Sensory impairments and incident disability in older men living in a British community: a 2 year follow-up study

BackgroundSensory impairments are common in older adults, who are a rapidly growing proportion of the UK population, making age-related sensory impairments an increasingly important public health concern. We explored the association between impairments in hearing and vision and the risk of incident mobility disability, activities of daily living (ADL), and instrumental ADL (IADL).Methods3981 men aged 63–85 years from the population-based British Regional Heart Study were followed from Jan 1, 2003, to April 30, 2005. Self-reported data on hearing aid use and ability to follow television at a volume acceptable to others allowed for four categories of hearing: could hear (reference group), could hear with hearing aid, could not hear and no aid, and could not hear despite aid. Vision impairment was defined as not being able to recognise a friend across a road. Measures of disability included mobility disability (defined as unable to take stairs up or down, or unable to walk 400 yards, or a combination of these movements), ADL difficulties, and IADL difficulties. Logistic regression was used to assess associations. All participants provided written, informed consent. Ethics approval was obtained from local research ethics committees.FindingsAt baseline, 3108 men were free from mobility disability, 3346 were free from ADL difficulties, and 3410 were free from IADL difficulties. New cases of disability at follow-up included mobility disability (n=238), ADL (n=260), and IADL (n=207). Men who could not hear and did not use a hearing aid had greater risks of mobility disability (age-adjusted relative risk 2·24, 95% CI 1·29–3·89). Being unable to hear, irrespective of hearing aid, was associated with increased risks of ADL (without aid 1·74, 1·19–2·55; with aid 2·01, 1·16–3·46). Men who could hear and used a hearing aid and men who could not hear despite an aid had increased risks of IADL (1·86, 1·29–2·70 and 2·74, 1·53–4·93, respectively). Vision impairment was not associated with incident mobility disability.InterpretationOlder men with hearing impairment have an increased risk of subsequent disability. Prevention and correction of hearing impairment could enhance independent living in later life. Further research is warranted on the possible pathways underlying the associations, to prevent adverse health outcomes associated with age-related hearing impairment.FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research (509546). SER is funded by a UK Medical Research Council Fellowship (G1002391).     

Vision impairment and risk of frailty: the English Longitudinal Study of Ageing

BackgroundAge-related vision impairment has been associated with comorbidities, current disability, and poor quality of life. However, it is unclear whether vision impairment is associated with increasing future frailty, further affecting ability to live independently. We investigated the association of poor vision with incident pre-frailty and frailty.Methods2836 men and women aged 60 years or more with data on vision (self-reported vision problems) and frailty status (Fried phenotype) from the nationally representative English Longitudinal Study of Ageing were followed up for 4 years for pre-frailty and frailty between 2004 and 2008. Frailty was defined according to number of Fried phenotype components present (slow walking, weak grip, self-reported exhaustion, weight loss, low physical activity) as non-frail (0 components), pre-frail (1–2), and frail (≥3). Participants non-frail at baseline were followed up for incident pre-frailty and frailty. Participants pre-frail at baseline were followed up for incident frailty.FindingsAt baseline, 1396 participants (49%) were non-frail, 1178 (42%) pre-frail, and 262 (9%) frail. At follow-up, there were 367 new cases of pre-frailty and frailty among those non-frail at baseline, and 133 new cases of frailty among those pre-frail at baseline. Cross-sectional analysis showed an association between vision impairment and frailty (age-adjusted and sex-adjusted odds ratio 2·53, 95% CI 1·95–3·30; p<0·0001) which remained after further adjustment for wealth, education, cardiovascular disease, diabetes, falls, cognition, and depression. In longitudinal analysis, compared with non-frail participants with no vision impairment, non-frail participants with vision impairment had double the risk of becoming pre-frail or frail at follow-up (2·07, 1·32–3·24; p=0·002) and the association remained after further adjustment for covariates (1·86, 1·17–2·95; p=0·009). Pre-frail participants with vision impairment did not have greater risks of becoming frail at follow-up (1·34, 0·82–2·19).InterpretationOlder adults who experience poor vision and are not frail have double the risk of becoming pre-frail or frail over 4 years. Public health interventions aiming to identify and actively manage vision impairment might prevent frailty.FundingAEML is funded by the National Institute for Health Research School for Public Health Research (509546). LAC is funded by the British Heart Foundation (RG/10/001/28296) and the Medical Research Council (RG71546). SER is funded by a UK Medical Research Council fellowship (G1002391).     

Insulin-like growth factor 1 and hearing impairment in older adults: results from the English Longitudinal Study of Ageing

BackgroundAge-related hearing impairment is the most common hearing disorder, affecting two-thirds of people aged over 70 years in the UK. It is a major cause of disability, with considerable social and health implications, accompanied by a major economic burden. With the condition essentially incurable, the focus becomes identification of risk factors. The biological determinants of hearing impairment remain poorly understood. Despite a suggestion from animal studies that insulin-like growth factor 1 (IGF-1) is implicated in the development of hearing impairment, we know of no studies in human beings.Methods4398 participants with no missing data (mean age at baseline 64·2 years [SD 8·1], 55% women) from the English Longitudinal Study of Ageing provided serum concentrations of IGF-1 in 2008 and 2012. We used the average of these two measurement when available, one if not. Hearing acuity was measured with a HearCheck Screener (Siemens, Erlangen, Germany) in 2014. Hearing impairment was defined as hearing fewer than all six tones, three with decreasing intensity at two frequencies (1 kHz and 3 kHz). Logistic regression models were used to estimate odds ratios (OR) of hearing impairment across five quintiles of IGF-1 concentration. Presence of interaction and non-linearity were assessed by likelihood ratio tests.FindingsMean IGF-1 was 16·1 nmol/L (SD 5·2). In the full analytical sample, IGF-1 was not associated with subsequent hearing impairment (OR per 5 nmol increase in IGF-1 1·01, 95% CI 0·94–1·09). However, this association differed by age (p_interaction=0·03). Thus, in participants younger than 60 years (n=1402), IGF-1 was linearly associated with a lower risk of hearing impairment (0·85, 0·73–0·99) after adjustment for age, sex, smoking, height, body-mass index, cognitive function, education, and self-reported hearing at baseline. Among participants 60 years and older, there was some evidence of a J-shaped association (p_curvature=0·02). Compared with the lowest quintile of IGF-1, ORs for quintiles 2, 3, 4, and 5 were 0·94 (0·72–1·22), 1·13 (0·86–1·48), 0·97 (0·74–1·27), and 1·24 (0·95–1·62), respectively, but associations were not statistically significant.InterpretationIn people at the lower end of the older-age spectrum, there was some support for lower levels of IGF-1 being linked with hearing impairment. These results warrant replication and then testing in trials of IGF-1 supplementation.FundingThe English Longitudinal Study of Ageing is supported by the National Institute on Aging (grant numbers 2RO1AG7644 and 2RO1AG017644-01A1) and a consortium of the UK government departments coordinated by the Economic and Social Research Council. The funding bodies had no role in the study design; collection, analysis, and interpretation of data; writing of the abstract; and decision to submit the abstract for publication.     

Depressive symptoms in the oldest-old: The role of sensory impairments

BackgroundWhile a fair amount of research has investigated the impact of sensory impairments on the mental health of young older adults (65–79 years of age), only a few studies have focused on the associations of sensory impairments with mental health outcomes in the oldest-old (80 years and older). To close this gap, this study examined the separate and combined effects of self-reported vision and hearing impairment for depressive symptoms in a sample of oldest-old individuals, controlling for other mental health risks (e.g., functional disability, health interference, and loneliness).MethodsCentenarians and near-centenarians (N = 119; average age = 99) were recruited from the community and geriatric healthcare organizations. In-person interviews were conducted at participants’ place of residence.ResultsVision impairment and its interaction with hearing impairment as well as functional disability, health interference with desired activities, and loneliness were significant predictors of depressive symptoms in hierarchical regression analyses. Hearing impairment alone was not associated with depressive symptoms, but follow-up analyses clarifying the interaction effect showed that individuals with poor vision had the highest levels of depressive symptoms, if they had a concurrent hearing impairment. Thus, a concurrent presence of poor vision and poor hearing resulted in an increased vulnerability for depressive symptoms.ConclusionsGiven that a majority of oldest-old has sensory impairments which can result in mental health issues, it is important to facilitate this population’s access to vision and audiological treatment and rehabilitation.     

Prevalence of finding sexual partners online and associations with sexual behaviour and sexual health outcomes: a British national probability survey

BackgroundOnline venues provide opportunities to facilitate sexual encounters, but the extent to which finding partners online is associated with risky sexual behaviour and poor sexual health outcomes is unclear; much of the research to date has focused on subpopulations, or convenience samples. We aimed to describe individuals' use of the internet to find sexual partners in a representative sample of the British population.MethodsThe third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) was a cross-sectional probability survey of 15 162 adults aged 16–74 years, which used computer-assisted personal-interview and self-interview, undertaken during 2010–12. The sample was weighted to account for selection probability and non-response, and corrected for differences in demographics according to the UK 2011 census. We estimated the prevalence of, and identified factors associated with, finding sexual partners online in the past year among 5698 men and 8198 women who reported sexual experience ever.FindingsUse of the internet to find sexual partners in the past year was reported by 5·2% of men (95% CI 4·7–5·8) (unweighted n=389) and 2·4% of women (2·1–2·8) (unweighted n=249), and was associated with younger age. After adjustment for age, individuals reporting a non-heterosexual identity (adjusted odds ratio for men 8·87, 5·95–13·22; for women 3·56, 2·20–5·78) were more likely to report finding partners online. This outcome was also associated with reporting sexual risk behaviours including sex without a condom with two or more partners (men 5·24, 3·71–7·39; women 6·36, 4·25–9·53), reporting five or more partners (11·19, 6·36–19·67; 17·44, 7·32–41·52), and reporting a new partner (13·27, 9·49–18·54; 14·93, 9·97–22·37). Sexual health clinic attendance (men 1·92, 1·18–3·15; women 2·25, 1·08–4·69), HIV testing (2·91, 1·91–4·44; 1·82 1·09–3·03), and diagnoses of sexually transmitted infections (men only 2·19, 1·17–4·12) were more common among individuals reporting finding partners online after adjustment for age and number of partners.InterpretationFinding partners online was strongly associated with markers of sexual risk and health-service uptake. Online opportunities have increased since 2010–12, so these data might underestimate the importance of this social phenomenon for public health and control of sexually transmitted infections. Given the cross-sectional survey design, neither directionality nor causality can be inferred.FundingNatsal-3 was supported by grants from the Medical Research Council (G0701757) and the Wellcome Trust (084840), with contributions from the Economic and Social Research Council and Department of Health.     

Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood: associations and potential explanations

BackgroundEvidence of the association between childhood maltreatment and risk of adult cardiometabolic disease is sparse. We investigated associations of different forms of child maltreatment with adult cardiometabolic markers and potential explanations.MethodsIn the 1958 British birth cohort, we tested associations of childhood neglect (ascertained at age 7 years and 11 years) and abuse (physical, sexual, psychological, self-reported at 45 years) with adult (45 years) cardiometabolic markers (blood pressure, lipids, glycated haemoglobin [HbA_1c]) using linear and logistic regressions. Models were adjusted, first for factors affecting measurements (eg, room temperature, postal delay of blood sample, and for women oral contraception and hormone replacement therapy) and early life factors (eg, birthweight, socioeconomic status) and second for explanatory factors (change in body-mass index from childhood to adulthood, adult socioeconomic status, lifestyles, mental health). We applied multiple imputation to missing data on neglect and covariates, and restricted analyses to individuals with observed cardiometabolic data.FindingsAmong 9349 participants (4650 men, 4699 women), 12% (1143) reported any form of abuse. Prevalence for sexual abuse was 1·6% (149), physical abuse 6·0% (565), and psychological abuse 10·0% (926), and 1627 (17·4%) had two or more indicators of childhood neglect. Childhood neglect was associated in adulthood with raised triglycerides by 3·9% (95% CI 0·4–7·4) and HbA_1c by 1·2% (0·4–2·0), and for women lower HDL by 0·05 mmol/L (0·01–0·08), after adjusting for early life covariates. Physical abuse was associated with increased risk of high LDL (odds ratio [OR] 1·24, 95% CI 1·00–1·55) and raised HbA_1c in men by 2·4% (0·6–4·2), and lower HDL in women by 0·06 mmol/L (0·01–0·12). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. Psychological abuse was associated with increased risk of high triglycerides (OR 1·23, 1·03–1·46) and low HDL by 0·04 mmol/L (0·01–0·07). Maltreatment was not associated with raised blood pressure. All associations disappeared after further adjustment: adult lifestyle was a key explanatory factor for most associations, adult socioeconomic status was important for associations with neglect but not abuse, body-mass index was important for neglect and physical abuse, and mental health was important for psychological abuse.InterpretationChildhood maltreatments were associated with poor lipid and HbA_1c profiles decades later in adulthood in this population cohort. Explanations for associations varied by form of maltreatment. Further work is needed on the role of life-course explanatory factors and on effective strategies to reduce or prevent long-term health consequences of maltreatment.FundingThis work was funded by the Department of Health Policy Research Programme through the Public Health Research Consortium and supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health. Data collection for participants at age 45 years was funded by the Medical Research Council (grant G0000934).     

Characterising the alcohol harm paradox: a population-based survey of adults in England

BackgroundThe alcohol harm paradox refers to the positive association of socioeconomic status (SES) with alcohol consumption and negative association with alcohol-related harm and dependence. To inform future research and to help elucidate the cause of the alcohol harm paradox, this study aimed to assess how far the paradox extends to a range of measures of SES and whether it varies by demographic characteristics.MethodsBetween March and December, 2014, data were collected on 16 871 participants from the Alcohol Toolkit Study, a monthly population survey of adults aged 16 and older. In this survey, interviews with 1800 individuals in England are conducted each month by the market research company, Ipsos MORI. Participants were asked to complete the Alcohol Use Disorders Identification Test (AUDIT), which consists of three parts: alcohol consumption (AUDIT-C), alcohol dependence (AUDIT-dependence), and alcohol harm (AUDIT-harm). SES was categorised as follows: qualifications after the age of 16 years (yes, no), employed full time (yes, no), owns own house (yes, no), owns own car (yes, no), income of less than £11 499 (yes, no), and a classification based on occupation called social grade (AB, C1, C2, D, E). A composite score was also derived with multiple correspondence analysis. Prevalence data were weighted to match the population in England.Findings11 295 participants (71%) reported that they drank alcohol (95% CI 69·7–71·2). Those who were aged 35–44 years (p=0·0009), 45–54 (p<0·0001), 55–64 (p<0·0001) and 65 years or over (p=0·0107) had higher odds of reporting that they drank alcohol than those aged 16–24. Those of higher socioeconomic status (p<0·0001) and men (p<0·0001), also had higher odds of drinking alcohol. After adjustment, positive associations with AUDIT-C were found between social grade AB relative to C2 (β=–0·26, p=0·0067) and D (β=–0·54, p<0·0001), educational level (β=–0·19, p=0·0242), and the composite score (β=–0·12, p<0·0001). All SES measures, except for car ownership and educational qualifications, were negatively associated with AUDIT-harm and AUDIT-dependence scores. The alcohol harm paradox was moderated by demographic characteristics: AUDIT-dependence was associated with measures of SES in men (β=–0·07, p=0·0110) but not women; and associations between AUDIT-C and SES were strengthened with increasing age, whereas associations between AUDIT-dependence and SES diminished.InterpretationAmong adults in England, the alcohol harm paradox is apparent across a range of measures of SES and seems to be more evident in younger men than in other demographic groups.FundingEB's salary is funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) and Cancer Research UK (CRUK). JB is funded by CRUK and the Society for the Study of Addiction. RW is funded by CRUK. The Alcohol Toolkit Study is funded by the NIHR SPHR.     

How the local built environment affects physical activity behaviour in older adults in the UK: a cross-sectional analysis linked to two national cohorts

BackgroundPolicy makers are increasingly interested in how changes in local neighbourhood environments can affect health behaviours, especially physical activity, but individual studies rarely consider multiple environmental dimensions. Although older people can be particularly at risk of physical challenges in their local environment, few studies have focused on this age group.MethodsWe developed a local environment audit instrument to capture multiple dimensions of the built environment that could affect the physical activity of older people; we linked the environmental data to physical activity behaviour collected in two nationally representative cohorts: the British Regional Heart Study and British Women's Heart and Health Study. Comprehensive foot-based audits were conducted by trained field staff in 20 towns across England and Scotland covering 590 lower super output areas and data zones; interobserver reliability of the instrument was high. The primary outcome was time spent in moderate-to-vigorous physical activity measured in participants for 1 week during 2010–12 with GT3X accelerometers (Actigraph, Pensacola, FL, USA). Using multilevel regression analysis, we assessed the association between aspects of the built environment and physical activity adjusted for individual-level confounders and area-level population density.Findings686 men and 638 women aged 69–92 years participated in the accelerometer study and were included in the analysis. Geometric mean time in moderate-to-vigorous physical activity was 26·3 min/day (geometric SD 2·7) in men and 23·8 min/day (SD 2·5) in women. There was no evidence of associations between any of the domains studied (quality of the built environment defined by latent class analysis; number of bus stops; area aesthetics; density of shops and services; amount of green space) and moderate-to-vigorous physical activity. Relative to areas with the worst quality walking environment, people living in areas with the best walking environments spent 2% more time in moderate-to-vigorous physical activity (95% CI −11 to 17, p=0·78 for overall trend).InterpretationAlthough small effect sizes cannot be discounted, this study suggests that older individuals might be less affected by their local neighbourhood environment than is often presumed in the scientific literature, reflecting both the heterogeneous functionality of this age group and the varying nature of their activity spaces.FundingThis study was funded by a grant from the Medical Research Council (MR/J007145/1). The collection and extraction of data on physical activity in these cohorts was supported by grants from the British Heart Foundation (PG/09/024 and PG/13/66/304422) and National Institute for Health Research (PDF 2010-03-23).     

Visual health inequalities: findings from UK Biobank

BackgroundLittle is known about inequalities in eye health. Between 2009 and 2010, 117 908 UK Biobank participants (aged 40–69 years) undertook an ophthalmic assessment, which included distance visual acuity. UK Biobank was not designed to be a fully representative population sample so prevalence estimation is precluded. However, the size and diversity of the sample provide a unique opportunity for investigation of socioeconomic influences on visual health in UK adults.MethodsHabitual (usual optical correction) distance acuity was measured with a standardised computer-based system. 112 314 participants were reliably assigned, on the basis of acuity in the better eye, into one of six categories spanning the spectrum of vision from bilateral normal vision (log of minimum angle of resolution [logMAR] 0·2 or better) to low-vision–blind (≤0·5, WHO taxonomy). Socioeconomic information included educational qualifications and Townsend Index. Multinomial and ordinal regression analyses were undertaken.FindingsThe frequency of normal bilateral vision decreased with age (age 40–49 years, 86% [21 934/25 645]; 50–59 years, 77% [27 482/35 786]; and 60–70 years, 72% [36 461/50 883]). Overall, risk of visual impairment across severity categories was associated with an increasing gradient of key demographic and socioeconomic variables, indicating deprivation. These patterns of visual health inequalities were not explained by risk of underlying eye disease. For example, compared with normal vision, socially significant visual impairment (SSVI), a mid-range category of visual impairment, was associated with increasing age (risk ratio 1·05, 95% CI 1·046–1·06), being female (1·09, 1·01–1·16), no educational qualifications (1·7, 1·4–1·9), a higher deprivation score (1·08, 1·07–1·09), and being part of any minority ethnic group (eg, Asian 2·5, 2·1–2·9). Participants unable to work or unemployed were at least 30% more likely to be in the SSVI category than were those with normal vision and, if employed, at least 9% more likely to have a lower status job.InterpretationThere are consistent patterns of associations between visual impairment across the full spectrum including, importantly, people with mild impairment, and known health determinants as well as key social outcomes. To our knowledge, our study provides evidence for the first time that policies tackling health inequalities as well as initiatives to address inequalities in ophthalmological clinical settings have the potential to improve visual health outcomes.FundingThis work was funded by the National Eye Research Centre. PMC is funded by the Ulverscroft Foundation and JSR receives part funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and University College London Institute of Ophthalmology. The study was undertaken at University College London Institute of Child Health, which receives a proportion of its funding from the Department of Health's NIHR Biomedical Research Centres funding scheme.     

First-in-man evidence of the mechanistic effects of biventricular pacing on coronary physiology

BackgroundNormal coronary blood flow is principally determined by a diastolic backward travelling decompression (suction) wave. Dyssynchronous heart failure may attenuate suction. We hypothesised that biventricular pacing, by restoring left ventricular (LV) synchronisation and improving LV relaxation, might increase this suction wave and coronary flow.MethodsTen patients with congestive heart failure (nine men; mean age 65 years [SD 12]; mean ejection fraction 26% [SD 7] with left bundle branch block (LBBB, mean QRS duration 174 ms [SD 18]) underwent atriobiventricular pacing at 100 beats per min. LV pressure was measured and wave intensity calculated from invasive coronary flow velocity and pressure, with native conduction (LBBB) and during biventricular pacing at atrioventricular (AV) delays of 40 ms (BiV-40), 120 ms (BiV-120), and separately pre-identified haemodynamically optimal AV delay (BiV-Opt). Data are given as median (IQR).FindingsCompared with LBBB, BiV-Opt enhanced coronary flow velocity time integral (VTI) by 15% (7–25, p=0·007), LV dP/dt_max by 17% (9–22, p=0·005), and _negdP/dt_max by 17% (9–22, p=0·005). The cumulative intensity of the diastolic backward decompression (suction) wave increased by 26% (18–54, p=0·005). Much of the increase in coronary flow VTI occurred in diastole (69% [41–84], p=0·047). The systolic compression waves also increased: forward by 36% (6–49; p=0·022) and backward by 38% (20–55, p=0·022). BiV-120 generated a smaller LV dP/dt_max (by 12% [5–23], p=0·013) and _negdP/dt_max (by 15% [8–40], p=0·009) increase than did BiV-OPT, with LBBB as reference; BiV-Opt and BiV-120 were not significantly different in coronary flow VTI or waves. BiV-40 was no different from LBBB.InterpretationWhen biventricular pacing improves left ventricular contraction and relaxation, it increases coronary blood flow velocity, predominantly by increasing the dominant diastolic backward decompression wave.FundingBritish Heart Foundation.     

Comparative impact of hearing and vision impairment on subsequent functioning

OBJECTIVES: The purpose of this study was to compare independent impacts of two levels of self-reported hearing and vision impairment on subsequent disability, physical functioning, mental health, and social functioning. DESIGN: A 1-year prospective cohort study. SETTING: San Francisco Bay Area, California. PARTICIPANTS: Two thousand four hundred forty-two community-dwelling men and women age 50 to 102 from the Alameda County Study (California). MEASUREMENTS: Hearing and vision impairment were assessed in 1994. Outcomes, measured in 1995, included physical disability (activities of daily living, instrumental activities of daily living, physical performance, mobility, and lack of participation in activities), mental health (self-assessed, major depressive episode), and social functioning (feeling left out, feeling lonely, hard to feel close to others, inability to pay attention). All 1995 outcomes were adjusted for baseline 1994 values. RESULTS: Both impairments had strong independent impacts on subsequent functioning. Vision impairment exerted a more wide-ranging impact on functional status, ranging from physical disability to social functioning. However, the results also highlighted the importance of hearing impairment, even when mild. CONCLUSIONS: These impairments can be partially ameliorated through prevention, assessment, and treatment strategies. Greater attention to sensory impairments by clinicians, patients, public health advocates, and researchers is needed to enhance functioning in older adults.     

Assessment of changes in the burden of Chlamydia trachomatis infection in the context of widespread opportunistic chlamydia screening: Pgp3 seroprevalence measured in a series of nationally representative cross-sectional household surveys

BackgroundOpportunistic screening of people aged under 25 years for genital Chlamydia trachomatis infection (chlamydia) was nationally implemented in England in 2008, but its impact is poorly understood. Antibodies to C trachomatis persist after infection, thus providing a marker of past infection. We aimed to explore the effect of screening on cumulative incidence of chlamydia (incidence of infection by a given age), as measured by C trachomatis antibodies.MethodsAnonymised serum samples from participants in the nationally representative Health Surveys for England (HSE) were tested for C trachomatis antibodies using two novel in-house Pgp3 ELISAs, which have demonstrated superior sensitivity to commercial assays. Determinants of being seropositive were explored with logistic regression among women (n=1402) and men (1119) aged 16–44 years in 2010–12 (years when questions about sexual behaviour were included in the survey). Seroprevalence trends among 16–24-year-old women (n=3361) were investigated over ten timepoints from 1994 to 2012.FindingsDuring 2010–12, Pgp3 seroprevalence among participants aged 16–44 years was 24·4% (95% CI 22·0–27·1) in women and 13·9% (11·8–16·2) in men. Seroprevalence increased with age (up to 33·5% [27·5–40·2] in 30–34-year-old women; 18·7% [13·4–25·6] in 35–39-year-old men) and with years since first sexual intercourse (38·2% [32·0–44·7] in women and 22·3% [16·2–29·8] in men aged 15–19 years). Total number of lifetime sexual partners and younger age at first sex were significantly associated with being seropositive (>10 lifetime sexual partners vs 1–4: odds ratio 3·84 women [95% CI 2·68–5·51], 5·95 men [3·41–10·35]; <16 years old at first sex vs >16: 2·26 women [1·61–3·16], 2·14 men [1·41–3·24]). 76·7% of seropositive 16–24-year-olds had never been diagnosed with chlamydia: among women, seroprevalence did not differ between the first (1994–96) and second (2001–02) periods sampled (prevalence ratio 1·04, 0·87–1·25); a non-significant decline was observed from 2008 to 2012 (prevalence ratio per year 0·94, 0·84–1·05).InterpretationOur application of Pgp3 ELISAs demonstrates a high lifetime risk of chlamydia among women and that a large proportion of infections go undiagnosed. A decrease in age-specific cumulative incidence after national implementation of opportunistic chlamydia screening has not yet been demonstrated. We propose that these assays be used more widely to assess the effect of chlamydia control programmes.FundingThe Health Survey for England was funded by the Health and Social Care Information Centre. Testing of stored serum samples was funded by the Health Protection Agency (now Public Health England). The funders played no part in the design, conduct, analysis, or reporting of this study, or in the decision to submit the abstract for publication.     

Assessment of calcification and inflammation with positron emission tomography in aortic stenosis and atherosclerosis

BackgroundCalcification and inflammation are key pathological processes in aortic stenosis and atherosclerosis. Using combined positron emission tomography and computed tomography (PET/CT), we sought to investigate their contribution to disease progression in aortic stenosis and to help identify vulnerable atherosclerotic plaque.MethodsIn the first part of the study patients with calcific aortic valve disease stenosis were prospectively compared with age-matched and sex-matched controls with normal valves. Aortic valve severity was determined at baseline and 1 year by echocardiography and CT calcium scoring. Calcification and inflammation in the valve were assessed by sodium 18-fluoride (NaF) and 18-fluorodeoxyglucose (FDG) uptake with PET. In the second part of the study NaF and FDG activity was assessed in the coronary arteries both in patients with stable coronary disease and in patients after myocardial infarction.Findings101 patients with aortic stenosis were compared with 20 controls. Tracer activity (target to background ratio [TBR]) was higher in patients with aortic stenosis than in controls (mean NaF 2·87 [SD 0·82] vs 1·55 [0·17], FDG 1·58 [0·21] vs 1·30 [0·13]; both p<0·01). NaF uptake displayed a progressive rise with valve severity (r²=0·540) with a more modest increase observed for FDG (r²=0·218). Baseline NaF correlated closely with alkaline phosphatase staining on immunohistochemistry (r²=0·79) and was a better predictor of disease progression at 1 year (r²=0·44, n=20) than was FDG (r²=0·02) or baseline calcium score (r²=0·36, current best predictor). Increased NaF activity was observed in 45 (42%) of 106 patients with stable coronary atherosclerosis and was localised to individual coronary plaques. These patients had higher rates of previous major adverse cardiovascular events (p=0·016) and higher Framingham risk scores (p=0·011) than did patients without increased uptake. In patients after myocardial infarction (n=15) intense NaF activity was observed at the site of the culprit lesion, with increased uptake compared with the maximum uptake elsewhere in the coronary arteries (TBR median 1·56 [IQR 1·49–1·82] vs 1·23 [1·15–1·48], p=0·02).InterpretationIn the valve, NaF holds promise in predicting aortic stenosis progression. In the coronary arteries it identifies culprit plaque post myocardial infarction and stable patients at elevated cardiac risk.FundingBritish Heart Foundation.     

Estimated effects of health conditions and risk factors on social and socioeconomic outcomes: mendelian randomisation of UK Biobank data

BackgroundA person's health might influence their ability to attend and concentrate at school, obtain, maintain, and be productive in employment, and maintain wellbeing and an active social life. We aimed to better understand the causal effects of health on social and socioeconomic outcomes, to help establish the broader benefits of investing in effective health policy, thereby strengthening the case for cross-governmental action to improve health and its wider determinants at the population level.MethodsWe used a mendelian randomisation approach to analyse data from the UK Biobank to estimate the effect of eight health conditions (asthma, breast cancer, coronary heart disease, depression, diabetes, eczema, migraine, osteoarthritis) and five risk factors (alcohol intake, body-mass index [BMI], cholesterol, systolic blood pressure, smoking) with known genetic determinants on 19 socioeconomic outcomes in men and women of white British ancestry, aged between 39 and 72 years. The main outcome measures were annual household income, deprivation (measured using the Townsend deprivation index [TDI]), degree-level education, satisfaction with health, and self-reported happiness and loneliness. UK Biobank received ethical approval from the Research Ethics Committee (11/NW/0382).FindingsOur cohort consisted of 337 009 men and women. Of the five risk factors, our results showed that higher BMI, smoking, and alcohol use affected socioeconomic outcomes. Smoking was estimated to reduce household income (mean difference –£24 394 [95% CI –£33 403 to –£15 384]), the chance of owning accommodation (absolute percentage change [APC] –21·5% [95% CI –29·3 to –13·6), being satisfied with health (APC –32·4% [–48·9 to –15·8), and of receiving a university degree (APC –73·8% [–90·7 to –56·9), and increased deprivation (mean difference in TDI 1·89 [1·13 to 2·64]). Of the eight health conditions, asthma decreased household income (mean difference –£13 519 [–£18 794 to –£8 243]), the chance of having a university degree (APC –17·0% [–25·3 to –8·7), and the chance of cohabiting (APC –11·0% [–18·0 to –4·0]), and migraine reduced the chance of having a weekly leisure or social activity (APC –43·7% [–66·0 to –21·3]), especially in men. No other associations were found.InterpretationHigher BMI, smoking, and alcohol use were all estimated to negatively affect multiple social and socioeconomic outcomes. Associations were not detected between health conditions and socioeconomic outcomes with the exceptions of depression, asthma, and migraine. Our findings might reflect true null associations, or be a result of selection bias (given the relative good health and older age of participants in UK Biobank compared with the eligible UK population), or a lack of power to detect effects.FundingThe Health Foundation.     

Social participation and tooth loss,vision, and hearing impairments among older Brazilian adults

Background

Vision and hearing impairments can reduce participation in social activities. Given the prominent role of the mouth in face-to-face interactions, this study evaluated the associations of tooth loss, vision, and hearing impairments with social participation among older adults.

Methods

This analysis included 1947 participants, aged 60+ years, who participated in three waves (2006, 2010, and 2015) of the Health, Wellbeing and Aging Study (SABE) in Brazil. Social participation was measured by the number of formal and informal social activities (requiring face-to-face interaction) participants were regularly involved in. Teeth were counted during clinical examinations and categorized as 0, 1–19, and 20+ teeth. Reports on vision and hearing impairments were classified into three categories (good, regular, and poor). The associations of each impairment with the 9-year change in the social participation score were tested in negative binomial mixed-effects models adjusting for time-variant and time-invariant covariates.

Results

Each impairment was associated with the baseline social participation score and the annual rate of change in the social participation score. Participants with 1–19 (incidence rate ratio: 0.96, 95% CI: 0.91–1.01) and no teeth (0.92, 95% CI: 0.87–0.97), those with regular (0.98, 95% CI: 0.95–1.01) and poor vision (0.86, 95% CI: 0.81–0.90), and those with regular (0.94, 95% CI: 0.91–0.98) and poor hearing (0.91, 95% CI: 0.87–0.95) had lower baseline social participation scores than those with 20+ teeth, good vision, and good hearing, respectively. Furthermore, participants with 1–19 (0.996, 95% CI: 0.990–1.002) and no teeth (0.994, 95% CI: 0.987–0.999), those with regular (0.996, 95% CI: 0.992–0.999) and poor vision (0.997, 95% CI: 0.991–1.003), and those with regular (0.997, 95% CI: 0.992–1.001) and poor hearing (0.995, 95% CI: 0.990–0.999) had greater annual declines in the social participation score than those with 20+ teeth, good vision and good hearing, respectively.

Conclusion

This 9-year longitudinal study shows that tooth loss, vision, and hearing impairments are associated with reduced social participation among older adults.     

Body-mass index adjustments to increase the validity of body fatness assessment in UK black African and South Asian children: a cross-sectional calibration study

BackgroundExcess childhood body fatness, overweightness, and obesity are a major public health challenge in the UK. Accurate assessments, usually based on body-mass index (BMI), are crucial. However, recent studies have demonstrated that BMI underestimates body fatness in South Asian children and overestimates it in black African children. These errors are a concern in these ethnic minority populations, particularly UK South Asians, who are at high risk of obesity, type 2 diabetes, and cardiovascular disease. We aimed to develop BMI adjustments for these children to ensure that BMI relates to body fatness in the same way as for white European children.MethodsFour recent UK population-based studies, which used deuterium dilution assessments of fat mass as a reference method, were pooled to include 1725 children (52% girls) aged 4–12 years (mean 9·3, SD 1·6) of white European, South Asian, and black African origins. A height-standardised fat-mass index (FMI) was derived to represent body fatness. Linear regression models were fitted, separately by sex, to quantify ethnic differences in BMI–FMI associations and to provide ethnic-specific BMI adjustments.FindingsThe FMI derived for this study population and used in analyses was fat mass/height⁵, which was independent of height for the 4–12-year age-group. BMI consistently underestimated body fatness in South Asians, requiring a BMI adjustment of +1·12 kg/m² (95% CI 0·83–1·41) for boys and +1·07 (0·74–1·39) for girls, irrespective of age and FMI. BMI overestimated body fatness in black Africans. However, adjustments for black African children were more complex, with statistically significant interactions between black African ethnicity and FMI (p=0·004 boys, p=0·003 girls) and between FMI and age-group (p<0·0001 boys and girls). BMI adjustments therefore varied by age-group and FMI level, between −0·24 and −2·84 kg/m² for boys and between −0·22 and −2·86 kg/m² for girls for unadjusted BMI values of 13 kg/m² in 10–12 year-olds and 25 kg/m² in 4–6 year-olds, respectively.InterpretationBMI underestimated body fatness in South Asians and overestimated it in black Africans. Ethnic-specific adjustments—increasing BMI in South Asians and reducing BMI in black Africans—can improve the accuracy of body fatness assessment in these children.FundingThis work was supported by the British Heart Foundation (grant ref PG/15/19/31336) and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (South London) (grant ref CLAHRC-2013-10022). Primary data collection was funded by the British Heart Foundation (PG/11/42/28895), BUPA Foundation (TBF-S09-019), Child Growth Foundation (GR 10/03), and Wellcome Trust (WT094129MA). MF is supported by Great Ormond Street Hospital Childrens' Charity.     

Generalised anxiety disorder and excess cancer deaths: findings from a large,longitudinal population study

BackgroundGeneralised anxiety disorder is a common and persistent disorder, and is associated with increased risk for disability and suicide. Previous studies have examined whether anxiety contributes to excess mortality from principal causes of death, with mixed findings. Possible mechanisms linking anxiety, pathogenesis, and premature mortality include dysregulation of the hypothalamus–pituitary–adrenal axis, impaired immunity, and poor coping. We aimed to assess whether generalised anxiety disorder contributes to excess cancer deaths using a large, longitudinal population study.MethodsWe used data from over 15 000 British participants over the age of 40 years from the EPIC-Norfolk study. We used health and lifestyle questionnaires to capture sociodemographics and medical history, and death certificates from the UK Office of National Statistics to identify cancer deaths. Generalised anxiety disorder (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) was measured in 1996–2000, and deaths from all cancers in participants were recorded between 2000 and 2015. To determine the association between anxiety and cancer mortality, Cox proportional hazards regression was conducted while adjusting for psychiatric and physical comorbidity, disability, medication use, body-mass index, behavioural risk factors, and sociodemographics. This study received ethics approval.Findings126 of 7139 men and 215 of 8799 women had generalised anxiety disorder; 796 of 7139 men and 648 of 8799 women died of cancer. Men with anxiety were over twice as likely as men without anxiety to die from cancer over 15 years of follow-up, but this association between anxiety and excess cancer deaths did not exist in women (hazard ratio 2·14, 95% CI 1·32–3·46 vs 1·03, 0·60–1·76). When we excluded those with a history of cancer, findings remained unchanged. Also, the association in men persisted in the long term, after the first 5 years were discounted.InterpretationIn men, anxiety has been linked to overexpression of tumour necrosis factor α and interleukin 6, implicated in inflammation-associated carcinogenesis. Compared with women, men are more likely to develop substance misuse to cope with anxiety, but when we accounted for behavioural risk factors, the association remained unchanged. Anxiety can lead to more frequent medical consultations and earlier detection of disease: when we discounted the first 5 years, the association remained strong in the long term, suggesting that factors other than increased medical help-seeking are accounting for this association. Clinicians should consider the presence of anxiety in men to prevent future cancer complications.FundingMedical Research Council UK, Cancer Research UK, National Institute for Health Research.     

Child maltreatment and living standards in adulthood: findings from a prospective birth cohort

BackgroundChild maltreatment (abuse and neglect) has well-established effects on mental health, but less is known about its influence on adult life economic circumstances. We aimed to establish associations of child maltreatment with such outcomes in mid-life.MethodsWe used data from the 1958 British birth cohort (n=8076) on child neglect and abuse (physical, sexual, psychological, and witnessing abuse) and adult (at age 50 years) long-term sickness absence, not in employment, education, or training (NEET), lacking assets, income-related support, poor educational qualifications, financial insecurity, manual social class, and social mobility. Logistic regression was used to assess associations with maltreatment separately and combined as a score (0, 1, ≥2) with and without adjustment for potential confounding factors (maternal age, birthweight, birth order, social class at birth, parental education, household amenities, crowding, and tenure at age 7 years). Missing values were imputed with multiple imputation chained equations.FindingsAbuse prevalence varied from 1% (n=115) for sexual abuse to 10% (776) for psychological abuse; 1208 (16%) were defined as neglected. 1506 (19%) of the population experienced one type of maltreatment, and 585 (7%) experienced two or more. All maltreatments were associated with most outcomes (eg, for physical abuse, adjusted odds ratio [OR] of long-term sickness absence was 2·33, 95% CI 1·62–3·35). There was a trend across multiple types of maltreatment and unfavourable outcomes—eg, adjusted OR for NEET increased for one and two or more maltreatments compared with no maltreatment (1·30 [1·02–1·65] and 1·72 [1·28–2·33], respectively; p_trend<0·0001). Likewise, adjusted OR for three or more unfavourable adult outcomes increased with more maltreatment compared with none (1·94 [1·59–2·37] for one and 2·23 (1·75–2·84] for two or more; p_trend<0·0001). Children who were sexually abused or neglected were less likely than those not sexually abused or neglected, respectively, to be upwardly mobile from birth to mid-adulthood (unadjusted OR 0·49 [0·30–0·81] and 0·45 [0·39–0·53]).InterpretationChild abuse was reported retrospectively in adulthood, although child neglect and potential confounding factors were ascertained prospectively and we examined a wide range of adult socioeconomic outcomes that are important because of their costs to individuals and society. That childhood maltreatments were associated with most unfavourable outcomes in mid-adulthood, has implications for the broader field of health equity. The increasing risk of poor adult outcome associated with multiple types of maltreatment suggests that they have an accumulating burden.FundingThis work was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium. The views expressed in this abstract are those of the authors and not necessarily those of the Department of Health.