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

Scottish Health Survey, 1995

Abstract copyright UK Data Service and data collection copyright owner.The Scottish Health Survey (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:estimate the prevalence of particular health conditions in Scotland;estimate the prevalence of certain risk factors associated with these health conditions and to document the pattern of related health behaviours;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;monitor trends in the population's health over time;make a major contribution to monitoring progress towards health targets.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. The Scottish Government Scottish Health Survey webpages contain further information about the series, including latest news and publications. The 1995 Scottish Health Survey is the first in the series. The survey consisted of a number of core questions and measurements (such as height and weight), plus modules of questions on selected subjects. The specific topic included in the 1995 survey was cardiovascular disease and its associated risk factors.For the fourth edition (October 2018),&nbsp; the variables PSU and Strata were added to the individual file.Main Topics:Physical activity: the questionnaire covers three types of physical activity: occupation, home, and sports and exercise. Two measures of physical activity were used: a frequency-intensity activity level and a maximum intensity level. Attitudes towards taking more exercise are also covered.Eating habits: information on self-reported eating habits was collected for a wide range of food types.Smoking: data on self-reported current and past smoking behaviour, attitudes to stopping smoking, and exposure to other people's tobacco smoke were collected. Levels of the blood analyte serum cotinine are used to validate self-reports of smoking behaviour.Drinking: self-reported levels of weekly alcohol consumption, attitudes to cutting down drinking, problem drinking among 16-17 year olds, and the relationship between the blood analyte gamma gt and reported alcohol consumption are covered.Blood pressure: blood pressure levels for the survey population were measured.Obesity: height, weight, body mass index (BMI), and waist-hip ratio were measured.Respiratory symptoms and lung function tests: data for three common respiratory symptoms - phlegm production, breathlessness and wheezing - were collected. Lung function test results for FEV1, FVC and PEF are contained in the dataset.Blood analytes: total and HDL-cholesterol, fibrinogen, haemoglobin and serum ferritin were analysed as well as vitamins A, C and E, and carotenoids.Cardiovascular disease and its risk factors: the survey contains questions on self-reported cardiovascular disease and related conditions. Data for the main risk factors - obesity, smoking, drinking, raised cholesterol, high blood pressure and lack of physical activity are also present.General health, use of health services, prescibed medicines and dental health: self-reported general health, longstanding illness or disability, and acute sickness in addition to the prevalence of gastroenteritis within the population was measured. Use of a number of health services - GP consultations, inpatient stays and outpatient visits, blood pressure and cholesterol monitoring are also present as are informants' reports of the prescribed medicines they take. Dental health data includes prevalence of false teeth, and dental practices.Psychosocial well-being: emotional well-being using GHQ12 was measured.Accidents: the number and causes of accidents along with their location and the types of injuries incurred are present in the dataset.Standard measures: Edinburgh Claudication questionnaire; Rose Angina questionnaire; blood pressure; body mass index; waist-hip ratio; GHQ12; MRC Respiratory questionnaire (breathlessness, phlegm and wheezing); social class based on Registrar General's Standard Occupational Classification; CAGE questionnaire for problem drinking (16-17 year olds only).</p

Health Survey for England, 1997

Abstract copyright UK Data Service and data collection copyright owner.The Health Survey for England (HSE)&nbsp;is a series of surveys designed to monitor trends in the nation's health.&nbsp; It was commissioned by NHS Digital and carried out by the Joint Health Surveys Unit of the National Centre for Social Research and the Department of Epidemiology and Public Health at University College London.The aims of the HSE series are:to provide annual data about the nation’s health;to estimate the proportion of people in England with specified health conditions;to estimate the prevalence of certain risk factors associated with these conditions;to examine differences between population subgroups in their likelihood of having specific conditions or risk factors;to assess the frequency with which particular combinations of risk factors are found, and which groups these combinations most commonly occur;to monitor progress towards selected health targetssince 1995, to measure the height of children at different ages, replacing the National Study of Health and Growth;since 1995, monitor the prevalence of overweight and obesity in children.The survey includes a number of core questions every year but also focuses on different health issues at each wave. Topics are revisited at appropriate intervals in order to monitor change. Further information about the series may be found on the NHS Digital Health Survey for England; health, social care and lifestyles webpage, the NatCen Social Research NatCen Health Survey for England webpage and the University College London Health and Social Surveys Research Group&nbsp;UCL Health Survey for England&nbsp;webpage. Changes to the HSE from 2015:Users should note that from 2015 survey onwards, only the individual data file is available under standard End User Licence (EUL). The household data file is now only included in the Special Licence (SL) version, released from 2015 onwards. In addition, the SL individual file contains all the variables included in the HSE EUL dataset, plus others, including variables removed from the EUL version after the NHS Digital disclosure review. The SL HSE is subject to more restrictive access conditions than the EUL version (see Access information). Users are advised to obtain the EUL version to see if it meets their needs before considering an application for the SL version.For the fourth edition (August 2017), a new version of the individual data file was deposited. A Government Office Region variable has been added, and some previous health authority and socio-economic variables removed.Main Topics:The 1997 survey had two separate elements: an interviewer visit and a nurse visit. At the first visit, all respondents aged 13 and over were asked to give a CAPI (computed assisted) interview on a range of health related topics. Parents/guardians of 2-12 year olds were interviewed about the child. In order to increase the number of children available for analysis in the 1997 survey, the design was modified - please see the section on 'Sampling Procedures' for further details. Information was collected on the following topics: interviewer survey: general health, longstanding illness, limiting longstanding illness, acute sickness, respiratory problems, accidents, eating habits, physical activity, smoking (respondents aged 8 years onwards), drinking (respondents aged 8 years onwards - including CAGE if 16 years and over), height/weight measurements, perception of current weight (respondents aged 8 years onwards), GHQ 12 (respondents aged 13 years and onwards - see definition below), use of contraceptive pill (respondents aged 16 years onwards), individual economic status/occupation (respondents aged 16 years onwards), educational attainment and ethnic group (respondents aged 16 years onwards). Some of the modules were administered by self-completion: information on smoking and drinking (respondents aged 8-24 years only), perception of current weight (all respondents asked), GHQ 12 (all respondents asked), use of contraceptive pill (all respondents asked). The self-completion questionnaire for parents of 4-15 year olds included questions on their child's strengths and difficulties and consultation about behavioural problems. At the nurse visit, information was collected on prescribed drugs (all age groups), vitamin supplements (all age groups) and nicotine replacements (16 years and over only). Upper arm circumference (age 2-17 year olds), waist/hip circumference (16 years and over), blood pressure (5 years and over) and lung function (7 years and over) were measured and blood (18-24 year olds only) and saliva (4-17 year olds only) samples. Blood was analysed for IgE, house dust mite IgE, cotinine and ferritin/haemoglobin. Saliva was analysed for cotinine. Some administrative data and some geographic identifiers have been left out of the dataset. Standard Measures General health questionnaire (GHQ12) - copyright David Goldberg, 1978 reproduced by permission of NFER - NELSON.<br

Scottish Health Survey, 1998

Abstract copyright UK Data Service and data collection copyright owner.The Scottish Health Survey (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:estimate the prevalence of particular health conditions in Scotland;estimate the prevalence of certain risk factors associated with these health conditions and to document the pattern of related health behaviours;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;monitor trends in the population's health over time;make a major contribution to monitoring progress towards health targets.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. The Scottish Government Scottish Health Survey webpages contain further information about the series, including latest news and publications. The 1998 Scottish Health Survey was designed to provide data at both national and regional level about the population aged 2 and over living in private households in Scotland. The sample for the 1998 survey, as in 1995, was drawn from the Postcode Address File (PAF). Sampled addresses were selected from 312 postal sectors, with 26 sectors covered each month. Each sector was covered by an interviewer/nurse team. Up to three households per address were eligible for inclusion. Where there were 4 or more households, 3 were selected at random. Within each household all persons aged 2-74 were eligible for inclusion in the survey. Where there was more than one adult aged 16-74, one was selected at random. Where there were three or more children aged 2-15, two we re selected at random. Information was obtained directly from those aged 13 or over. Information about children aged 2-12 was obtained from a parent, with the child present. An interview with each eligible person (Stage 1) was followed by a visit by a nurse (Stage 2), who made a number of measurements and requested permission to obtain a sample of blood from those aged 11 and over. Saliva samples were also collected from those aged 4 and over. Blood and saliva samples were sent to a laboratory for analysis. Interviewing was conducted throughout the year to take account of seasonal differences. Computer-assisted interviewing was used by both interviewers and nurses.For the second edition (October 2018),&nbsp; the variables ‘region’ (Health Board recoded- use for Strata) and ‘PSU’ (PSU - postcode sector) were added to the individual file.Main Topics:Topics covered in the interviewer visit in the 1998 survey were general health, cardiovascular disease and use of services, asthma, accidents, eating habits, physical activity, eating habits, psychosocial health, smoking, alcohol consumption and standard classification questions. The nurse visit covered prescribed medicines, food poisoning, mid-upper arm circumference (2-15 year olds), blood pressure (5-74), demi-span (65-74), waist and hip (16-74), lung function (7-74), blood sample (11-74) and saliva sample (2-74). Standard Measures General Health Questionnaire (GHQ12) Rose Angina questionnaire MRC Respiratory questionnair

Health Survey for England, 1996

Abstract copyright UK Data Service and data collection copyright owner.The Health Survey for England (HSE)&nbsp;is a series of surveys designed to monitor trends in the nation's health.&nbsp; It was commissioned by NHS Digital and carried out by the Joint Health Surveys Unit of the National Centre for Social Research and the Department of Epidemiology and Public Health at University College London.The aims of the HSE series are:to provide annual data about the nation’s health;to estimate the proportion of people in England with specified health conditions;to estimate the prevalence of certain risk factors associated with these conditions;to examine differences between population subgroups in their likelihood of having specific conditions or risk factors;to assess the frequency with which particular combinations of risk factors are found, and which groups these combinations most commonly occur;to monitor progress towards selected health targetssince 1995, to measure the height of children at different ages, replacing the National Study of Health and Growth;since 1995, monitor the prevalence of overweight and obesity in children.The survey includes a number of core questions every year but also focuses on different health issues at each wave. Topics are revisited at appropriate intervals in order to monitor change. Further information about the series may be found on the NHS Digital Health Survey for England; health, social care and lifestyles webpage, the NatCen Social Research NatCen Health Survey for England webpage and the University College London Health and Social Surveys Research Group&nbsp;UCL Health Survey for England&nbsp;webpage. Changes to the HSE from 2015:Users should note that from 2015 survey onwards, only the individual data file is available under standard End User Licence (EUL). The household data file is now only included in the Special Licence (SL) version, released from 2015 onwards. In addition, the SL individual file contains all the variables included in the HSE EUL dataset, plus others, including variables removed from the EUL version after the NHS Digital disclosure review. The SL HSE is subject to more restrictive access conditions than the EUL version (see Access information). Users are advised to obtain the EUL version to see if it meets their needs before considering an application for the SL version.For the fifth edition (August 2017), a new version of the individual data file was deposited. A Government Office Region variable has been added, and some previous health authority and socio-economic variables removed.Main Topics:The survey had two separate elements: an interviewer visit and a nurse visit. At the first visit all respondents aged 13 and over were asked to give a CAPI (computed assisted) interview on a range of health related topics. Parents/Guardians of 2-12 year olds were interviewed about the child. The interview collected information relating to respondents' history of respiratory and atopic conditions, non-fatal accidents and general health. Adults were questioned about smoking and drinking behaviour. All respondents aged 8 and over were then asked to complete a booklet. For adults and young adults (from the age of 16) these self-completion documents contained further modules on general health, specifically the SF-36 and EuroQol questionnaires. 8-17 year olds completed questions on smoking and drinking experiences. At the end of the interview, all respondents were asked to have their height and weight measured. A limited amount of proxy information was obtained, where possible, about those unwilling or unable to take part in the survey. Those who agreed to the second visit, made later by a nurse, were then surveyed about their use of prescribed medications. Then, if the respondent was willing, further anthropometric measurements (i.e. demi-span, mid-upper arm circumference) were taken, their blood pressure was measured and they provided a blood sample (which was analysed for IgE, house dust mite IgE, cotinine for adults and for children, ferritin, and haemoglobin). Children aged 4-15 were asked to give a saliva sample for the analysis of cotinine. Data on age at death, date of death and causes of death (ICD codes) are also included for those respondents known to have died.<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.