Women?s health in mid-life: life course social roles and agencyas quality

Data from a prospective British birth cohort study showed that women who were childless, lone mothers or full-timehomemakers between the ages of 26 and 54 were more likely to report poor health at age 54 than women who occupiedmultiple roles between these ages. To explain this finding we developed and tested a theory of role quality based on theconcept of agency by drawing on Giddens? theory of structuration and Doyal and Gough?s theory of human needs.According to our theory, the patriarchal structuration (drawing on Giddens? term) of work and family roles provides bothlimitation and opportunity for the expression of agency. Doyal and Gough?s theory of human needs was then used toidentify the restriction of agency as a possible influence on health. This theory of role quality was operationalised using ameasure of work (paid and unpaid) quality at age 36 and a measure of work and family stress between ages 48 and 54. Therelatively poor subjective health in mid-life of lone mothers was explained by work and family stress and adult social class.In contrast, the poor health in mid-life of long-term homemakers and childless women was less easily explained.Homemaker?s excess risk of reporting poor health at age 54 remained strong and significant even after adjusting for rolequality and socioeconomic indicators, and childless women were at an increased risk of reporting poor health despite thesocial advantage inherent in attaining educational qualifications and occupying professional or managerial occupations.This study highlights the need to develop measures of role quality specifically designed to capture agency aspects of socialroles

From paediatrics to geriatrics: a life course perspective on the MRC National Survey of Health and Development

For over 40 years I have enjoyed working collaboratively on research projects to increase understanding of population health with the aim of ultimately improving quality of life. For almost 30 years I have been part of the study team responsible for the MRC National Survey of Health and Development (NSHD), the oldest of the British birth cohort studies; and for the last 10 years have had the privilege of being the NSHD director. Such a long-term study depends on a committed and scientifically productive study team which maintains study member engagement and attracts expert scientific collaborators. For the last 20 years, I have collaborated with Professor Yoav Ben-Shlomo and others to develop the field of life course epidemiology, the study of the long term effects of social and biological exposures and experiences across life on later life health. So at the outset, I acknowledge that this personal opinion piece which I was invited to submit has implicitly and explicitly been influenced by many colleagues. It also should be read in conjunction with an accompanying article in this issue on the recent 24th follow-up of the NSHD at the age of 70 years (Kuh et al., this issue) and a recent updated review of life course epidemiology

Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies

BACKGROUND: Socioeconomic inequalities in childhood body-mass index (BMI) have been documented in high-income countries; however, uncertainty exists with regard to how they have changed over time, how inequalities in the composite parts (ie, weight and height) of BMI have changed, and whether inequalities differ in magnitude across the outcome distribution. Therefore, we aimed to investigate how socioeconomic inequalities in childhood and adolescent weight, height, and BMI have changed over time in Britain. METHODS: We used data from four British longitudinal, observational, birth cohort studies: the 1946 Medical Research Council National Survey of Health and Development (1946 NSHD), 1958 National Child Development Study (1958 NCDS), 1970 British Cohort Study (1970 BCS), and 2001 Millennium Cohort Study (2001 MCS). BMI (kg/m2) was derived in each study from measured weight and height. Childhood socioeconomic position was indicated by the father's occupational social class, measured at the ages of 10-11 years. We examined associations between childhood socioeconomic position and anthropometric outcomes at age 7 years, 11 years, and 15 years to assess socioeconomic inequalities in each cohort using gender-adjusted linear regression models. We also used multilevel models to examine whether these inequalities widened or narrowed from childhood to adolescence, and quantile regression was used to examine whether the magnitude of inequalities differed across the outcome distribution. FINDINGS: In England, Scotland, and Wales, 5362 singleton births were enrolled in 1946, 17 202 in 1958, 17 290 in 1970, and 16 404 in 2001. Low socioeconomic position was associated with lower weight at childhood and adolescent in the earlier-born cohorts (1946-70), but with higher weight in the 2001 MCS cohort. Weight disparities became larger from childhood to adolescence in the 2001 MCS but not the earlier-born cohorts (pinteraction=0·001). Low socioeconomic position was also associated with shorter height in all cohorts, yet the absolute magnitude of this difference narrowed across generations. These disparities widened with age in the 2001 MCS (pinteraction=0·002) but not in the earlier-born cohorts. There was little inequality in childhood BMI in the 1946-70 cohorts, whereas inequalities were present in the 2001 cohort and widened from childhood to adolescence in the 1958-2001 cohorts (pinteraction<0·05 in the later three cohorts but not the 1946 NSHD). BMI and weight disparities were larger in the 2001 cohort than in the earlier-born cohorts, and systematically larger at higher quantiles-eg, in the 2001 MCS at age 11 years, a difference of 0·98 kg/m2(95% CI 0·63-1·33) in the 50th BMI percentile and 2·54 kg/m2(1·85-3·22) difference at the 90th BMI percentile were observed. INTERPRETATION: Over the studied period (1953-2015), socioeconomic-associated inequalities in weight reversed and those in height narrowed, whereas differences in BMI and obesity emerged and widened. These substantial changes highlight the impact of societal changes on child and adolescent growth and the insufficiency of previous policies in preventing obesity and its socioeconomic inequality. As such, new and effective policies are required to reduce BMI inequalities in childhood and adolescence. FUNDING: UK Economic and Social Research Council, Medical Research Council, and Academy of Medical Sciences/the Wellcome Trust

Educational attainment and women's environmental mastery in midlife: findings from a British Birth Cohort Study

Using data from 1,184 women in the MRC National Survey of Health and Development, we estimated associations between education and Ryff's environmental mastery scale scores at age 52. Confirmatory factor analysis indicated two subscales, here termed mastery skills and mastery accomplishments. Low education was associated with higher mastery skills. This was partly explained by childhood socioeconomic position, as mastery was lower among those with fathers in the most and least advantaged occupational classes. Education was not associated with mastery accomplishments in unadjusted models. Lower ambitions for family/home were associated with higher mastery accomplishments and may have partly suppressed as an association between education and mastery accomplishments. This study highlights childhood as well as adult correlates of mastery and adds to mounting evidence that higher mastery is not universally found among those who are more educated

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

Birth weight, early childhood growth and lung function in middle to early old age: 1946 British birth cohort

Background Findings from previous studies investigating the relationship between birth weight and adult lung function have been inconsistent, and data on birth weight and adult lung function decline are lacking. Few studies have investigated the relation between early childhood growth and adult lung function. Methods FEV1 and FVC were measured at ages 43 years, 53 years and 60–64 years in the 1946 British birth cohort study. Multiple linear regression models were fitted to study associations with birth weight and weight gain at age 0–2 years. Multilevel models assessed how associations changed with age, with FEV1 and FVC as repeated outcomes. Results 3276 and 3249 participants were included in FEV1 and FVC analyses, respectively. In women, there was a decreasing association between birth weight and FVC with age. From the multilevel model, for every 1 kg higher birth weight, FVC was higher on average by 66.3 mL (95% CI 0.5 to 132) at 43 years, but significance was lost at 53 years and 60–64 years. Similar associations were seen with FEV1, but linear change (decline) from age 43 years lost statistical significance after full adjustment. In men, associations with birth weight were null in multilevel models. Higher early life weight gain was associated with higher FEV1 at age 43 years in men and women combined but not in each sex. Conclusions Birth weight is positively associated with adult lung function in middle age, particularly in women, but the association diminishes with age, potentially due to accumulating environmental influences over the life course

Vascular risk factors for male and female urgency urinary incontinence at age 68 years from a British birth cohort study

OBJECTIVE: To investigate the prevalence of urgency urinary incontinence (UUI) at age 68 years and the contribution of vascular risk factors to male and female UUI pathogenesis in addition to the associations with raised body mass index (BMI). SUBJECTS AND METHODS: In all, 1 762 participants from the Medical Research Council (MRC) National Survey for Health and Development birth cohort who answered the International Consultation on Incontinence Questionnaire short form (ICIQ-SF), at age 68 years, were included. Logistic regression was used to estimate associations between UUI and earlier life vascular risk factors including: lipid status, diabetes, hypertension, BMI, previous stroke or transient ischaemic attack (TIA) diagnosis; adjusting for smoking status, physical activity, co-presentation of stress UI symptoms, educational attainment; and in women only, type of menopause, age at period cessation, and use of hormone replacement therapy (HRT). RESULTS: UUI was reported by 12% of men and 19% of women at age 68 years. Female sex, previous stroke or TIA diagnosis, increased BMI and hypertension (in men only) at age 60-64 years were independent risk factors for UUI. Female sex, increased BMI, and a previous diagnosis of stroke/TIA increased the relative risk of more severe UUI symptoms. Type and timing of menopause and HRT use did not alter the estimated associations between UUI and vascular risk factors in women. CONCLUSION: Multifactorial mechanisms lead to UUI and vascular risk factors may contribute to the pathogenesis of bladder overactivity in addition to higher BMI. Severe UUI appears to be a distinct presentation with more specific contributory mechanisms than milder UUI

Adiposity, telomere length and telomere attrition in midlife: the 1946 British Birth Cohort.

BACKGROUND: Obesity has been linked with shorter telomere length, both of which have been implicated in ageing, but the impact of early life adiposity on telomere length is unclear. METHODS: We included 2,479 participants from the MRC National Survey of Health and Development with measurements of body mass index (BMI), waist and hip circumference and leukocyte telomere length (LTL) at age 53, of whom 1,000 had second measurements at age 60-64. Relative LTL was measured with rt-PCR. Linear regression was performed to investigate associations between adiposity and LTL. BMI from childhood through adulthood was used to assess adiposity across the life course. RESULTS: We found no cross-sectional associations between adiposity measures and LTL at age 53 or 60-64. Longitudinally, each unit gain in waist circumference weakly corresponded with a 0.06% (95% CI: -1.31 to 0.10) LTL decrease annually, with association approaching statistical significance (P=0.09). Being overweight at age 6 and 15 corresponded to a non-significant shorter LTL at age 53 and they are associated with 2.06% (95% CI: 0.05 to 4.08%) and 4.26% (1.98 to 6.54%) less LTL attrition in midlife, respectively compared to those who were not overweight. CONCLUSION: There is a weak indication that greater telomere loss was seen with greater concurrent BMI gain. Adolescent overweight corresponded to shorter telomeres in midlife, albeit weakly, and with less subsequent attrition. Our findings point toward potential pathways which may link adiposity and ageing outcomes