Which circulating antioxidant vitamins are confounded by socioeconomic deprivation? The MIDSPAN family study

<p><b>Background:</b> Antioxidant vitamins are often described as having “independent” associations with risk of cancer, cardiovascular disease (CVD) and mortality. We aimed to compare to what extent a range of antioxidant vitamins and carotenoids are associated with adulthood and childhood markers of socioeconomic deprivation and to adverse lifestyle factors.</p> <p><b>Methods and Findings:</b> Socioeconomic and lifestyle measures were available in 1040 men and 1298 women from the MIDSPAN Family Study (30–59 years at baseline) together with circulating levels of vitamins A, C, E, and carotenoids (α-carotene, β-carotene, lutein and lycopene). Markers of socioeconomic deprivation in adulthood were consistently as strongly associated with lower vitamin C and carotenoid levels as markers of adverse lifestyle; the inverse association with overcrowding was particularly consistent (vitamin C and carotenoids range from 19.1% [95% CI 30.3–6.0] to 38.8% [49.9–25.3] lower among those in overcrowded residencies). These associations were consistent after adjusting for month, classical CVD risk factors, body mass index, physical activity, vitamin supplements, dietary fat and fibre intake. Similar, but weaker, associations were seen for childhood markers of deprivation. The association of vitamin A or E were strikingly different; several adult adverse lifestyle factors associated with higher levels of vitamin A and E, including high alcohol intake for vitamin A (9.5% [5.7–13.5]) and waist hip ratio for vitamin E (9.5% [4.8–14.4]), with the latter associations partially explained by classical risk factors, particularly cholesterol levels.</p> <p><b>Conclusions:</b> Plasma vitamin C and carotenoids have strong inverse associations with adulthood markers of social deprivation, whereas vitamin A and E appear positively related to specific adverse lifestyle factors. These findings should help researchers better contextualize blood antioxidant vitamin levels by illustrating the potential limitations associated with making causal inferences without consideration of social deprivation.</p&gt

Is council tax valuation band a predictor of mortality?

BACKGROUND: All current UK indices of socio-economic status have inherent problems, especially those used to govern resource allocation to the health sphere. The search for improved markers continues: this study proposes and tests the possibility that Council Tax Valuation Band (CTVB) might match requirements. PRESENTATION OF THE HYPOTHESIS: To determine if there is an association between CTVB of final residence and mortality risk using the death registers of a UK general practice. TESTING THE HYPOTHESIS: Standardised death rates and odds ratios (ORs) for groups defined by CTVB of dwelling (A – H) were calculated using one in four denominator samples from the practice lists. Analyses were repeated three times – between number of deaths and CTVB of residence of deceased 1992 – 1994 inclusive, 1995 – 1997 inc., 1998 – 2000 inc. In 856 deaths there were consistent and significant differences in death rates between CTVBs: above average for bands A and B residents; below average for other band residents. There were significantly higher ORs for A, B residents who were female and who died prematurely (before average group life expectancy). IMPLICATIONS OF THE HYPOTHESIS: CTVB of final residence appears to be a proxy marker of mortality risk and could be a valuable indicator of health needs resource at household level. It is worthy of further exploration

Cancer risks in populations living near landfill sites in Great Britain

Previous studies have raised concerns about possible excess risks of bladder, brain and hepatobiliary cancers and leukaemias near landfill sites. Several cancers have been implicated, but no consistent pattern has emerged. We present a large nationwide analysis of selected cancers near landfill sites in Great Britain. The base population comprised people living within 2 km of 9565 (from a total of 19 196) landfill sites that were operational at some time from 1982 to 1997, with populations living more than 2 km from a landfill as reference. Risks of cancers at the above sites were computed with adjustment for age, sex, year of diagnosis, region and deprivation. National post-coded registers provided a total of 341 856 640 person–years for the adult cancer analyses and 113 631 443 person–years for childhood leukaemia. There were 89 786 cases of bladder cancer, 36 802 cases of brain cancer, 21 773 cases of hepatobiliary cancer, 37 812 cases of adult leukaemia and 3973 cases of childhood leukaemia. In spite of the very large scale of this national study, we found no excess risks of cancers of the bladder and brain, hepatobiliary cancer or leukaemia, in populations living within 2 km of landfill sites. The results were similar if the analysis were restricted to landfill sites licensed to carry special (hazardous) waste. Our results do not support suggestions of excess risks of cancer associated with landfill sites reported in other studies

Geographical variation in cardiovascular incidence: results from the British Women's Heart and Health Study

BACKGROUND: Prevalence of cardiovascular disease (CVD) in women shows regional variations not explained by common risk factors. Analysis of CVD incidence will provide insight into whether there is further divergence between regions with increasing age. METHODS: Seven-year follow-up data on 2685 women aged 59-80 (mean 69) at baseline from 23 towns in the UK were available from the British Women's Heart and Health Study. Time to fatal or non-fatal CVD was analyzed using Cox regression with adjustment for risk factors, using multiple imputation for missing values. RESULTS: Compared to South England, CVD incidence is similar in North England (HR 1.05 (95% CI 0.84, 1.31)) and Scotland (0.93 (0.68, 1.27)), but lower in Midlands/Wales (0.85 (0.64, 1.12)). Event severity influenced regional variation, with South England showing lower fatal incident CVD than other regions, but higher non-fatal incident CVD. Kaplan-Meier plots suggested that regional divergence in CVD occurred before baseline (before mean baseline age of 69). CONCLUSIONS: In women, regional differences in CVD early in adult life do not further diverge in later life. This may be due to regional differences in early detection, survivorship of women entering the study, or event severity. Targeting health care resources for CVD by geographic variation may not be appropriate for older age-groups

Comparison of Bayesian and frequentist approaches in modelling risk of preterm birth near the Sydney Tar Ponds, Nova Scotia, Canada

<p>Abstract</p> <p>Background</p> <p>This study compares the Bayesian and frequentist (non-Bayesian) approaches in the modelling of the association between the risk of preterm birth and maternal proximity to hazardous waste and pollution from the Sydney Tar Pond site in Nova Scotia, Canada.</p> <p>Methods</p> <p>The data includes 1604 observed cases of preterm birth out of a total population of 17559 at risk of preterm birth from 144 enumeration districts in the Cape Breton Regional Municipality. Other covariates include the distance from the Tar Pond; the rate of unemployment to population; the proportion of persons who are separated, divorced or widowed; the proportion of persons who have no high school diploma; the proportion of persons living alone; the proportion of single parent families and average income. Bayesian hierarchical Poisson regression, quasi-likelihood Poisson regression and weighted linear regression models were fitted to the data.</p> <p>Results</p> <p>The results of the analyses were compared together with their limitations.</p> <p>Conclusion</p> <p>The results of the weighted linear regression and the quasi-likelihood Poisson regression agrees with the result from the Bayesian hierarchical modelling which incorporates the spatial effects.</p

Identifying change over time in small area socio-economic deprivation

The measurement of area level deprivation is the subject of a wide and ongoing debate regarding the appropriateness of the geographical scale of analysis, the input indicator variables and the method used to combine them into a single figure index. Whilst differences exist, there are strong correlations between schemes. Many policy-related and academic studies use deprivation scores calculated cross-sectionally to identify areas in need of regeneration and to explain variations in health outcomes. It would be useful then to identify whether small areas have changed their level of deprivation over time and thereby be able to: monitor the effect of industry closure; assess the impact of area-based planning initiatives; or determine whether a change in the level of deprivation leads to a change in health. However, the changing relationship with an outcome cannot be judged if the ‘before’ and ‘after’ situations are based on deprivation measures which use different, often time-point specific variables, methods and geographies. Here, for the whole of the UK, inputs to the Townsend index obtained from the 1991 and 2001 Censuses have been harmonised in terms of variable detail and with the 1991 data converted to the 2001 Census ward geography. Deprivation has been calculated so that the 1991 scores are directly comparable with those for 2001. Change over time can be then identified. Measured in this way, deprivation is generally shown to have eased due to downward trends in levels of lack of access to a car, non-home ownership, household overcrowding but most particularly, to reductions in levels of unemployment. Despite these trends, not all locations became less deprived with gradients of deprivation largely persisting within the UK’s constituent countries and in different area types. For England, Wales and Scotland, the calculation of Townsend scores can readily be backdated to incorporate data from the 1971 and 1981 Censuses to create a 1971–2001 set of comparable deprivation scores. The approach can also be applied to the Carstairs index. Due to differences in data availability prior to 1991, incorporating small areas in Northern Ireland would be challenging