bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP67 Increase in State Suicide Rates in the USA During Economic Recession
Authors: Reeves A , Stuckler D , McKee M , Gunnell D , Chang S-S , Basu S 
Published: September 2013

BackgroundEvidence from European countries indicates a significant rise in suicides from the economic recession, totalling more than 1000 excess deaths in the UK alone. Among the worst affected economies in Europe, such as Greece, suicides have risen by more than 60% since 2007. Thus far, there has been little or no analysis of US mental health data, mostly owing to delays in data availability.MethodsWe use data on suicide mortality rates from 1999 to 2010 from the Centers for Disease Control and Prevention. Unemployment data come from the Bureau of Labour Statistics. Time-trend regression models were used to assess excess suicides occurring during the economic crisis—i.e., deaths over and above the level that would be expected if historical trends continued.ResultsIn the years before the onset of the crisis (from 1999 to 2007), the suicide mortality rate in the USA was rising on average at a rate of 0·12 per 100 000 per year (95% CI 0.09, 0.14). Coinciding with the onset of the recession, the suicide rate accelerated. There were an additional 0·51 deaths per 100000 per year (0.28, 0.75) in 2008–10. This acceleration corresponds to an additional 1580 suicides per year (860, 2300). Thus, during the recessionary period after 2007, there were an estimated 4750 excess suicide deaths (2750, 6920). Next we investigated the association between rising unemployment and suicide mortality rates. A one percentage point rise in unemployment is associated with a 0·99% increase in the suicide rate ([0.60, 1.38], p < 0.0001), which is closer to the association estimated when there were no labour market protections (1·06%).ConclusionOur findings have immediate implications for policy. Given that some countries have avoided increases in suicides despite significant economic downturns, there is a clear need to implement policy initiatives that promote the resilience of populations during the ongoing recession. Active labour market programmes—projects that immediately help the unemployed find social support and new work opportunities (even part time)—and mental health prevention programmes seem to mitigate significantly the negative mental health effects of recessions.
OP68 Chronic Pain and Mental Health: What can we Learn from the Health Survey for England 2011?
Authors: Whalley R E , Bridges S 
Published: September 2013

BackgroundChronic pain persists over a period of time, typically for three months or more. Questions on chronic pain were included in the Health Survey for England (HSE) 2011 for the first time, as recommended by the Chief Medical Officer’s 2008 report: ‘Pain: Breaking Through the Barrier’. This landmark publication was unable to present definitive estimates of chronic pain prevalence. Results from HSE 2011 fill this gap and allow the mental health and social characteristics of those living with it to be explored.MethodsAll participants who lived with chronic pain were asked about the intensity of pain, areas affected, interference with everyday life and any support received. Chronic pain grades were assigned using Von Korff’s scale ranging from Grade 0 ‘Pain Free’ to Grade IV ‘Severely limiting pain’. Results were analysed by measures of mental health, socio-economic status and the Index of Multiple Deprivation. Results will also be analysed by Healthy Foundations segmentation, which categorises segments of the population by personal motivation, material deprivation and well-being, developed by the Department of Health to improve the effectiveness of targeting health policy and interventions.ResultsOverall, 31% of men and 37% of women reported experiencing any level of chronic pain, with 18% of men and 19% of women experiencing ‘severely limiting pain’; higher than the 11% previously estimated in the Chief Medical Officer’s report. Chronic pain was more prevalent among the poorest in society. Those living in the lowest income households were more likely to be living with chronic pain than those living in higher income households. The same pattern was evident by deprivation with the prevalence of chronic pain being higher among those living in more deprived areas. Mental wellbeing was associated negatively with chronic pain. Those with chronic pain were significantly more likely to report feelings of anxiety or depression; 70% of men and 68% of women with ‘Severely Limiting’ pain reported feelings of anxiety or depression compared with 17% and 22% respectively among those who were pain-free.ConclusionThe 2011 HSE data provides a new, representative, insight into the prevalence, social characteristics and mental health of living with chronic pain. Additional analysis using the Healthy Foundations segmentation will provide further insight into the social patterning of health behaviours. This is an important insight into a key health issue and highlights how chronic pain, like many other health behaviours, is socially patterned and related to other inequalities.
OP07 The Association between Socioeconomic Position and Longitudinal Adult Social Integration in a British Birth Cohort
Authors: Harvey K , Muniz G , Kuh D , Stafford M 
Published: September 2013

BackgroundThe quantity and quality of an individual’s social relationships have been associated with health behaviours, healthcare utilisation and health outcomes. The Public Health and Health and Social Care Outcomes Frameworks include social isolation indicators but do not explicitly consider socioeconomic patterning.Observational studies suggest that social network characteristics are socioeconomically patterned, with those with lower educational attainment, income or occupational grade having more frequent contact with family but smaller friendship networks and less frequent participation in groups. Results, however, are not consistent and studies fail to consider changes over time.MethodsUsing data from the MRC National Survey of Health and Development (also known as the 1946 British birth cohort), this study takes a lifecourse approach to exploring the relationship between socio-economic position on trajectories of social integration between age 36 and 60–64 (n = 1487). Trajectories of social integration were developed from observed variables (frequency of social group participation, frequency of informal social contact and marital status) using Latent Class Analysis. Socio-economic position in childhood (father’s occupation) and early adulthood (educational attainment and head of household occupation) were modelled as covariates to explore how the odds of following each profile varied by socioeconomic position.ResultsFour profiles of social integration were identified for men, one increasing and three decreasing. Higher levels of education were associated with reduced odds of following a profile of decreasing social integration (ORs 0.61 to 0.73) compared to the increasing social integration profile. Four profiles were identified for women: one stably high, one increasing and two declining. The relationship with socioeconomic position was stronger and consistent across measures. Those with higher education or higher head of household occupation were more likely to maintain high levels of social integration (each one level increase in educational attainment was associated with an OR of maintaining high social integration of 2.89). An association between childhood socioeconomic position and head of household was also found.ConclusionThese findings suggest that those with lower socioeconomic position are more at risk of declining social integration up to age 60–64, particularly amongst women. Previous research suggests that low levels of social integration are related to both morbidity and mortality. Further research is required to explore the health impact of profile of social integration and the potential benefit of intervention to support maintenance of social networks at older ages, particularly for those with lower educational attainment or lower occupational grade.
OP75 Increased Consumption of Fruit and Vegetables for the Primary Prevention of Cardiovascular Diseases – A Cochrane Systematic Review
Authors: Hartley L C , Igbinedion E , Holmes J , Thorogood M , Clarke A , Stranges S , Hooper L , Rees K 
Published: September 2013

BackgroundCardiovascular disease (CVD) is a global burden and varies between regions. This regional variation has been linked in part to dietary factors and low fruit and vegetable intake has been associated with higher rates of CVD. Objectives: To determine the effectiveness of advice to increase fruit and vegetable consumption and the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.MethodsThe following electronic databases were searched with no language restrictions from their inception to October 2012: MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library and trial registers. Included studies fulfilled the following criteria: study design – RCT’s, participants - free of CVD (includes those at high risk of CVD), intervention - advice to increase fruit and vegetable consumption or the provision of fruit and vegetables to increase consumption, comparator - no intervention or minimal intervention (e.g. no face to face advice), outcomes - diagnosis of CVD or change in the risk factor profile for CVD (blood pressure, lipids). Two reviewers independently screened titles and abstracts, assessed shortlisted studies for formal inclusion/exclusion, abstracted data and assessed methodological quality.ResultsDatabase searching resulted in 7222 of which 298 went forward for informal inclusion and exclusion. Nine RCT’s met the inclusion criteria. Five trials investigated the provision of fruit and vegetables, and four trials examined advice to increase fruit and vegetable consumption. The intervention components, and the dietary advice provided differed between trials. None of the trials reported clinical events. There was no strong evidence for effects of individual trials of provision of fruit and vegetables on cardiovascular risk factors, but trials were heterogeneous and short term. Dietary advice showed favourable effects on blood pressure (SBP: mean difference -3.0 mmHg [95% CI -4.91, -1.08], DBP: mean difference -0.85 mmHg [-1.96, 0.26]) and to a lesser extent total cholesterol levels over six months (mean difference -0.13 mmol/l [-0.33, 0.08]), but few trials contributed to each analysis.ConclusionThere are very few studies to date examining provision of, or advice to increase the consumption of, fruit and vegetables in the absence of additional dietary interventions or other lifestyle interventions for the primary prevention of CVD. The limited evidence suggests advice to increase fruit and vegetables as a single intervention has favourable effects on CVD risk factors but more trials are needed to confirm this.
OP79 Physical Activity Levels Across Adult Life and Grip Strength In Early Old Age: Updating findings from a British Birth Cohort
Authors: Dodds R , Kuh D , Sayer A Aihie , Cooper R 
Published: September 2013

BackgroundObservational studies do not always find positive associations between physical activity and muscle strength despite intervention studies consistently showing that resistance exercise improves muscle strength in older adults. In previous analyses of the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort, there was no evidence of an association between leisure time physical activity (LTPA) across adulthood and grip strength at age 53 years. This new study tested the hypothesis that cumulative benefits of physical activity across adulthood on grip strength will have emerged by age 60–64 years.MethodsData from the MRC NSHD were used to investigate the associations between self-reported participation in LTPA at ages 36, 43, 53 and 60–64 years and grip strength at 60-64. Linear regression models were constructed to examine the effect of activity at each age separately and as a cumulative score, including adjustment for potential confounders (gender, height, weight, smoking status, limiting disability, educational attainment and occupational class). Formal testing of two different life course hypotheses, the sensitive period and accumulation models, was also performed.ResultsThere were complete longitudinal data available for 778 men and 867 women. Being more active at ages 36, 53 (men only) and 60–64 was associated with stronger grip at 60-64 in models adjusted for gender only. These findings attenuated after adjustment for confounders but associations with LTPA at 53 and 60–64 remained, with for example those who were most active at 60–64 having 1.73 kg ([95% CI 0.61, 2.85], p < 0.01) stronger grip than those who were inactive. There was also evidence of a cumulative effect of LTPA across mid-life; compared to the third of participants who reported the least LTPA participation across the four time points, those in the top third had on average 2.11 kg ([0.88, 3.35], p < 0.01) stronger grip after adjustment for confounders. Consistent with this, in comparison to a fully saturated model, an accumulation model best fit the data.ConclusionIncreased levels of physical activity across adulthood were associated with stronger grip at age 60–64, in both men and women. As these associations have emerged since age 53 years it suggests that LTPA across adulthood may prevent decline in grip strength in early old age. Given the negative health outcomes associated with weaker grip at similar ages, the findings from this observational study provide additional evidence in support of guidelines which recommend that physical activity should be maintained across adult life.
OP80 Inequalities in Heart Failure in Older Age: Prospective Associations between Socioeconomic Measures and Heart Failure Incidence in A 10-Year follow-up Study
Authors: Ramsay S E , Whincup P H , Papacosta O , Morris R W , Lennon L , Wannamethee S G 
Published: September 2013

BackgroundFew studies have examined the prospective associations between socioeconomic measures and incident heart failure, and little is known about possible mechanisms underlying the relationship. The aim of this study was to investigate the association of socioeconomic measures with incident heart failure in older adults and to examine possible underlying pathways.MethodsA socially and geographically representative cohort of men aged 60–79 years in 1998–2000 from 24 British towns was followed-up for 10 years for incident heart failure (fatal and non-fatal based on death certificates and doctor-diagnosis). Adult socioeconomic measures included longest-held occupational social class, education, pension (state only or state with private), and amenities (car and house ownership, access to central heating) – a cumulative score of adverse socioeconomic measures from 0 to ≥ 4 was used. Childhood socioeconomic measures included father’s occupational social class, and household amenities. Prevalent myocardial infarction and heart failure cases were excluded.ResultsAmong 3839 men, 232 incident cases of heart failure occurred over 10 years. The hazard for heart failure was higher in the lowest occupational social classes; hazard ratio for social class IV & V (lowest social class) was 1.70 (95% CI 0.97, 2.96) compared to social class I (highest social class). Heart failure risk increased with increasing score of adverse adult socioeconomic measures (p for trend = 0.0006). Compared to men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.17 (1.34, 3.53), which was attenuated to 1.85 (1.11, 3.08) after adjusting for systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor and plasma vitamin C slightly weakened the hazard ratio to 1.72 (1.01, 2.94). Risk of heart failure did not vary by childhood socioeconomic measures.ConclusionInequalities in heart failure in older populations need to be addressed – the risk of heart failure in older age was greater in the most deprived socioeconomic groups, which was only partly explained by established and novel risk factors for heart failure.
OP81 Not Eating Breakfast is Associated with increased Type 2 Diabetes Risk Markers in a Multiethnic Population of Children: the Child Heart and Health Study in England (CHASE)
Authors: Donin A S , Nightingale C M , Owen C G , Rudnicka A R , Stephen A M , Cook D G , Whincup P H 
Published: September 2013

BackgroundPrevention of type 2 diabetes and one of its precursor obesity are important public health priorities both in adults and in children. In adults, not eating breakfast regularly has been associated with increased risks of obesity and possibly type 2 diabetes. However, little information is available on the influence of breakfast consumption on type 2 diabetes risk markers in children. We therefore examined the relations between self-reported breakfast consumption, type 2 diabetes risk markers and dietary energy and nutrient intakes in childhood.MethodsInformation was collected on usual breakfast frequency in a multi-ethnic population of primary school children in London, Birmingham and Leicester. Children provided detailed 24 hour recalls, measurements of body composition and fasting blood samples which enabled fasting blood lipids, glucose, HbA1c and insulin resistance to be measured.ResultsAmong 4283 children studied, 26% did not eat breakfast every day; these children had higher insulin resistance, HbA1c, glucose, triglycerides, systolic BP, C-reactive protein, skinfold sum and fat mass index than children who reported eating breakfast daily. Differences in insulin resistance, HbA1c, glucose persisted after adjustment for adiposity. Children who did not eat breakfast every day had lower total energy intakes but higher energy density and total fat% energy (particularly mono unsaturated fat% energy). They also had lower intakes of carbohydrates, total non-starch polysaccharides; all micronutrient intakes were also much lower including vitamin B12, folate, vitamin C, calcium and iron. However, adjustment for these differences in diet could not fully account for the differences in type 2 diabetes markers observed.ConclusionChildren who did not eat breakfast had an adverse type 2 diabetes risk profile and higher body fat. These patterns could not be fully explained by observed differences in diet. Breakfast consumption may protect against emerging diabetes risk in childhood, but the underlying reasons for this have still to be established.
OP82 Ethnic Differences in Alcohol-Related Diseases in Scotland
Authors: Bhala N , Brin G , Bansal N , Ward H , Bhopal R 
Published: September 2013

BackgroundAlcohol-related harms, most commonly liver disease-related, are a public health priority in Scotland. Previous research has identified variations in liver disease mortality endpoints using country of birth as a proxy for ethnicity in the UK. We report ethnic differences in the incidence of alcohol-related and liver disease using an adequate measure of ethnicity in Scotland.MethodsUsing the Scottish Health & Ethnicity Linkage Study (SHELS), linking NHS hospital admissions and mortality to the Scottish census 2001, we explored ethnic differences in incidence (2001-2010) of specific alcohol-related diseases (ARD) (ISD definition for ARD, all liver diseases, alcoholic liver disease) in Scotland. Risk ratios (RR) were calculated using Poisson regression with robust variance and multiplied by 100, by gender and adjusted for age. The White Scottish population was the standard reference population (100).ResultsFor alcohol-related diseases, White Irish had about a 2 fold higher risk for both men (RR 225 [95% CI 196, 258]) and women (182 [147, 224]); other British women also had a 25% higher risk (126 [107, 148]). Other White British men had a 10% lower risk (89 [80, 98]), with risks even lower in Pakistani men (66 [55, 78]) and women (49 [30, 78]) and Chinese men (47 [38, 58]). For alcoholic liver disease, White Irish had about a 50% higher risk of ALD for both men (165 [130, 209]) and women (150 [117, 193]). Other White British men had about a third lower risk of ALD (61 [50, 75]), as did Pakistani men (62 [42, 90]) and a composite of South Asian women (75 [58, 91]). For all liver diseases, some ethnic groups had about a third higher risk: Chinese men (144 [50, 175]) and women (133 [107, 165]) as well as Pakistani women (140 [112, 176]). Lower risks for all liver diseases occurred in other White British men (72 [62, 83]) and women (77 [69, 87]) and other White women (74 [64, 90]).ConclusionThese findings show persistent differences in incidence by ethnicity for both alcohol-related and liver disease in Scotland, with important health implications throughout the UK. New policy, research and practical action are required to address these differences.
OP83 Contribution of Behavioural Risk Factors and Socio-Economic Position to Mortality in British South Asian and European Adults: 17 year follow-up of the Newcastle Heart Project Cohort
Authors: Tran A , Hayes L , McNally R , Unwin N , Bhopal R , White M 
Published: September 2013

BackgroundBritish South Asians experience excess cardiovascular disease (CVD) morbidity and mortality. Evidence for this is often based on studies using place of birth as a proxy for ethnicity. We examined the contribution of CVD risk factors and socio-economic position (SEP) to mortality in Europeans and South Asians, who provided confirmation of their ethnicity.MethodsSouth Asian and European origin individuals, aged 25–74 years, were recruited (April 1993 to March 1997). Ethnicity was determined by self-identified ancestry; at least 3 grandparents born in India, Pakistan or Bangladesh indicated South Asian ethnicity. Lifestyle, SEP, biochemical and anthropometric data were collected. Participants were mortality flagged with the NHS Medical Research Information Service. A lifestyle risk score, including BMI and self-reported physical activity, diet, smoking and alcohol consumption (range 0–5) was dichotomised to categorise a ‘healthy’ (score 0–2) or ‘unhealthy’ lifestyle (score 3–5). SEP was determined by the occupation of the head of the household. Age-adjusted hazard ratios (HR) for death were derived from Cox regression analyses.Results817 Europeans and 684 South Asians were followed up for 12-17 years. Mean follow-up was 14.9 and 13.9 years for Europeans and South Asians respectively. 5 Europeans and 34 South Asians were lost to follow-up, most commonly because individuals were no longer NHS registered (2 Europeans, 27 South Asians). Mortality ratios, standardised to a Newcastle-upon-Tyne European population, for Europeans and South Asians were 76.5 and 60.3 respectively (z-test of significance for difference between ethnic groups, p = 0.168). 28% and 49% of European men and women respectively (chi-square for difference, p < 0.001), and 23% and 26% (South Asian men and women, NS) were classified as having a healthy lifestyle. Having an unhealthy lifestyle was significantly associated with mortality in European women only (HR 1.8; 95% CI 1.03, 3.25). SEP was associated with mortality in European women and South Asian men (HR for manual vs non-manual occupation 3.1 [1.3, 7.5] and 3.7 [1.4, 9.9] respectively). SEP attenuated the effects of lifestyle on mortality in further models.ConclusionNo significant difference in SMR between Europeans and South Asians found at 12–17 years of follow-up, although in contrast to previous studies we report a higher SMR in Europeans than in South Asians. There was a trend towards higher mortality in those with a less healthy lifestyle, but this was statistically significant only in European women. Adjusting for SEP attenuated the relationship between lifestyle and mortality suggesting that both SEP and lifestyle influence mortality.