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Davies LE, Sinclair DR, Kingston A, Spiers GF, Hanratty B. Is it possible to identify populations experiencing material disadvantage in primary care? A feasibility study using the Clinical Practice Research Database. J Epidemiol Community Health 2024:jech-2024-222396. [PMID: 39227144 DOI: 10.1136/jech-2024-222396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/04/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Material disadvantage is associated with poor health, but commonly available area-based metrics provide a poor proxy for it. We investigate if a measure of material disadvantage could be constructed from UK primary care electronic health records. METHODS Using data from Clinical Practice Research Datalink Aurum (May 2022) linked to the 2019 English Index of Multiple Deprivation (IMD), we sought to (1) identify codes that signified material disadvantage, (2) aggregate these codes into a binary measure of material disadvantage and (3) compare the proportion of people with this binary measure against IMD quintiles for validation purposes. RESULTS We identified 491 codes related to benefits, employment, housing, income, environment, neglect, support services and transport. Participants with one or more of these codes were defined as being materially disadvantaged. Among 30,897,729 research-acceptable patients aged ≥18 with complete data, only 6.1% (n=1,894,225) were classified as disadvantaged using our binary measure, whereas 42.2% (n=13,038,085) belonged to the two most deprived IMD quintiles. CONCLUSION Data in a major primary care research database do not currently contain a useful measure of individual-level material disadvantage. This represents an omission of one of the most important health determinants. Consideration should be given to creating codes for use by primary care practitioners.
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Affiliation(s)
- Laurie E Davies
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David R Sinclair
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Kingston
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Frances Spiers
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty/Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Shen A, Chen C, Zhang Z, Zhou J, Lv Y, Wang J, Li J. Associations between socioeconomic status and rates of blood pressure changes among Chinese older adults: a longitudinal community-based cohort study. Public Health 2024; 232:121-127. [PMID: 38772200 DOI: 10.1016/j.puhe.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/06/2024] [Accepted: 04/18/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES The relationships between socioeconomic status (SES) and blood pressure changes among older adults in China remain unclear. This study aimed to examine the associations between SES and rates of blood pressure changes among Chinese older adults. STUDY DESIGN Community-based, prospective, longitudinal cohort study. METHODS This study included 13,541 participants aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey between 2002 and 2018. SES was assessed by educational level, occupation, household yearly per capita income, and financial support. The estimated annual changes (EACs) of blood pressure were computed as the difference in blood pressure levels between any two adjacent surveys divided by the time interval. Associations between SES and EACs of blood pressure were evaluated using generalised estimating equations. RESULTS Lower SES was significantly associated with greater annual increases of blood pressure among Chinese older adults. The effect of SES on EACs of blood pressure was more pronounced among non-hypertensive participants. Compared to EACs among non-hypertensive participants with high SES, multivariable-adjusted EACs among those with low SES increased by 0.57 mmHg (95% confidence interval [CI]: 0.16, 0.99), 0.32 mmHg (95% CI: 0.07, 0.57), and 0.40 mmHg (95% CI: 0.13, 0.66) for systolic blood pressure, diastolic blood pressure, and mean arterial pressure, respectively. CONCLUSIONS This study revealed strong associations between SES and EACs of blood pressure among Chinese older adults, especially in the non-hypertensive population. Findings suggest that prevention strategies for hypertension should pay more attention to the older population with low SES.
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Affiliation(s)
- Anna Shen
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zenghang Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Davies LE, Spiers GF, Sinclair DR, Kingston A, Hanratty B. Characteristics of older unpaid carers in England: a study of social patterning from the English Longitudinal Study of Ageing. Age Ageing 2024; 53:afae049. [PMID: 38497238 PMCID: PMC10945290 DOI: 10.1093/ageing/afae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND A growing number of older people provide unpaid care, but contemporary research evidence on this group is limited. AIM This study aims to describe the characteristics of older people who provide unpaid care and how these vary by socioeconomic position. METHODS Using recent information from the English Longitudinal Study of Ageing (ELSA wave 9, 2019), we analysed cross-sectional data on 1,282 unpaid carers aged ≥50. Data on sociodemographics, health, social wellbeing, care intensity and caregiver-recipient relationships were extracted. Total net non-pension wealth quintiles were used as a relative measure of socioeconomic position. Differences between the poorest and richest wealth quintiles were examined through logistic regression. FINDINGS Most older carers in ELSA were female and looking after another older person. Poor mental and physical health and social isolation were common, and socially patterned. Compared with carers in the middle wealth group, the poorest group were more likely to be living with the person they cared for (odds ratio (OR) 1.56 [95% confidence interval (CI) 1.03-2.36]) and more likely to experience loneliness (OR 2.29 [95% CI 1.42-3.69]), dependency (i.e. the need for help with activities of daily living) (OR 1.62 [95% CI 1.05-2.51]), chronic pain (OR 1.81 [95% CI 1.23-2.67]), a higher number of diseases (OR 1.75 [95% CI 1.15-2.65]) and fair/poor self-rated health (OR 2.59 [95% CI 1.79-3.76]). The poorest carers were also less likely to have a high quality of life (OR 0.51 [95% CI 0.33-0.80]) or be in work (OR 0.33 [95% CI 0.19-0.59]). CONCLUSION Our findings suggest that financially disadvantaged unpaid carers (and their households) may have the greatest needs for intervention and support. Focussing resources on this group has potential to address social inequalities.
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Affiliation(s)
- Laurie E Davies
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Gemma F Spiers
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
| | - David R Sinclair
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Andrew Kingston
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
| | - Barbara Hanratty
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Older People and Frailty / Healthy Ageing, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE4 5PL, UK
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Ruiz M, Hu Y, Martikainen P, Bobak M. Life Course Socioeconomic Position and Cognitive Aging Trajectories: A Cross-National Cohort Study in China and England. Innov Aging 2023; 7:igad064. [PMID: 37746633 PMCID: PMC10516463 DOI: 10.1093/geroni/igad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 09/26/2023] Open
Abstract
Background and Objectives Cross-national research on cognitive aging inequality has largely concentrated on Western countries. It is unclear whether socioeconomic position (SEP) has similar effects on cognitive decline in emerging economies. We compared the association between life course SEP and cognitive function trajectories between China and England, the largest nation under state socialism and one of the oldest capitalist countries. Research Design and Methods This cross-cohort study examined participants aged 50 years and older from the China Health and Retirement Longitudinal Study (n = 12,832) and the English Longitudinal Study of aging (n = 8,875). Cognition z-scores were derived using comparable measures of memory and time orientation on 4 occasions. Life course SEP was self-reported by participants at baseline. Seven- to 8-year trajectories of cognition z-scores were estimated using latent growth curve modeling. Country- and gender-specific associations between childhood/adolescent deprivation, education, material wealth, and home ownership were evaluated in relation to model intercept (baseline level) and linear slope (annual rate of change) of cognition. Results After multivariable adjustment, education was positively associated with the greatest differences in baseline cognition across country and gender. Education was further linked to a slower rate of cognitive decline (z-score units per year); but compared with those with low education, Chinese men (b = 0.032) and women (b = 0.065) with high education had significantly slower declines than English men (b = -0.004) and women (b = 0.010) with high education. Discussion and Implications Despite substantial between-cohort differences in downstream and upstream determinants of dementia, education provided the greatest benefits to cognitive aging in England but particularly in China.
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Affiliation(s)
- Milagros Ruiz
- School of Health and Social Care, University of Essex, Colchester, UK
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Yaoyue Hu
- Lab 1, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Max Planck—University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
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Avis SR, Figtree GA. Poorer care for the poor? Having fewer assets is associated with poorer care during, and worse outcomes after, an IHCA. Resuscitation 2022; 180:78-80. [PMID: 36167197 DOI: 10.1016/j.resuscitation.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Suzanne R Avis
- Cardiovascular Discovery Group, Kolling Institute, University of Sydney, Sydney, Australia; Tasmanian School of Medicine, University of Tasmania, Sydney, Australia.
| | - Gemma A Figtree
- Cardiovascular Discovery Group, Kolling Institute, University of Sydney, Sydney, Australia
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Koffman J, Bajwah S, Davies JM, Hussain JA. Researching minoritised communities in palliative care: An agenda for change. Palliat Med 2022; 37:530-542. [PMID: 36271636 DOI: 10.1177/02692163221132091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care access, experiences and outcomes of care disadvantage those from ethnically diverse, Indigenous, First nation and First people communities. Research into this field of inquiry raises unique theoretical, methodological, and moral issues. Without the critical reflection of methods of study and reporting of findings, researchers may inadvertently compromise their contribution to reducing injustices and perpetuating racism. AIM To examine key evidence of the place of minoritised communities in palliative care research to devise recommendations that improve the precision and rigour of research and reporting of findings. METHODS Narrative review of articles identified from PubMed, CINAHL and Google Scholar for 10 years augmented with supplementary searches. RESULTS We identified and appraised 109 relevant articles. Four main themes were identified (i) Lack of precision when working with a difference; (ii) 'black box epidemiology' and its presence in palliative care research; (iii) the inclusion of minoritised communities in palliative care research; and (iv) the potential to cause harm. All stymie opportunities to 'level up' health experiences and outcomes across the palliative care spectrum. CONCLUSIONS Based on the findings of this review palliative care research must reflect on and justify the classification of minoritised communities, explore and understand intersectionality, optimise data quality, decolonise research teams and methods, and focus on reducing inequities to level up end-of-life care experiences and outcomes. Palliative care research must be forthright in explicitly indentifying instances of structural and systemic racism in palliative care research and engaging in non-judgemental debate on changes required.
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Affiliation(s)
- Jonathan Koffman
- University of Hull, Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Sabrina Bajwah
- King's College London, Cicely Saunders Institute, London, UK
| | - Joanna M Davies
- King's College London, Cicely Saunders Institute, London, UK
| | - Jamilla Akhter Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
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