Ventilatory function as a predictor of mortality in lifelong non-smokers: evidence from large British cohort studies

Background Reduced ventilatory function is an established predictor of all-cause mortality in general population cohorts. We sought to verify this in lifelong non-smokers, among whom confounding by active smoking can be excluded, and investigate associations with circulatory and cancer deaths. Methods In UK Biobank, among 149 343 white never-smokers aged 40–69 years at entry, 2401 deaths occurred over a mean of 6.5-year follow-up. In the Health Surveys for England (HSE) 1995, 1996, 2001 and Scottish Health Surveys (SHS) 1998 and 2003 combined, there were 500 deaths among 6579 white never-smokers aged 40–69 years at entry, followed for a mean of 13.9 years. SD (z) scores for forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) were derived using Global Lung Initiative 2012 reference equations. These z-scores were related to deaths from all causes, circulatory disease and cancers using proportional hazards models adjusted for age, sex, height, socioeconomic status, region and survey. Results In the HSE–SHS data set, decreasing z-scores for FEV1 (zFEV1) and FVC (zFVC) were each associated to a similar degree with increased all-cause mortality (hazard ratios per unit decrement 1.17, 95% CI 1.09 to 1.25 for zFEV1 and 1.19, 95% CI 1.10 to 1.28 for zFVC). This was replicated in Biobank (HRs 1.21, 95% CI 1.17 to 1.26 and 1.24, 1.19 to 1.29, respectively). zFEV1 and zFVC were less strongly associated with mortality from circulatory diseases in HSE–SHS (HR 1.22, 95% CI 1.06 to 1.40 for zFVC) than in Biobank (HR 1.47, 95% CI 1.35 to 1.60 for zFVC). For cancer mortality, HRs were more consistent between cohorts (for zFVC: HRs 1.12, 95% CI 1.01 to 1.24 in HSE–SHS and 1.10, 1.05 to 1.15 in Biobank). The strongest associations were with respiratory mortality (for zFVC: HRs 1.61, 95% CI 1.25 to 2.08 in HSE–SHS and 2.15, 1.77 to 2.61 in Biobank). Conclusions Spirometric indices predicted mortality more strongly than systolic blood pressure or body mass index, emphasising the importance of promoting lung health in the general population, even among lifelong non-smokers

The health benefits of a targeted cash transfer: The UK Winter Fuel Payment.

Each year, the UK records 25,000 or more excess winter deaths, primarily among the elderly. A key policy response is the "Winter Fuel Payment" (WFP), a labelled but unconditional cash transfer to households with a member above the female state pension age. The WFP has been shown to raise fuel spending among eligible households. We examine the causal effect of the WFP on health outcomes, including self-reports of chest infection, measured hypertension, and biomarkers of infection and inflammation. We find a robust, 6 percentage point reduction in the incidence of high levels of serum fibrinogen. Reductions in other disease markers point to health benefits, but the estimated effects are less robust

Scottish Health Survey, 2003

<p>Abstract copyright UK Data Service and data collection copyright owner.</p>The <I>Scottish Health Survey</I> (SHeS) series was established in 1995. Commissioned by the Scottish Government Health Directorates, the series provides regular information on aspects of the public's health and factors related to health which cannot be obtained from other sources. The SHeS series was designed to:<ul><li>estimate the prevalence of particular health conditions in Scotland;</li><li>estimate the prevalence of certain risk factors associated with these health conditions and to document the pattern of related health behaviours;</li><li>look at differences between regions and between subgroups of the population in the extent of their having these particular health conditions or risk factors, and to make comparisons with other national statistics for Scotland and England;</li><li>monitor trends in the population's health over time;</li><li>make a major contribution to monitoring progress towards health targets.</li></ul>Each survey in the series includes a set of core questions and measurements (height and weight and, if applicable, blood pressure, waist circumference, urine and saliva samples), plus modules of questions on specific health conditions that vary from year to year. Each year the core sample has also been augmented by an additional boosted sample for children. Since 2008 NHS Health Boards have also had the opportunity to boost the number of adult interviews carried out in their area. <br> <br> The Scottish Government <a href="http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/scottish-health-survey" title="Scottish Health Survey">Scottish Health Survey</a> webpages contain further information about the series, including latest news and publications. <br> <br>The <i>Scottish Health Survey, 2003 </i> was designed to provide data at both national and regional level about the population living in private households in Scotland. The sample for the 2003 survey, as in 1995 and 1998, was drawn from the Postcode Address File (PAF). Sampled addresses were selected from 312 postal sectors, with 26 sectors covered each month. Each point contained 44 addresses, 26 of these formed the main sample where all adults and up to 2 children per household were eligible to take part. The remaining 18 addresses formed a child boost sample at which only households containing children aged 0-15 were eligible to take part. This was done to ensure that sufficient numbers of children were included in the sample overall. All private households in the general population sample were eligible for inclusion in the survey (up to a maximum of three households per address).<br> <br> Information was obtained directly from persons aged 13 and over. Information about children under 13 was obtained from a parent with the child present.<br> An interview with each eligible person (stage 1) was followed by a nurse visit (stage 2) both using computer-assisted interviewing. Of the original 312 sample points, the nurse visit was split into 3 sample types, 210 standard sample points, 58 ECG sample points and 44 spot urine sample points. In the ECG points adults aged 35 and over were asked to participate in an ECG test in addition to the standard measurements carried out in the nurse visit. In the urine points adults aged 16 and over were asked to provide a urine sample for the analysis of dietary electrolytes. The ECG and urine points did not overlap.<br> <br> The standard nurse visit collected blood pressure measurements, saliva samples, waist and hip, mid-upper arm circumference and demi-span measurements, lung function and non-fasting blood samples.Blood and saliva samples were sent to a laboratory for analysis. Interviewing was conducted throughout the year to take account of seasonal differences.<br> <br> For the second edition (June 2011), a revised version of the individual file was deposited, containing revisions to the derived variables in the alcohol and adult physical activity sections. A document explaining the revisions has also been provided. <br><B>Main Topics</B>:<br>Topics covered in the interviewer visit in the 2003 survey were general health, cardiovascular disease and use of services, asthma, accidents, eating habits, adult (16+) and child (2-15) physical activity, fruit and vegetable consumption, smoking, alcohol consumption, dental health, economic activity, education, parental history, measurements and standard classification questions. <br> <br> The nurse visit covered prescribed medicines, immunisations, measurements at birth and feeding, infant length measurements, vitamin supplements, nicotine replacements, food poisoning, upper arm circumference (2-15), blood pressure (5+), demi-span (65+), waist and hip circumference (16+), lung function (7+), blood sample (11+), saliva sample (4+), ECG (35+) and urine sample (16+).<br

Vertical and horizontal aspects of socio-economic inequity in general practitioner contacts in Scotland

Health status varies across socio-economic groups and health status is generally assumed to predict health care needs. Therefore the need for health care varies across socio-economic groups, and studies of equity in the distribution of health care between socio-economic groups must compare levels of utilisation with levels of need. Economic studies of equity in health care generally assume that health care needs can be derived from the current health-health care relationship. They therefore do not consider whether the current health-health care relationship is (vertically) equitable and the focus is restricted to horizontal inequity. This paper proposes a framework for incorporating the implications of vertical inequity for the socio-economic distribution of health care. An alternative to the current health-health care relationship is proposed using a restriction on the health-elasticity of health care. The health-elasticity of general practitioner contacts in Scotland is found to be generally negative, but positive at low levels of health status. Pro-rich estimates of horizontal inequity and vertical inequity are obtained but neither is statistically significant. Further analysis demonstrates that the magnitude of vertical inequity in health care may be larger than horizontal inequity. Copyright © 2002 John Wiley & Sons, Ltd.