follows: boys, odds ratio 2.50 (95% confidence intervals 1.73–3.60) and girls 3.39 (2.36–4.85). Corresponding figures for obesity were: boys 4.31 (2.82–6.61) and girls 5.68 (3.61–8.95). Compared with their White British peers, obesity was associated with larger effects on blood pressure measures only among Indians, despite more overweight and obesity among black Caribbean girls and overweight among Black African girls. The effect of socio-economic status was inconsistent.Conclusions:The tendency to high blood pressure among adult Black African origin populations was not evident at these ages. These results suggest that the rise in obesity in adolescence portends a rise in early onset of cardiovascular disease across ethnic groups, with Indians appearing to be more vulnerable.