Relation between number of siblings and adult mortality and stroke risk: 25 year follow up of men in the Collaborative study

<b>Study objective</b>: To investigate the relation between number of siblings, mortality risk, and stroke risk. <b>Design</b>: Prospective cohort study. <b>Setting</b>: 27 workplaces in Scotland. <b>Participants</b>: 5765 employed men aged 35–64 from a variety of different workplaces, screened between 1970 and 1973. <b>Main results</b>: There were strong relationships between number of siblings and socioeconomic variables and also with adult behavioural measures. Men with greater numbers of siblings had an increased risk of dying of all causes, coronary heart disease, lung cancer, stomach cancer, and respiratory disease over a 25 year follow up period. Adjustment for risk factors could explain these associations, excepting stomach cancer mortality. With the definition of stroke as either a hospital admission for stroke or death from stroke, there was a strong relation between number of siblings and haemorrhagic stroke, but not ischaemic stroke. <b>Conclusions</b>: Number of siblings is strongly related to mortality risk, but as it is also related to many risk factors, adjustment for these can generally explain the relation with mortality. The exceptions are stomach cancer mortality and haemorrhagic stroke, which are known to be related to deprivation in childhood, and, in the case of stomach cancer to childhood infection

Alcohol consumption and use of acute and mental health hospital services in the West of Scotland Collaborative prospective cohort study

<b>Background</b>: Overconsumption of alcohol affects health. Data from men from the West of Scotland Collaborative study were analysed to see how reported alcohol wasrelated to acute and mental health hospital admissions. <b>Methods</b>: Men (N=5772) from a prospective cohort study located in 27 workplaces in West and Central Scotland were screened when aged 35-64 in 1970-3.The number of acute and mental health admissions and bed-days were calculated by alcohol category (none, 1-7,8-14, 15-21, 22-34 and 35 or more units per week) tothe end of 2005. Specific causes were coronary heartdisease (CHD), stroke, respiratory diseases and alcohol related. <b>Results</b>: Men who consumed 22 or more units per week had a 20% higher rate of acute admissions than non drinkers.The number of bed-days were higher for men drinking eight or more units and increased with consumption, with the highest category having a 58% higher rate of bed-days than non-drinkers. Non-drinkers had the highest admissions for CHD. For stroke, drinkers of 15 or more units had higher admissions and higher number of bed-days and these increased with increasing consumption. Respiratory admissions were higher for drinkers of 22 or more units and bed-days were higher for drinkers of 15 or more units. Alcohol-related admissions and number of bed-days generally increased with consumption. Mental health admissions and number of bed-days were raised for drinkers of 22 or more units with a suggestion of a J-shaped relationship. <b>Conclusion</b>: Alcohol consumption has a substantialeffect on acute and mental health admissions and bed-days

Some social and physical correlates of intergenerational social mobility: evidence from the west of Scotland Collaborative Study

Mainstream sociological studies of intergenerational social mobility have emphasised social factors such as education and the material and cultural resources of the family of origin as the main influences on the chances and direction of social mobility. Medical sociology in contrast has been more interested in its physical correlates such as height and health status. Data from the West of Scotland Collaborative study allow an examination of the relationship between social mobility and both social and physical factors. Height, education and material circumstances in the family of origin, indexed as the number of siblings, were each independently associated with the chances of both upward and downward social mobility in this dataset. In each case the net effect of this social mobility was to constrain the social distribution of these variables. Any role which these factors may play in indirect health selection, it is argued, cannot account for social class differences in adult health

The relation between questions indicating transient ischaemic attack and stroke in 20 years of follow up in men and women in the Renfrew/Paisley Study

<b>STUDY OBJECTIVE</b> Transient ischaemic attack (TIA) is often a precursor to stroke, so identification of people experiencing TIA could assist in stroke prevention by indicating those at high risk of stroke who would benefit most from intervention for other stroke risk factors. The objective of this study was to investigate whether answers to a simple questionnaire for TIA could predict the occurrence of stroke in the following 20 years. DESIGNProspective cohort study, conducted between 1972 and 1976, with 20 years of follow up. <b>SETTING</b> Renfrew and Paisley, Scotland. <b>PARTICIPANTS</b> 7052 men and 8354 women aged 45-64 years at the time of screening completed a questionnaire and attended a physical examination. The questionnaire asked participants if they had ever, without warning, suddenly lost the power of an arm, suddenly lost the power of a leg, suddenly been unable to speak properly or suddenly lost consciousness. These four questions were taken as indicators of TIA and were related to subsequent stroke mortality or hospital admission. <b>MAIN RESULTS</b> For women, each question was significantly related to stroke risk, whereas for men only the question on loss of power of arm was significantly related to stroke risk. Men and women answering two or more questions positively had double the relative rate of stroke compared with men and women answering none of the questions positively, even after adjusting for other risk factors for stroke. <b>CONCLUSIONS</b> A simple questionnaire for TIA could help predict stroke over 20 years of follow up. Targeting men and women who report TIA with early treatment could help to prevent strokes from occurring

Milk, coronary heart disease and mortality

<b>STUDY OBJECTIVE</b> To study the association between reported milk consumption and cardiovascular and all cause mortality. <b>DESIGN</b> A prospective study of 5765 men aged 35-64 at the time of examination. <b>SETTING</b> Workplaces in the west of Scotland between 1970 and 1973. <b>PARTICIPANTS</b> Men who completed a health and lifestyle questionnaire, which asked about daily milk consumption, and who attended for a medical examination. <b>MAIN RESULTS</b> 150 (2.6%) men reported drinking more than one and a third pints a day, Some 2977 (51.6%) reported drinking between a third and one and a third pints a day and 2638 (45.8%) reported drinking less than a third of a pint a day. There were a total of 2350 deaths over the 25 year follow up period, of which 892 deaths were attributed to coronary heart disease. The relative risk, adjusted for socioeconomic position, health behaviours and health status for deaths from all causes for men who drank one third to one and a third pints a day versus those who drank less than a third of a pint was 0.90 (95% CI 0.83, 0.97). The adjusted relative risk for deaths attributed to coronary heart disease for men who drank one third to one and a third pints a day versus those who drank less than one third of a pint was 0.92 (95% CI 0.81, 1.06). <b>CONCLUSIONS</b> No evidence was found that men who consumed milk each day, at a time when most milk consumed was full fat milk, were at increased risk of death from all causes or death from coronary heart disease

Psychological distress, physical illness, and risk of coronary heart disease

Study objective: The aims of this study are to confirm the association between psychological distress and coronary heart disease (CHD) using an epidemiological community study with hospital admissions data and to examine if any association is explained by existing illness. Design: Prospective cohort study modelling the association between psychological distress, measured using the 30 item general health questionnaire (GHQ), and hospital admissions data for CHD (ICD 410–414), using proportional hazards modelling adjusted for sociodemographic, CHD risk factors, and angina, bronchitis, diabetes, ischaemia, and stroke. Setting: Two suburbs of Glasgow, Renfrew and Paisley, in Scotland. Participants: 6575 men and women aged 45–64 years from Paisley. Main: results: Five year CHD risk in distressed men compared with non-distressed men was 1.78 (95% confidence intervals (CI), 1.15 to 2.75) in age adjusted analysis, 1.78 (95% CI, 1.14 to 2.79) with sociodemographic and CHD risk factor adjustment, and 1.61 (95% CI 1.02 to 2.55) with additional adjustment for existing illness. Psychological distress was unrelated to five year CHD risk in women. In further analysis, compared with healthy, non-distressed men, distressed physically ill men had a greater risk of CHD than non-distressed physically ill men, a relative risk of 4.01 (95% CI 2.42 to 6.66) compared with 2.12 (95% CI 1.35 to 3.32). Conclusion: The association of psychological distress with an increased risk of five year CHD risk in men could be a function of baseline physical illness but an effect independent of physical illness cannot be ruled out. Its presence among physically ill men greatly increases CHD risk

Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study

<b>Objective:</b> To investigate the association between social circumstances in childhood and mortality from various causes of death in adulthood. Design: Prospective observational study. Setting: 27 workplaces in the west of Scotland. <b>Subjects:</b> 5645 men aged 35-64 years at the time of examination. <b>Main outcome measures:</b> Death from various causes. <b>Results:</b> Men whose fathers had manual occupations when they were children were more likely as adults to have manual jobs and be living in deprived areas. Gradients in mortality from coronary heart disease, stroke, lung cancer, stomach cancer, and respiratory disease were seen (all P<0.05), generally increasing from men whose fathers had professional and managerial occupations (social class I and II) to those whose fathers had semiskilled and unskilled manual occupations (social class IV and V). Relative rates of mortality adjusted for age for men with fathers in manual versus non-manual occupations were 1.52 (95% confidence interval 1.24 to 1.87) for coronary heart disease, 1.83 (1.13 to 2.94) for stroke, 1.65 (1.12 to 2.43) for lung cancer, 2.06 (0.93 to 4.57) for stomach cancer, and 2.01 (1.17 to 3.48) for respiratory disease. Mortality from other cancers and accidental and violent death showed no association with fathers' social class. Adjustment for adult socioeconomic circumstances and risk factors did not alter results for mortality from stroke and stomach cancer, attenuated the increased risk of coronary heart disease and respiratory disease, and essentially eliminated the association with lung cancer. <b>Conclusions:</b> Adverse socioeconomic circumstances in childhood have a specific influence on mortality from stroke and stomach cancer in adulthood, which is not due to the continuity of social disadvantage throughout life. Deprivation in childhood influences risk of mortality from coronary heart disease and respiratory disease in adulthood, although an additive influence of adulthood circumstances is seen in these cases. Mortality from lung cancer, other cancer, and accidents and violence is predominantly influenced by risk factors that are related to social circumstances in adulthood

Carboxyhaemoglobin concentration, smoking habit, and mortality in 25 years in the Renfrew/Paisley prospective cohort study

Objective: To investigate how carboxyhaemoglobin concentration is related to smoking habit and to assess whether carboxyhaemoglobin concentration is related to mortality. Design: Prospective cohort study. Setting: Residents of the towns of Renfrew and Paisley in Scotland. Participants: The whole Renfrew/Paisley study, conducted between 1972 and 1976, consisted of 7048 men and 8354 women aged 45–64 years. This study was based on 3372 men and 4192 women who were screened after the measurement of carboxyhaemoglobin concentration was introduced about halfway through the study. Main outcome measures: Deaths from coronary heart disease (CHD), stroke, chronic obstructive pulmonary disease (COPD), lung cancer, and all causes in 25 years after screening. Results: Carboxyhaemoglobin concentration was related to self reported smoking and for each smoking category was higher in participants who reported inhaling than in those who reported not inhaling. Carboxyhaemoglobin concentration was positively related to all causes of mortality analysed (relative rates associated with a 1 SD (2.93) increase in carboxyhaemoglobin for all causes, CHD, stroke, COPD, and lung cancer were 1.26 (95% confidence interval (CI) 1.19 to 1.34), 1.19 (95% CI 1.13 to 1.26), 1.19 (95% CI 1.13 to 1.26), 1.64 (95% CI 1.47 to 1.84), and 1.69 (95% CI 1.60 to 1.79), respectively). Adjustment for self reported cigarette smoking attenuated the associations but they remained relatively strong. Conclusions: Self reported smoking data were validated by the objective measure of carboxyhaemoglobin concentration. Since carboxyhaemoglobin concentration remained associated with mortality after adjustment for smoking, carboxyhaemoglobin seems to capture more of the risk associated with smoking tobacco than does self reported tobacco consumption alone. Analysing mortality by self reported cigarette smoking underestimates the strength of association between smoking and mortality

The relation between adult height and haemorrhagic and ischaemic stroke in the Renfrew/Paisley study

Adult height is a useful marker of fetal growth, growth and nutrition in childhood and childhood infections. Studies reporting inverse associations between height and stroke therefore provide support for the hypothesis that exposures acting in early life are important determinants of risk of stroke. However, few studies have been able to examine the association between height and stroke subtype. We recently showed that height is inversely related to ischaemic stroke, but because of small numbers it was not possible to robustly analyse the association between height and haemorrhagic stroke. A Norwegian study has shown a stronger inverse association with haemorrhagic compared with ischaemic stroke, but adjustment for socioeconomic position was not possible. We recently reported a significant inverse association between height and stroke mortality in both men and women in the Renfrew/Paisley cohort. Here we examine the association between height and subtype of incident stroke in this cohort

Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men

Both subjective and objective measures of lower social position have been shown to be associated with poorer health. A psychosocial, as opposed to material, aetiology of health inequalities predicts that subjective social status should be a stronger determinant of health than objective social position. In a workplace based prospective study of 5232 Scottish men recruited in the early 1970s and followed up for 25 years we examined the association between objective and subjective indices of social position, perceived psychological stress, cardiovascular disease risk factors and subsequent health. Lower social position, whether indexed by more objective or more subjective measures, was consistently associated with an adverse profile of established disease risk factors. Perceived stress showed the opposite association. The main subjective social position measure used was based on individual perceptions of workplace status (as well as their actual occupation, men were asked whether they saw themselves as “employees”, “foremen”, or “managers”). Compared to foremen, employees had a small and imprecisely estimated increased risk of all cause mortality, whereas managers had a more marked decreased risk. The strongest predictors of increased mortality were father's manual as opposed to non-manual occupation; lack of car access and shorter stature, (an indicator of material deprivation in childhood). In the fully adjusted analyses, perceived work-place status was only weakly associated with mortality. In this population it appears that objective material circumstances, particularly in early life, are a more important determinant of health than perceptions of relative status. Conversely, higher perceived stress was not associated with poorer health, presumably because, in this population, higher stress was not associated with material disadvantage. Together these findings suggest that, rather than targeting perceptions of disadvantage and associated negative emotions, interventions to reduce health inequalities should aim to reduce objective material disadvantage, particularly that experienced in early life