Neighborhood Deprivation and Eye Diseases.

This is the accepted manuscript. The final version is available from http://www.tandfonline.com/doi/abs/10.3109/09286586.2015.1066017?journalCode=iope20

Variations of health check attendance in later life: results from a British birth cohort study

Background:Older adults are advised to attend a number of preventive health checks to preserve health andidentify risk factors for disease. Previous research has identified a number of health and social factors, labelled aspredisposing, enabling and need factors, using Andersen’s Behavioural Model of Health Service Use, that areassociated with health care utilisation. We aimed to assess associations between factors from childhood andadulthood, and health check attendance in later life in a British birth cohort study.Methods:For 2370 study members from the MRC National Survey of Health and Development (NSHD), healthcheck attendance was assessed at age 68. Study members were asked if they: attended blood pressure andcholesterol checks, had their eyes tested, received the influenza vaccine, attended colon cancer screening anddental checks. Health and social factors from childhood and adulthood were used in binomial regression models totest associations with health check attendance in men and women.Results:Health check attendance was high; 41% reported attending all six health checks within the recommendedtime frame. In multivariable models, being a non-smoker and having more health conditions in adulthood wereassociated with greater health check attendance in men and women. In women, childhood socioeconomicadvantage, being more physically active in midlife and previously attending screening procedures, and in men,greater self-organisation in adolescence and being married were associated with attending more health checks inlater life, following adjustments for childhood and adulthood factors.Conclusions:A number of predisposing, enabling and need factors from childhood and adulthood were found tobe associated with health check attendance at age 68, demonstrating the relevance of applying a life courseperspective to Andersen’s model in investigating health check attendance in later life. Health related factors werefound to be stronger correlates of health check attendance than socioeconomic factors

Assessing the relative importance of correlates of loneliness in later life:Gaining insight using recursive partitioning

OBJECTIVES: Improving the design and targeting of interventions is important for alleviating loneliness among older adults. This requires identifying which correlates are the most important predictors of loneliness. This study demonstrates the use of recursive partitioning in exploring the characteristics and assessing the relative importance of correlates of loneliness in older adults. METHOD: Using exploratory regression trees and random forests, we examined combinations and the relative importance of 42 correlates in relation to loneliness at age 68 among 2453 participants from the birth cohort study the MRC National Survey of Health and Development. RESULTS: Positive mental well-being, personal mastery, identifying the spouse as the closest confidant, being extrovert and informal social contact were the most important correlates of lower loneliness levels. Participation in organised groups and demographic correlates were poor identifiers of loneliness. The regression tree suggested that loneliness was not raised among those with poor mental wellbeing if they identified their partner as closest confidante and had frequent social contact. CONCLUSION: Recursive partitioning can identify which combinations of experiences and circumstances characterise high-risk groups. Poor mental wellbeing and sparse social contact emerged as especially important and classical demographic factors as insufficient in identifying high loneliness levels among older adults

Ethnic inequalities in healthcare use and care quality among people with multiple long-term health conditions living in the United Kingdom: a systematic review and narrative synthesis

Indicative evidence suggests that the prevalence of multiple long-term conditions (i.e., conditions that cannot be cured but can be managed with medication and other treatments) may be higher in people from minoritised ethnic groups when compared to people from the White majority population. Some studies also suggest that there are ethnic inequalities in healthcare use and care quality among people with multiple long-term conditions (MLTCs). The aims of this review are to (1) identify and describe the literature that reports on ethnicity and healthcare use and care quality among people with MLTCs in the UK and (2) examine how healthcare use and/or care quality for people with MLTCs compares across ethnic groups. We registered the protocol on PROSPERO (CRD42020220702). We searched the following databases up to December 2020: ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science core collection. Reference lists of key articles were also hand-searched for relevant studies. The outcomes of interest were patterns of healthcare use and care quality among people with MLTCs for at least one minoritised ethnic group, compared to the White majority population in the UK. Two reviewers, L.B. and B.H., screened and extracted data from a random sample of studies (10%). B.H. independently screened and extracted data from the remaining studies. Of the 718 studies identified, 14 were eligible for inclusion. There was evidence indicating ethnic inequalities in disease management and emergency admissions among people with MLTCs in the five studies that counted more than two long-term conditions. Compared to their White counterparts, Black and Asian children and young people had higher rates of emergency admissions. Black and South Asian people were found to have suboptimal disease management compared to other ethnic groups. The findings suggest that for some minoritised ethnic group people with MLTCs there may be inadequate initiatives for managing health conditions and/or a need for enhanced strategies to reduce ethnic inequalities in healthcare. However, the few studies identified focused on a variety of conditions across different domains of healthcare use, and many of these studies used broad ethnic group categories. As such, further research focusing on MLTCs and using expanded ethnic categories in data collection is needed

Bi-directional associations between religious attendance and mental health: findings from a British birth cohort study

Background- There is evidence that religious attendance is associated with positive outcomes for mental health; however, there are few longitudinal studies, and even fewer, which take into account the possibility of bi-directional associations. This study aimed to investigate bi-directional associations between religious attendance and mental health. Methods- Participants were 2125 study members who provided data at age 68–69 from the Medical Research Council National Survey of Health and Development (1946 British birth cohort study). Mental health was assessed using the 28-item General Health Questionnaire at ages 53, 60–64 and 68–69. Religious attendance was measured using a 4-point scale (weekly=3, monthly=2, less than monthly=1 or never=0) at ages 43, 60–64 and 68–69. Cross-lagged path analysis was used to assess reciprocal associations between mental health and religious attendance, adjusting for gender and education. Results- Previous religious attendance was strongly related to later attendance (r=0.62–0.74). Similarly, mental health at baseline was strongly associated with subsequent mental health scores (r=0.46–0.54). Poor mental health at age 53 and 60–64 was associated with more frequent religious attendance at age 60–64 (b=0.04; 95% CI: 0.02 to 0.06; p<0.05), and 68–69 (b=0.03; 95% CI: 0.02 to 0.06; p<0.05), respectively. There was no evidence that religious attendance at age 43, 60–64 or 68–69 was associated with later or concurrent mental health. Conclusion- Using birth cohort data from the UK, it was found that poor mental health was associated with later religious attendance but not vice versa. Future research should confirm these novel findings and explore the underlying mechanisms between religious attendance and mental health

De-standardization and gender convergence in work–family life courses in Great Britain: A multi-channel sequence analysis

This study addresses the question of de-standardized life courses from a gender perspective. Multi-channel sequence analysis is used to characterise the domains of work, partnership and parenthood in combination across the adult life courses of three birth cohorts of British men and women between the ages of 16 and 42. Three research questions are addressed. First, we examine whether there is evidence of increasing between-person de-standardization (diversity) and within-person differentiation (complexity) in work and family life courses across cohorts during the main childrearing years. Second, we investigate whether men's and women's work–family life courses are converging over time. Finally, we assess the link between educational attainment and work–family life courses across cohorts. Data are from the MRC National Survey of Health and Development 1946 birth cohort (n = 3012), the National Child Development Study 1958 birth cohort (n = 9616), and the British Cohort Study 1970 birth cohort (n = 8158). We apply multi-channel sequence analysis to group individuals into twelve conceptually-based work–family life course types. We find evidence of growing between-person diversity, across cohorts, for both women and men. In addition, partnership trajectories are growing more complex for both genders, while parental biographies and women's work histories are becoming less so. Women's and men's work–family life courses are becoming increasingly similar as more women engage in continuous full-time employment; however, life courses involving part-time employment or a career break remain common for women in the most recent cohort. Continuous, full-time employment combined with minimal family ties up to age 42 emerged as the most common pattern for women and the second most common for men in the 1970 cohort

Socio-economic inequalities in profiles of social integration across adulthood: evidence from a British birth cohort study

Social integration in older age is a key quality of life component and is associated with reduced mortality and morbidity risk. There are socio-economic differences in social integration, but the influence of different indicators of socio-economic position on long-term change in social integration at older ages is not known. This study aimed to identify profiles of social integration across adulthood and explore the impact of various socio-economic indicators at different ages. Data were drawn from the MRC National Survey of Health and Development. A latent class analysis used measures of contact with friends and family, participation in group activities and marital status at ages 36, 43 and 60-64 to identify profiles of change in social integration for men and women. One-step analyses related profiles to father’s occupation-based socio-economic position, own educational attainment and head of household occupation-based socio-economic position.  Four profiles of social integration were identified for men: high and maintained, married; medium and maintained, married; declining, married; and declining, unmarried. Higher head of household occupation and educational attainment were associated with greater likelihood of maintained integration. Four profiles of social integration were also identified for women: high and maintained, married; high and maintained, unmarried; declining group participation, unmarried; and declining group participation, married. Higher socio-economic position on all indicators was associated with greater likelihood of maintained integration. Lower socio-economic groups are more likely to experience declining social integration by early old age. Support to promote social integration may be particularly important for those with lower occupational grade or education

Local area unemployment, individual health and workforce exit: ONS Longitudinal Study

This work was jointly funded by the Economic and Social Research Center (ESRC) and the United Kingdom’s Medical Research Council, under the Lifelong Health and Wellbeing Cross-Council Programme initiative [ES/L002892/1]. CeLSIUS is supported by the ESRC Census of Population Programme (Award Ref: ES/ K000365/1)

Parent-child relationships and offspring’s positive mental wellbeing from adolescence to early older age

We examined parent-child relationship quality and positive mental well-being using Medical Research Council National Survey of Health and Development data. Well-being was measured at ages 13–15 (teacher-rated happiness), 36 (life satisfaction), 43 (satisfaction with home and family life) and 60–64 years (Diener Satisfaction With Life scale and Warwick Edinburgh Mental Well-being scale). The Parental Bonding Instrument captured perceived care and control from the father and mother to age 16, recalled by study members at age 43. Greater well-being was seen for offspring with higher combined parental care and lower combined parental psychological control (p < 0.05 at all ages). Controlling for maternal care and paternal and maternal behavioural and psychological control, childhood social class, parental separation, mother’s neuroticism and study member’s personality, higher well-being was consistently related to paternal care. This suggests that both mother–child and father–child relationships may have short and long-term consequences for positive mental well-being