Area deprivation across the life course and physical capability in mid-life: findings from the 1946 British Birth Cohort

Physical capability in later life is influenced by factors occurring across the life course, yet exposures to area conditions have only been examined cross-sectionally. Data from the National Survey of Health and Development, a longitudinal study of a 1946 British birth cohort, were used to estimate associations of area deprivation (defined as percentage of employed people working in partly skilled or unskilled occupations) at ages 4, 26, and 53 years (residential addresses linked to census data in 1950, 1972, and 1999) with 3 measures of physical capability at age 53 years: grip strength, standing balance, and chair-rise time. Cross-classified multilevel models with individuals nested within areas at the 3 ages showed that models assessing a single time point underestimate total area contributions to physical capability. For balance and chair-rise performance, associations with area deprivation in midlife were robust to adjustment for individual socioeconomic position and prior area deprivation (mean change for a 1-standard-deviation increase: balance, −7.4% (95% confidence interval (CI): −12.8, −2.8); chair rise, 2.1% (95% CI: −0.1, 4.3)). In addition, area deprivation in childhood was related to balance after adjustment for childhood socioeconomic position (−5.1%, 95% CI: −8.7, −1.6). Interventions aimed at reducing midlife disparities in physical capability should target the socioeconomic environment of individuals—for standing balance, as early as childhood

U.S. State Policy Contexts and Physical Health among Midlife Adults

This study examines how state policy contexts may have contributed to unfavorable adult health in recent decades. It merges individual-level data from the 1993–2016 Behavioral Risk Factor Surveillance System (n=2,166,835) with 15 state-level policy domains measured annually on a conservative to liberal continuum. We examined associations between policy domains and health among adults ages 45–64 years and assess how much of the associations is accounted by adults’ socioeconomic, behavioral/lifestyle, and family factors. A more liberal version of the civil rights domain was associated with better health. It was disproportionately important for less-educated adults and women, and its association with adult health was partly accounted by educational attainment, employment, and income. Environment, gun safety, and marijuana policy domains were, to a lesser degree, predictors of health in some model specifications. In sum, health improvements require a greater focus on macro-level factors that shape the conditions in which people live

Does an elite education benefit health? Findings from the 1970 British Cohort Study

Background Attending private school or a higher status university is thought to benefit future earnings and occupational opportunities. We examined whether these measures were beneficially related to health and selected health-related behaviours in midlife. Methods Data were from up to 9799 participants from the 1970 British birth Cohort Study. The high school attended (private, grammar, or state) was ascertained at 16 years, and the university attended reported at 42 years (categorised as either a higher (Russell Group institution) or normal status institutions). Self-reported health, limiting illness, and BMI were reported at 42 years, along with television viewing, take-away meal consumption, physical inactivity, smoking, and high risk alcohol drinking. Associations were examined using multiple regression models, adjusted for gender, childhood socioeconomic, health, and cognitive measures. Results Private school and higher status university attendance were associated with favourable self-rated health, lower BMI, and beneficially associated with health related-behaviours. For example, private school attendance was associated with 0.56 (95% CI: 0.48, 0.65) odds of lower self-rated health (OR for higher status university: 0.32 (0.27, 0.37)). Associations were largely attenuated by adjustment for potential confounders, except for those of private schooling and higher status university attendance with lower BMI and television viewing, and less frequent take-away meal consumption. Conclusions Private school and higher status university attendance were related to better self-rated health, lower BMI, and multiple favourable health behaviours in midlife. Findings suggest that type or status of education may be an important under-researched construct to consider when documenting and understanding socioeconomic inequalities in health

Life Course Socioeconomic Position and Mid-Late Life Cognitive Function in Eastern Europe.

Objectives.To investigate whether the positive relation between socioeconomic position (SEP) across the life course and later life cognitive function observed in Western populations exists in former communist countries with apparently smaller income inequalities.Method.Structural equation modeling analysis of cross-sectional data on 30,846 participants aged 45-78 years in four Central and Eastern European centers: Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania), and six Czech towns from the HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study. SEP was measured using self-reported childhood (maternal education, household amenities), adult (education), and older adult (current material circumstances) indicators. Latent variable for cognition was constructed from word recall, animal naming, and letter search

Contribution of smoking towards the association between socioeconomic position and dementia : 32-year follow-up of the Whitehall II prospective cohort study

Background There is consistent evidence of social inequalities in dementia but the mechanisms underlying this association remain unclear. We examined the role of smoking in midlife in socioeconomic differences in dementia at older ages.Methods Analyses were based on 9951 (67% men) participants, median age 44.3 [IQR=39.6, 50.3] years at baseline in 1985-1988, from the Whitehall II cohort study. Socioeconomic position (SEP) and smoking (smoking status (cur-rent, ex-, never-smoker), pack years of smoking, and smoking history score (combining status and pack-years)) were measured at baseline. Counterfactual mediation analysis was used to examine the contribution of smoking to the association between SEP and dementia.Findings During a median follow-up of 31.6 (IQR 31.1, 32.6) years, 628 participants were diagnosed with dementia and 2110 died. Analyses adjusted for age, sex, ethnicity, education, and SEP showed smokers (hazard ratio [HR] 1.36 [95% CI 1.10-1.68]) but not ex-smokers (HR 0.95 [95% CI 0.79-1.14]) to have a higher risk of dementia compared to never-smokers; similar results for smoking were obtained for pack-years of smoking and smoking history score. Mediation analysis showed low SEP to be associated with higher risk of dementia (HRs between 1.97 and 2.02, depending on the measure of smoking in the model); estimate for the mediation effect was 16% for smoking status (Indirect Effect HR 1.09 [95% CI 1.03-1.15]), 7% for pack-years of smoking (Indirect Effect HR 1.03 [95% CI 1.01 -1.06]) and 11% for smoking history score (Indirect Effect HR 1.06 [95% CI 1.02-1.10]). Interpretation Our findings suggest that part of the social inequalities in dementia is mediated by smoking.Funding NIHCopyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) The Health 2022;23: Published https://doi.org/10.1016/j. lanepe.2022.100516Peer reviewe

Longitudinal patterns of physical activity from midlife to old age: predictors and consequences for cardiovascular disease morbidity and mortality risks

BACKGROUND/AIMS: Physical activity is important for almost all aspects of healthy ageing, including cardiovascular disease (CVD) prevention. While an age-related decline in physical activity is clear from cross-sectional studies, there are few prospective cohort studies with sufficient follow up to identify the long-term patterns of physical activity across adulthood and into old age. Subsequently, the predictors and health consequences of long-term patterns of physical activity are unclear. The primary aim of this thesis is to identify the patterns of long-term physical activity from midlife to old age and examine the predictors of such patterns and consequences in relation to cardiovascular morbidity and mortality. METHODS: This thesis uses data from the British Regional Heart Study, a prospective cohort study of men recruited in 1978-80 when they were aged 40 to 59 years. Initially, this thesis uses data from baseline up to the 20-year follow up, when men were aged 60-79 years, to examine change and trajectories of total and specific types of physical activity. Subsequent analyses explore associations between trajectories of physical activity and CVD risk factors, major stroke and coronary heart disease events, CVD mortality and all-cause mortality up until June 2016. RESULTS: One of the key findings was that total physical activity levels in old age were largely predicted by midlife physical activity. Trajectories of physical activity varied according to type; walking and recreational activity were more variable over time than total physical activity and sport/exercise. Smoking, being overweight or obese and suffering from breathlessness were associated with increased odds of following unfavourable trajectories for total and specific types of physical activity. Sociodemographic, health and behavioural factors were also associated but the direction and magnitude of associations were specific to physical activity type. Compared to a low, decreasing trajectory, light stable and moderate, increasing trajectories were associated with more favourable levels of CVD risk factors and a lower risk of all-cause mortality, CVD mortality and major coronary heart disease. There was also a dose-response relationship, suggesting that higher levels of physical activity across adulthood were more favourable. CONCLUSIONS: Physical activity levels in midlife largely determine activity levels throughout adulthood and into old age. Sport and exercise appears to be the most stable physical activity type and the strongest predictor of subsequent activity levels, whereas walking and recreational activity are more variable. A range of sociodemographic, health and behavioural factors were associated with long-term patterns of physical activity and could be used to inform intervention strategies. Although sustaining/increasing moderate levels of physical activity from midlife to old age are optimal for minimising risks of CVD and mortality, maintaining a light level of physical activity across the adult life course can also provide significant survival benefits and could be achievable for the least active

Body mass index, prudent diet score and social class across three generations: evidence from the Hertfordshire Intergenerational Study.

BACKGROUND: Studies describing body mass index (BMI) and prudent diet score have reported that they are associated between parents and children. The Hertfordshire Intergenerational Study, which contains BMI, diet and social class information across three generations, provides an opportunity to consider the influence of grandparental and parental BMI and prudent diet score across multiple generations, and the influence of grandparental and parental social class on child BMI. METHODS: Linear regressions examining the tracking of adult BMI and prudent diet score across three generations (grandparent (F0), parent (F1) and child (F2)) were run from parent to child and from grandparent to grandchild. Linear mixed models investigated the influence of F0 and F1 BMI or prudent diet score on F2 BMI and prudent diet score. Linear regressions were run to determine whether social class and prudent diet score of parents and grandparents influenced the BMI of children and grandchildren. RESULTS: BMI was significantly associated across each generational pair and from F0 to F1 in multilevel models. Prudent diet score was significantly positively associated between grandparents and grandchildren. Lower grandparental and parental social class had a significantly positive association with F2 BMI (F0 low social class: b=1.188 kg/m2, 95% CI 0.060 to 2.315, p=0.039; F1 middle social class: b=2.477 kg/m2, 95% CI 0.726 to 4.227, p=0.006). CONCLUSION: Adult BMI tracks across generations of the Hertfordshire Intergenerational Study, and child BMI is associated with parental and grandparental social class. The results presented here add to literature supporting behavioural and social factors in the transmission of BMI across generations

The Power of Birth Cohorts to Study Risk Factors for Cognitive Impairment

PURPOSE OF REVIEW: Birth cohorts are studies of people the same time; some of which have continuously followed participants across the life course. These are powerful designs for studying predictors of age-related outcomes, especially when information on predictors is collected before these outcomes are known. This article reviews recent findings from these cohorts for the outcomes of cognitive function, cognitive impairment, and risk of dementia, in relation to prior cognitive function, and social and biological predictors. RECENT FINDINGS: Cognitive function and impairment are predicted by a wide range of factors, including childhood cognition, education, occupational status and complexity, and biological factors, including genetic and epigenetic. The particular importance of high and rising blood pressure in midlife is highlighted, with some insight into brain mechanisms involved. Some limitations are noted, including sources of bias in the data. Despite these limitations, birth cohorts have provided valuable insights into factors across the life course associated with cognitive impairment

Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: A cohort study

BACKGROUND: Multimorbidity is increasingly common and is associated with adverse health outcomes, highlighting the need to broaden the single-disease framework that dominates medical research. We examined the role of midlife clinical characteristics, socioeconomic position, and behavioural factors in the development of cardiometabolic multimorbidity (at least 2 of diabetes, coronary heart disease, and stroke), along with how these factors modify risk of mortality. METHODS AND FINDINGS: Data on 8,270 men and women were drawn from the Whitehall II cohort study, with mean follow-up of 23.7 years (1985 to 2017). Three sets of risk factors were assessed at age 50 years, each on a 5-point scale: clinical profile (hypertension, hypercholesterolemia, overweight/obesity, family history of cardiometabolic disease), occupational position, and behavioural factors (smoking, alcohol consumption, diet, physical activity). The outcomes examined were cardiometabolic disease (diabetes, coronary heart disease, stroke), cardiometabolic multimorbidity, and mortality. We used multi-state models to examine the role of risk factors in 5 components of the cardiometabolic disease trajectory: from healthy state to first cardiometabolic disease, from first cardiometabolic disease to cardiometabolic multimorbidity, from healthy state to death, from first cardiometabolic disease to death, and from cardiometabolic multimorbidity to death. A total of 2,501 participants developed 1 of the 3 cardiometabolic diseases, 511 developed cardiometabolic multimorbidity, and 1,406 died. When behavioural and clinical risk factors were considered individually, only smoking was associated with all five transitions. In a model containing all 3 risk factor scales, midlife clinical profile was the strongest predictor of first cardiometabolic disease (hazard ratio for the least versus most favourable profile: 3.74; 95% CI: 3.14-4.45) among disease-free participants. Among participants with 1 cardiometabolic disease, adverse midlife socioeconomic (1.54; 95% CI: 1.10-2.15) and behavioural factors (2.00; 95% CI: 1.40-2.85), but not clinical characteristics, were associated with progression to cardiometabolic multimorbidity. Only midlife behavioural factors predicted mortality among participants with cardiometabolic disease (2.12; 95% CI: 1.41-3.18) or cardiometabolic multimorbidity (3.47; 95% CI: 1.81-6.66). A limitation is that the study was not large enough to estimate transitions between each disease and subsequent outcomes and between all possible pairs of diseases. CONCLUSIONS: The importance of specific midlife factors in disease progression, from disease-free state to single disease, multimorbidity, and death, varies depending on the disease stage. While clinical risk factors at age 50 determine the risk of incident cardiometabolic disease in a disease-free population, midlife socioeconomic and behavioural factors are stronger predictors of progression to multimorbidity and mortality in people with cardiometabolic disease

Baby Boomers & adult Ageing: Issues for Social and Public policy

This paper provides a critical assessment of academic and policy approaches to population ageing with an emphasis on the baby boomer cohort and constructions of late-life identity. It is suggested that policy towards an ageing population has shifted in focus, away from particular social hazards and towards an attempt to re-engineer the meaning of legitimate ageing and social participation in later life. Three themes are identified: constructing the baby boomers as a force for social change, a downward drift of the age associated with 'older people' and a shift away from defining ageing identities through consumption, bacl towards work and production. The paper concludes with a discussion of the implications for future social and public policy