bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP04 Airway Obstruction and All-Cause and Respiratory Mortality: Exploring the Relationship between three Definitions of Obstruction, Smoking using Healths Survey for England and Scottish Health Survey Data
Authors: Moody A , Scholes S , Mindell J 
Published: September 2013

BackgroundDebate continues about the predictive value of different spirometry based definitions of chronic obstructive pulmonary disease (COPD). We explored the hazard of death for three overlapping definitions, and any significant interactions with smoking.MethodsData from the Health Survey for England (years 1995–1997, 2001) and Scottish Health Survey (1995, 1998, and 2003) were used. 30001 adults aged 45+ were interviewed, had spirometry data, and linked mortality records (HSE extracted in 2011; SHeS in 2008).Cox regression was used to estimate the hazard ratios of those with COPD/airflow obstruction, compared with those without, adjusted for age, socio-economic position, smoking, drinking, body mass index (BMI), and longstanding-illness. Sex-specific models, for all-cause and respiratory mortality, used three definitions: fixed threshold (FT): FEV1/FVC < 0.70 and FEV1< 80% predicted; lower limit of normal (LLN): FEV1/FVC1; self-reported COPD as a longstanding-illness (COPD).ResultsFor men meeting FT criteria the hazard ratio (HR) for all-cause mortality was 1.49 (95% CI 1.37, 1.62), compared with those not meeting the criteria. Despite capturing a smaller group, the HR for LLN was not significantly different: 1.60 (1.44, 1.78), nor was the HR for those reporting COPD 1.73 (1.45, 2.05). Similar, overlapping ratios were found for women: FT 1.52 (1.37, 1.68); LLN 1.62 (1.42, 1.85) and COPD 1.76 (1.42, 2.18). The relationship between COPD/obstructed airflow and mortality was stronger for respiratory mortality, with greater differentiation between measures. Among men, FT HR 2.69 (2.16, 3.36) just overlapped with LLN 4.20 (3.30, 5.35), but was lower than reported COPD 5.19 (3.79, 7.10). Among women, the figures were: FT 3.46 (2.68, 4.47), LLN 4.24 (3.17, 5.66), COPD 6.36 (4.31, 9.37). Smoking was a significant risk factor for mortality in all models, independently of airway obstruction, but results showed a significant interaction between cigarette pack-years and COPD. Among adults without COPD, the HR gradually increased to 1.7 (all-cause mortality) for those with 50+ pack-years, relative to never smokers and around 2 for respiratory deaths. Among adults reporting COPD, the HR for pack-years ≥1 was around 3 for all-cause and >6 for respiratory deaths.ConclusionParticipants mentioning COPD as a longstanding illness had the highest respiratory mortality. The HR for those meeting LLN criteria was higher, but not significantly so, than using FT. Any history of smoking increased mortality dramatically among those reporting COPD, compared with a more graded increase of risk by number of pack-years for those not reporting COPD.
OP40 A New Obesity Measure: Is it a Useful Predictor of Heart Disease and All Cause Mortality?
Authors: Boniface D R 
Published: September 2013

BackgroundKrakauer and Krakauer [2012] have developed an obesity measure, the ABSI (A Body Shape Index), based on waist circumference, height and weight, which has particular sensitivity to abdominal fatness. It is a strong predictor of all cause mortality in the USA population sample of 14,105 adults in the National Health and Nutrition Examination Survey (NHANES) 1999–2004. The ABSI is based on a novel logic. It is in the form of the ratio (waist measured) to (waist predicted from height and weight). It has little correlation with BMI and is designed to identify excess waist size irrespective of BMI.MethodsABSI-UK was constructed in the same way as the Krakauer and Krakauer original version but from parameters of height, weight and waist from the Health Survey for England. The usefulness of the ABSI to predict CHD and all cause mortality in the 23 year follow-up of the 9003 men and women participants in the UK Health and Lifestyle Survey was compared with the usefulness of: ABSI-UK, BMI, waist, linear combination of BMI and waist, waist to hip ratio, and waist to height ratio, using Cox survival analysis adjusted for age and sex.ResultsThe ABSI indices were found to be the strongest predictors of all cause and CHD mortality in this sample. Differences in the relative distribution of height between the UK and the USA mean that ABSI-UK is a better predictor in the UK sample, but the improved performance may not be sufficient to justify a different measure. For all-cause mortality the rank ordering by effectiveness from best to worst by Wald statistic was ABSI-UK (60.5), ABSI (47.7), linear combination of waist and BMI (24.3), waist to height ratio (21.4), waist to hip ratio (12.8), waist (11.0), and BMI (0.117). BMI did not reach statistical significance whereas ABSI-UK had a HR of 1.50 (95% CI 1.35, 1.66).ConclusionWhere waist measurement is available in addition to height and weight, ABSI appears to be the preferred choice of obesity measure. Further tests of the ABSI obesity measure should be carried out in different samples. The role of ABSI as a confounder in analyses of the effects of other behaviours such as dietary measures should be investigated.
OP48 Determinants of Active Commuting: Longitudinal Results from the Commuting and Health in Cambridge Study
Authors: Panter J , Dalton A , Griffin S , Ogilvie D 
Published: September 2013

BackgroundNumerous cross-sectional studies have examined the associations between individual, psychological and environmental characteristics and active commuting, but few longitudinal studies exist to support more robust causal inference. Using two complementary approaches to longitudinal analysis, we aimed to build on this evidence by exploring whether (a) individual, psychological, workplace and route environmental characteristics, (b) changes in route environmental characteristics, were associated with changes in active commuting.Methods655 adult commuters completed postal questionnaires concerning past-week commuting trips at similar times of year in 2009 and 2010. We computed changes in time spent walking and cycling and the proportion of car trips, and identified those who took up or maintained walking, cycling or alternatives to the car as the usual mode of travel. Using multivariable logistic regression, we assessed the associations between uptake and maintenance of travel behaviours and baseline individual, psychological and perceived and objective environmental characteristics and between changes in active commuting and changes in perceived environmental characteristics of the route to work.ResultsMean within-participant changes in active commuting were relatively small (walking: +3.0 minutes/week; cycling: -5.3 minutes/week). A lack of free workplace parking predicted uptake of walking and alternatives to the car, while less favourable attitudes towards car use predicted continued use of alternatives to the car. Self-reported and objectively-assessed convenience of public transport respectively predicted uptake of walking (OR 2.47 [95% CI 1.44, 4.25]) and cycling (2.59 [0.99, 6.78]). Those who reported an increase in the convenience of public transport were more likely to take up alternatives to the car (3.24 [1.28, 8.14]) and those who reported convenient cycle routes at baseline were more likely to take up cycling (2.48 [1.04, 5.93]) and alternatives to the car (4.65 [1.45, 14.92]). Those who reported an increase in the perceived danger of cycling reported 8% more car trips, whereas those who reported a decrease were more likely to take up alternatives to the car (2.50 [1.07, 5.86]).DiscussionIndividual, psychological and environmental factors were associated with uptake of active commuting. A few environmental characteristics relating to the convenience and safety of routes for active travel and the convenience of public transport were associated with changes in active commuting both as baseline predictors of change and as dynamic correlates of change, suggesting that these may be suitable targets for interventions to promote walking and cycling to work.
OP49 Socio-Economic Status and Lung Cancer Incidence in Men with type 2 Diabetes in Scotland (2001-2007)
Authors: Walker J , Wild S 
Published: September 2013

BackgroundDiabetes is a chronic disease which affects c. 5% of Scottish men; lung cancer is the second most common cancer among men in Scotland. While both conditions exhibit marked social patterning (specifically, higher prevalence in deprived groups), little research has sought to determine whether the relationship between socio-economic status (SES) and lung cancer differs between men with and without diabetes.MethodsData from a population-based national diabetes register and the Scottish Cancer Registry, combined with all-Scotland population totals, were used to investigate associations between Type 2 diabetes (T2DM), SES and lung cancer. SES was represented by quintiles of the Scottish Index of Multiple Deprivation (a composite area-based measure of multiple deprivation). Age-standardised incidence rates for lung cancer at ages 55–79 during the period 2001–2007 were calculated, by quintile of SES, for men with and without T2DM. Generalised linear models (GLMs) were fitted to estimate the relative risk (RR) of lung cancer associated with T2DM in each SES quintile, adjusted for age.ResultsAmong men without T2DM, age-standardised incidence of lung cancer (per 100,000 of population) in the least deprived and most deprived quintiles was, respectively, 165.2 (95% CI 155.7, 174.8) and 551.0 (533.4, 568.7). Corresponding rates in men with T2DM were 208.1 (172.4, 243.8) and 363.3 (322.7, 403.8). Relative risk of lung cancer (T2DM vs. no diabetes) ranged from 1.22 (0.98, 1.53) in the least deprived quintile to 0.67 (0.59, 0.76) in the most deprived quintile, decreasing monotonically in intermediate quintiles. Across all SES quintiles combined RR of lung cancer in men with T2DM was 0.81 (0.73, 0.89). The interaction of SES with T2DM was highly significant (p < 0.001).ConclusionMarked social gradients for lung cancer incidence were observed both in men with and without T2DM. However, the influence of SES on cancer incidence differed materially by diabetes status: among more deprived men, the risk of lung cancer was attenuated in those with Type 2 diabetes. Possible explanations include lower prevalence of obesity and risk of diabetes among deprived men who smoke, higher prevalence of diabetes among this group, survival bias and more intensive smoking cessation guidance given to deprived men with diabetes in the course of their ongoing clinical management.
OP51 What are the Commonest Symptoms of Cancer and the Risk Factors for Delay in Presentation with Cancer Symptoms?
Authors: Forbes LJL , Warburton F , Richards M A , Ramirez A J 
Published: September 2013

BackgroundOne year cancer survival is poor in the UK compared with similar developed countries. Poor one year survival may be due to delay in symptomatic presentation leading to advanced stage at diagnosis. Much of the research to date has focussed on risk factors for delayed presentation for people with specific cancers. To inform public health approaches to promoting early symptomatic presentation of across all cancer types, we aimed to identify the most common symptoms of cancer and risk factors for delay in presentation of those symptoms in a UK population of cancer patients.MethodsWe surveyed 2,923 cancer patients who had been diagnosed after symptomatic presentation, using a self-complete questionnaire asking about nature and duration of symptoms and barriers to symptomatic presentation (response rate 79%). We weighted percentages reporting each symptom by the incidence of each cancer site to ensure representativeness of the general population of cancer patients. We considered patients reporting more than three months from first noticing the symptom to first seeing a doctor to have delayed presentation.ResultsThe four commonest symptoms were pain (30%), systemic symptoms (23% [fatigue 17%, weight loss 8%]), bleeding (20%) and lump (17%). 69% had experienced one or more of these symptoms. Delay in presentation was reported by one fifth of cancer patients and was most common among patients with prostate and rectal cancer and malignant melanoma and among more socioeconomically deprived people. Change of bowel habit and urinary symptoms (in men only) were the symptoms most likely to be associated with delay in presentation. Among 48% of the patients who reported that anything had put them off going to the doctor with their cancer symptoms, 58% reported that they had not recognised that their symptom was serious; 32% of these had delayed presentation. Worry about wasting the doctor’s time was reported by 12% of patients; 33% of these had delayed presentation. Worry about what the doctor might find (7%) and embarrassment were less common (3%), but were frequently associated with delay in presentation (47% of those who reported worry about what the doctor might find and 60% of those who reported embarrassment).ConclusionThese unique data on the nature of the most common symptoms of cancer and risk factors for delayed symptomatic presentation among a representative sample of cancer patients can inform public health approaches to promoting diagnosis of cancer at an early stage and contribute to improving cancer survival.
OP06 Opposing Processes Contingent on Early Smoking: A Cross-Cohort Comparison of Socioeconomic Inequalities in Alcohol use Across the Youth-To-Adult Transition
Authors: Green M J , Leyland A H , Sweeting H , Benzeval M 
Published: September 2013

BackgroundEvidence of associations between socioeconomic position (SEP) and alcohol use in adolescence and young adulthood is inconsistent, possibly because causal mechanisms associated with SEP pull in different directions. For example, more affluent young people may have greater resources for obtaining alcohol, and may drink for pleasure, whilst socioeconomic adversity may increase coping-motivated drinking. Our previous research on adolescents showed disadvantaged SEP was associated with higher levels of drinking in combination with early smoking, but lower levels of drinking without smoking. We investigate whether such opposing processes contingent on early smoking are present in multiple contexts and across the transition into adulthood.MethodsData were taken from the British 1970 birth cohort study (BCS70; N = 11,649), 1958 National Child Development Study (NCDS58; N = 15,242), and the youth cohort of the Scottish Twenty-07 Study (T07; N = 1,515). T07 represents experiences in the specific context of Glasgow at the same historical time as BCS70, whilst NCDS58 respondents grew up 12 years earlier. Measures were obtained when respondents were aged approximately 16 years and in young adulthood, when respondents were aged approximately 22–26 years across the three studies. Path analyses tested direct associations between parental social class at age 16 and both weekly drinking at age 16 and heavy drinking in young adulthood (>14/21 units last week for women/men), adjusting for an indirect path via early smoking (defined as daily smoking at age 16).ResultsIn all three studies, a manual compared to a non-manual parental social class was associated with a higher likelihood of daily smoking at age 16, and daily smoking at 16 was associated with a higher likelihood of weekly drinking at 16. Adjusting for the indirect relationship via smoking, a manual social class was directly associated with a lower likelihood of weekly drinking at 16 (ORs ranged between 0.51-0.70; p < 0.05). Daily smoking at 16 also exhibited positive associations with young adult drinking. Adjusting for the indirect paths via early smoking and adolescent drinking, a manual parental social class was only associated with a lower likelihood of young adult drinking in BCS70 (OR was 0.64 compared to 1.03 and 1.00 in NCDS and T07). Gender-stratified analyses produced very similar results.ConclusionEarly smoking may mark out mechanisms related to socioeconomic disadvantage which promote heavier drinking, but there is otherwise a tendency for the more affluent to drink more heavily, which seems consistent in adolescence, but more context dependent in young adulthood.
OP60 Poor Educational Outcomes for Young People with Caring Responsibilities
Authors: Brennan C A , Smith E , Farragher T M 
Published: September 2013

BackgroundConservative estimates suggest there are 175,000 children and young people in the UK with caring responsibilities for a dependent relative. The level and type of care varies between families but up to 20% may be caring for 20 hours or more a week and up to 7% for over 50 hours a week. Many of these children are from single parent households and so are likely to lack the support of other adult relatives living nearby. Caring roles in young people have been associated with poor health outcomes and disruption to schooling which may limit opportunities in later life. This study explored the association between young people identified as carers and their educational achievement using data from the Longitudinal Study of Young People in England (LSYPE).MethodsLSYPE is a large-scale nationally representative cohort of young people aged 13 to 14 years in 2004 who were followed annually to explore progress through education and training. Young people were identified as having caring responsibilities or not from three self-report questions. Educational achievement at age 16 years was provided through data linkage with the National Pupil Database. The association between attainment of 5 or more GCSE and equivalents and caring responsibilities was explored using logistic regression and adjusted by other predictor variables which included; demographics, young person’s health, young person’s social behaviour, parental factors and family structure.ResultsEducational data were available on 16,122 of the cohort at aged 16 years and 11,466 also had data on caring responsibilities. The final sample included 2,906 (25%) young carers and 8,560 (75%) young people without caring responsibilities. Young carers had 35% decreased odds of achieving 5 or more GCSE’s or equivalent compared to non carers within the cohort: OR 0.65 [95% CI 0.59, 0.7]). The association remained on controlling for other predictor variables: OR 0.73 [0.64, 0.83]). Detailed exploration of the associations between predictor variables, caring responsibilities and educational attainment will be presented.ConclusionThe results suggest that a young person’s caring role can have a negative impact on their outcomes in compulsory education. Even given the increased likelihood of disadvantage and health difficulties amongst young carers, they are less likely to achieve a recognised minimum standard of educational attainment and this is likely to impact on future life chances.
OP66 Stress in the City: A Multilevel Analysis of Anxiolytic Uptake in Northern Ireland
Authors: Maguire A , O’Reilly D 
Published: September 2013

BackgroundHalf the world’s population now live in cities and by 2030 this proportion will increase to two-thirds. There is growing concern over the negative implications for health associated with living in urban areas. Individuals living in cities are thought to be at an increased risk of cancer, heart attack, stroke and schizophrenia and cities are also associated with increased deprivation and disadvantage. Studies testing the association between urban dwelling and disorders such as depression and anxiety have produced conflicting results. This study aims to discover if living in a city increases your risk of suffering from depression or anxiety, using antidepressant and anxiolytic prescribing as proxy indicators.MethodsAnxiolytic and antidepressant prescribing data from the national prescribing database was linked to individual level census data from the Northern Ireland longitudinal study. Multilevel regression analyses were carried out to test the association between city dwelling and prescription drug uptake, adjusting for natural clustering of individuals within neighbourhoods. The effect of selective migration was tested by identifying moves to and from city and rural areas.ResultsIn the unadjusted model individuals living in cities were 80% more likely than those living in rural areas to receive an anxiolytic (OR 1.80 [95% CI 1.64, 1.96]) 37% more likely to receive an antidepressant (1.37 [1.29, 1.45]). After full adjustment for age, gender, marital status, education, measures of socio-economic disadvantage, limiting long term illness, area deprivation and crime levels individuals living in cities were still 34% more likely to receive anxiolytic medication compared to those living in rural areas (1.34 [1.23, 1.46]). The association between city dwelling and antidepressant uptake attenuated more. Results from the selective migration analysis found that “ever living” in a city increased the likelihood of receiving anxiolytic medication but had no significant effect on antidepressant uptake.ConclusionEven after adjustment for known mental health risk factors city living increases the likelihood of receiving anxiolytic medication. Some studies have suggested that the lack of social networks and individualistic society created in cities has a negative impact on mental health. Interestingly though city dwelling appears to impact anxiety disorders more than depression. Further analyses will be carried out adjusting for social fragmentation.
OP69 Occurrence of Liver Cirrhosis in England, A Cohort Study, 1998-2009: A Comparison with Cancer
Authors: Ratib S , West J , Crooks C J , Fleming K M 
Published: September 2013

BackgroundIn contrast to cancer there is no routine registration of the occurrence of newly diagnosed cases of cirrhosis across most of the world despite its high associated mortality. To therefore put in context the burden of cirrhosis within England we calculated incidence of disease and trends over time and compared this to the top twenty cancers diagnosed in the UK.MethodsWe used the Clinical Practice Research Datalink and linked English Hospital Episode Statistics to identify adult cases of cirrhosis from 1998 to 2009. We described trends in incidence by sex and aetiology. We applied the age- and sex-specific incidence figures to (i) the 2009 age- and sex-stratified population of the UK, to estimate the number of people being newly diagnosed with cirrhosis, and (ii) the European age- and sex-stratified population, to calculate the change in incidence between 1998 and 2009.ResultsA total of 5118 incident cases of cirrhosis aged 18 or over were identified between 1998 and 2009, 57.9% were male. Over the 12-year period crude incidence increased by 50.6% from 25.8 in 1998 to 37.5 in 2009 per 100,000 person-years. Incidence increased for all aetiology types. We estimated approximately 17,000 people were newly diagnosed with cirrhosis in 2009 in the UK, greater than that of the fifth most common cancer non-Hodgkin’s lymphoma. The percentage change in incidence of cirrhosis between 1998 and 2009 for both men (45.2%) and women (28.4%) was greater than that seen for the top four most commonly diagnosed cancers in the UK (breast, lung, bowel and prostate).ConclusionCirrhosis has increased more than that of the top four cancers during 1998 to 2009 in England. The burden of cirrhosis is continuing to rise for all aetiology types. Many of the aetiologies of cirrhosis are preventable; therefore strategies to monitor and reduce the incidence of this disease are urgently needed.