Jennifer Mindell

The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants. Using HSE 2003-2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28,470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models. Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a ...

Consistent estimation of the burden of chronic obstructive pulmonary disease (COPD) has been hindered by differences in methods, including different spirometric cut-offs for impaired lung function. The impact of different definitions on the prevalence of potential airflow obstruction, and its associations with key risk factors, is evaluated using cross-sectional data from two nationally representative population surveys. Pooled cross-sectional analysis of Wave 2 of the UK Household Longitudinal Survey and the Health Survey for England 2010, including 7879 participants, aged 40-95 years, who lived in England and Wales, without diagnosed asthma and with good-quality spirometry data. Potential airflow obstruction was defined using self-reported physician-diagnosed COPD; a fixed threshold (FT) forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7 and an age-specific, sex-specific, height-specific and ethnic-specific lower limit of normal (LLN). Standardised ques...

The criterion validity of the 2008 Physical Activity and Sedentary Behavior Assessment Questionnaire (PASBAQ) was examined in a nationally representative sample of 2,175 persons aged ≥16 years in England using accelerometry. Using accelerometer minutes/day greater than or equal to 200 counts as a criterion, Spearman's correlation coefficient (ρ) for PASBAQ-assessed total activity was 0.30 (95% confidence interval (CI): 0.25, 0.35) in women and 0.20 (95% CI: 0.15, 0.26) in men. Correlations between accelerometer counts/minute of wear time and questionnaire-assessed relative energy expenditure (metabolic equivalent-minutes/day) were higher in women (ρ = 0.41, 95% CI: 0.36, 0.46) than in men (ρ = 0.32, 95% CI: 0.26, 0.38). Similar correlations were observed for minutes/day spent in vigorous activity (women: ρ = 0.39, 95% CI: 0.33, 0.46; men: ρ = 0.31, 95% CI: 0.26, 0.36) and moderate-to-vigorous activity (women: ρ = 0.42, 95% CI: 0.36, 0.48; men: ρ = 0.38, 95% CI: 0.32, 0.45). Corr...

Use of objective physical activity measures is rising. We investigated the representativeness of survey participants who wore an accelerometer. 4273 adults aged 16+ from a cross-sectional survey of a random, nationally representative general population sample in England in 2008 were categorized as 1) provided sufficient accelerometry data [4-7 valid days (10+ hrs/d), n = 1724], 2) less than that (n = 237), or 3) declined (n = 302). Multinomial logistic regression identified demographic, socioeconomic, health, lifestyle, and biological correlates of participants in these latter 2 groups, compared with those who provided sufficient accelerometry data (4+ valid days). Those in the random subsample offered the accelerometer were older and more likely to be retired and to report having a longstanding limiting illness than the rest of the adult Health Survey for England participants. Compared with those providing sufficient accelerometry data, those wearing the accelerometer less were you...

The extent that controlled diabetes impacts upon mortality, compared with uncontrolled diabetes, and how pre-diabetes alters mortality risk remain issues requiring clarification. We carried out a cohort study of 22,106 Health Survey for England participants with a HbA1C measurement linked with UK mortality records. We estimated hazard ratios (HRs) of all-cause, cancer and cardiovascular disease (CVD) mortality and 95% confidence intervals (CI) using Cox regression. Average follow-up time was seven years and there were 1,509 deaths within the sample. Compared with the non-diabetic and normoglycaemic group (HbA1C <5.7% [<39mmol/mol] and did not indicate diabetes), undiagnosed diabetes (HbA1C ≥6.5% [≥48mmol/mol] and did not indicate diabetes) inferred an increased risk of mortality for all-causes (HR 1.40, 1.09-1.80) and CVD (1.99, 1.35-2.94), as did uncontrolled diabetes (diagnosed diabetes and HbA1C ≥6.5% [≥48mmol/mol]) and diabetes with moderately raised HbA1C (diagnosed diabetes and HbA1C 5.7-<6.5% [39-<48mmol/mol]). Those with controlled diabetes (diagnosed diabetes and HbA<5.7% [<39mmol/mol]) had an increased HR in relation to mortality from CVD only. Pre-diabetes (those who did not indicate diagnosed diabetes and HbA1C 5.7-<6.5% [39-<48mmol/mol]) was not associated with increased mortality, and raised HbA1C did not appear to have a statistically significant impact upon cancer mortality. Adjustment for BMI and socioeconomic status had a limited impact upon our results. We also found women had a higher all-cause and CVD mortality risk compared with men. We found higher rates of all-cause and CVD mortality among those with raised HbA1C, but not for those with pre-diabetes, compared with those without diabetes. This excess differed by sex and diabetes status. The large number of deaths from cancer and CVD globally suggests that controlling blood glucose levels and policies to prevent hyperglycaemia should be considered public health priorities.

Health Examination Surveys (HESs) can provide essential information on the health and health determinants of a population, which is not available from other data sources. Nevertheless, only some European countries have systems of national HESs. A study conducted in 2006-2008 concluded that it is feasible to organize national HESs using standardized measurement procedures in nearly all EU countries. The feasibility study also outlined a structure for a European Health Examination Survey (EHES), which is a collaboration to organize standardized HESs in countries across Europe.To facilitate setting up national surveys and to gain experience in applying the EHES methods in different cultures, EHES Joint Action (2010-2011) planned and piloted standardized HESs in the working age population in 12 countries. This included countries with earlier national HESs and countries which were planning their first national HES. The core measurements included in all surveys were weight, height, waist circumference and blood pressure, and blood samples were taken to measure lipid profiles and glucose or glycated haemoglobin (HbA1c). These are modifiable determinants of major chronic diseases not identified in health interview surveys. There was a questionnaire to complement the data on the examination measurements. Evaluation of the pilot surveys was based on review of national manuals and evaluation reports of survey organizers; observations and discussions of survey procedures during site visits and training seminars; and other communication with the survey organizers. Despite unavoidable differences in the ways HESs are organized in the various countries, high quality and comparability of the data seems achievable. The biggest challenge in each country was obtaining high participation rate. Most of the pilot countries are now ready to start their full-size national HES, and six of them have already started. The EHES Pilot Project has set up the structure for obtaining comparable high quality health indicators on health and important modifiable risk factors of major non-communicable diseases from the European countries. The European Union is now in a key position to make this structure sustainable. The EHES core survey can be expanded to cover other measurements.

UCL logo UCL Discovery. ... (Health Survey for England ). Information Centre: London. Full text not available from this repository. Type: Report. Title: Health Survey for England 2004. The health of minority ethnic groups. Keywords: Health, Survey, England, Ethnicity. UCL ...

We report the results of a randomized single-centre study designed to assess the effects of simvastatin on blood lipids, blood biochemistry, haematology and other measures of safety and tolerability in preparation for a large-scale multicentre mortality study. Six hundred and twenty-one individuals considered to be at increased risk of coronary heart disease were randomized, following a 2-month placebo 'run-in' period, to receive 40 mg daily simvastatin, 20 mg daily simvastatin or matching placebo. Their mean age was 63 years, 85% were male, 62% had a history of prior myocardial infarction (MI), and the mean baseline total cholesterol was 7.0 mmol.l-1. Median follow-up in the present report is 3.4 years. Eight weeks after randomization, 40 mg daily simvastatin had reduced non-fasting total cholesterol by 29.2% +/- 1.1 (2.03 +/- 0.08 mmol.l-1) and 20 mg daily simvastatin had reduced it by 26.8% +/- 1.0 (1.87 +/- 0.07 mmol.l-1). Almost all of the difference in total cholesterol at 8 weeks was due to the reduction in LDL cholesterol (40.8% +/- 1.6 and 38.2% +/- 1.4 among patients allocated 40 mg and 20 mg of simvastatin daily respectively), but simvastatin also reduced triglycerides substantially (19.0% and 17.3%) and produced a small increase in HDL cholesterol (6.4% and 4.8%). These effects were largely sustained over the next 3 years, with 40 mg daily simvastatin producing a slightly greater reduction in total cholesterol at 3 years (25.7% +/- 1.9 reduction) than did 20 mg daily simvastatin (22.2% +/- 1.8). There were no differences between the treatment groups in the numbers of reports of 'possible adverse effects' of treatment or of a range of different symptoms or conditions (including those related to sleep or mood) recorded at regular clinic follow-up. Mean levels of alanine aminotransferase, aspartate aminotransferase and creatine kinase were slightly increased by treatment, but there were no significant differences between the treatment groups in the numbers of patients with significantly elevated levels. A slightly lower platelet count in the simvastatin group was the only haematological difference from placebo, with no difference in the numbers of patients with low platelet counts. In summary, the simvastatin regimens studied produced large sustained reductions in total cholesterol, LDL cholesterol and triglyceride and small increases in HDL cholesterol. They were well tolerated, with no evidence of serious side-effects during the first 3 years of this study.(ABSTRACT TRUNCATED AT 400 WORDS)

Renal replacement therapy rates are inversely related to socioeconomic status (SES) in developed countries. The relationship between chronic kidney disease (CKD) and SES is less clear. This study examined the relationships between SES and CKD and albuminuria in England. Data from the Health Survey for England 2009 and 2010 were combined. The prevalence of CKD 3-5 and albuminuria was calculated, and logistic regression used to determine their association with five individual-level measures and one area-level measure of SES. The prevalence of CKD 3-5 was 5.2% and albuminuria 8.0%. Age-sex-adjusted CKD 3-5 was associated with lack of qualifications [odds ratio (OR) 2.27 (95% confidence interval 1.40-3.69)], low income [OR 1.50 (1.02-2.21)] and renting tenure [OR 1.36 (1.01-1.84)]. Only tenure remained significant in fully adjusted models suggesting that co-variables were on the causal pathway. Albuminuria remained associated with several SES measures on full adjustment: low income [OR ...

ABSTRACT Objective To explore the characteristics associated with active travel, including leisure activity, and to assess the contribution of active travel to and from school to children's overall activity level. Design Cross-sectional health examination survey. Setting The Health Survey for England 2008 surveyed a random nationally-representative sample of the general free-living population in England. Participants Children aged 5–15 years who had complete information on all variables used (n=4468), including self-reported physical activity. Analyses predicting objectively measured physical activity were repeated using a subsample of children with at least 4 days actigraph wear (n=603). Main outcome measures Active travel (walked to/from school at least once in the last week, or cycled to/from school at least once in the last week, vs neither); met the physical activity recommendations (at least 60 min daily on all 7 days vs did not, self-reported); actigraph-measured activity tertile (highest, middle, vs lowest); other walking or cycling (did any other walking, did any other cycling). Results 64% of children walked to/from school, 3% cycled, and 33% did neither; 410 children with sufficient actigraph wear walked and 19 cycled to/from school at least weekly. Children who walked or cycled to/from school were more active than those who did neither (self-reported, met recommendations: walking OR 1.17, (95% CI 1.00 to 1.37), cycling OR 1.93 (1.33 to 2.80); actigraph-measured highest activity tertile: walking OR 3.51, (1.81 to 6.80), cycling OR 5.22, (0.90 to 30.38); actigraph-measured middle activity tertile: walking OR 2.09 (1.21 to 3.6), cycling OR 6.54 (1.54 to 27.80)). The profile of walkers and cyclists differed. Walkers generally came from a deprived area (OR 1.45, 1.25 to 1.69) and were less likely to have a limiting illness (OR 0.69, 0.54 to 0.87). Cyclists were generally older (OR 1.12, 1.06 to 1.19), male (OR 4.03, 2.60 to 6.25), and most likely to meet the recommendations (self-report OR 1.86, 1.28 to 2.70). For self-reported activity, time spent cycling to/from school (OR 1.31, 1.09 to 1.59) contributed more to meeting the recommendations than time spent walking to/from school (OR 1.08, 1.02 to 1.15) or in sports (OR 1.17, 95% CI 1.14 to 1.20). For actigraph-measured activity, only time spent walking to school (OR 1.80, 1.41 to 2.30) and in sports (OR 1.10, 1.01 to 1.20) were significantly associated with being in the highest activity tertile. However, the actigraph measures bi-axial movement so does not capture cycling. Conclusion Children who reported walking or cycling to/from school were more active than those who did neither. Longitudinal studies are required to ascertain whether encouraging active travel increases overall activity levels in less active children.

ABSTRACT There is a growing interest internationally in synergies between reduction of greenhouse gases and increase in active travel (walking, bicycling, and use of public transport). Active travel is associated with reductions in cardiovascular diseases, depression, dementia, and diabetes. We aimed to assess whether people who undertake more active transport because of concerns about the environment benefit from their increased activity personally through reduced likelihood of being overweight or obese, or having diabetes or hypertension.