Intergenerational continuities of ethnic inequalities in general health in England.

BACKGROUND: Previous research strongly suggests that ethnic minority groups are more likely to suffer a poorer health profile compared with the overall population, although it is not clear whether these inequalities persist over generations. This study aimed to establish the degree to which ethnic inequalities in health are transmitted from the first to the second generation, and to determine the extent to which intergenerational changes in socioeconomic status and health behaviours might explain any variation that exists. METHODS: Data from the 1999 and 2004 Health Surveys for England assessed the prevalence of fair/poor general health across first (n = 4492) and second (n = 5729) generations of six ethnic minority populations. A white population was selected as reference (n = 18 407). The risk of fair/poor general health was estimated by applying logistic regression models and stepwise inclusion of demographic, socioeconomic and behavioural variables. Generational movement relative to the white baseline was assessed for all ethnic groups adjusted for age and sex. RESULTS: No significant differences in levels of reported fair/poor general health were observed between generations. After adjusting for improved socioeconomic position, the second generation became more likely to report worse health, whereas adjusting for differences in health behaviours had no effect. The Bangladeshi population showed significant intergenerational improvement in general health relative to the white reference, showing a reduction in the odds ratio (95% CI) from 2.75 (2.14 to 3.56) for the first generation to 1.58 (1.17 to 2.13) in the second generation. CONCLUSION: Ethnic minorities in England report consistent rates of fair/poor general health across generations, despite the health benefits resulting from upward social mobility. These health inequalities are unaffected by changes in health behaviours. Understanding these intergenerational pathways will have important public health policy implications as the migrant population not only ages, but also reproduces.

Infant feeding, solid foods and hospitalisation in the first 8 months after birth.

Most infants in the UK start solids before the recommended age of 6 months. We assessed the independent effects of solids and breast feeding on the risk of hospitalisation for infection in term, singleton infants in the Millennium Cohort Study (n = 15,980). For both diarrhoea and lower respiratory tract infection (LRTI), the monthly risk of hospitalisation was significantly lower in those receiving breast milk compared with those receiving formula. The monthly risk of hospitalisation was not significantly higher in those who had received solids compared with those not on solids (for diarrhoea, adjusted odds ratio 1.39, 95% CI 0.75 to 2.59; for LRTI, adjusted odds ratio 1.14, 95% CI 0.76 to 1.70), and the risk did not vary significantly according to the age of starting solids.

Breast-feeding initiation and exclusive duration at 6 months by social class--results from the Millennium Cohort Study.

OBJECTIVES: To assess breast-feeding initiation and rates of exclusive breast-feeding for the first 6 months after birth, and to examine social class differences in breast-feeding rates. DESIGN: First sweep of a longitudinal population-based survey, the Millennium Cohort Study. SETTING: Four countries of the UK. SUBJECTS: Subjects were 18 125 singletons born over a 12-month period spanning 2000-01. Data were collected by parental interview on the initiation of breast-feeding and exclusivity at 1, 4 and 6 months after birth. RESULTS: Overall breast-feeding was initiated for 71% of babies, and by 1, 4 and 6 months of age the proportions being exclusively breast-fed were 34%, 3% and 0.3%, respectively. There were clear social class differences and mothers with routine jobs with the least favourable working conditions were more than four times less likely (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.18-0.29) to initiate breast-feeding compared with women in higher managerial and professional occupations. Women in routine jobs were less likely to exclusively breast-feed their infants at 1 month (OR 0.42, 95% CI 0.36-0.50) and 4 months (OR 0.5, 95% CI 0.31-0.77) compared with women in higher managerial and professional occupations. CONCLUSIONS: Clear social class differences in breast-feeding initiation and exclusivity for the first 4 months were apparent in this large UK sample. By 6 months, less than 1% of babies were being exclusively breast-fed. A co-ordinated multi-faceted strategy is required to promote breast-feeding, particularly among lower-income women.

Birthweight and behavioural problems in children: a modifiable effect?

BACKGROUND: Low birthweight has been shown to predict behavioural problems in children. Less is known about the effect of birthweight, and how this may interact with the social environment in determining behaviour in a general population sample. We have examined the relationship between birthweight and social factors on childhood psychological well-being. METHODS: Cross-sectional analysis of data on 5181 children aged 4-15 years from a randomly selected household population, the 1997 Health Survey for England. The main outcome measures were behavioural problems as defined by the Strengths and Difficulties Questionnaire (SDQ) in relation to birthweight and social environmental factors. RESULTS: Birthweight was a significant predictor of total difficulties score (odds ratio [OR] = 1.27, 95% CI : 1.07, 1.49), hyperactivity in boys (OR = 1.25, 95% CI : 1.05, 1.51), and peer problems in girls (OR = 1.24, 95% CI : 0.99, 1.53). There was a strong social class gradient in the prevalence of behavioural problems for all birthweight tertiles. Bivariate analysis showed that high total difficulties score was significantly more common in lower birthweight tertiles for social classes III non-manual and III manual (P:-value for trend 0.05 and 0.03, respectively). There were smaller, non-significant effects of birthweight on the prevalence of behavioural problems in social class I and II, and IV and V. Statistical tests for an interaction between birthweight and social class were not significant. CONCLUSIONS: Early life factors, such as birthweight and social class have important influences on psychological well-being in children. The birthweight effect is influenced by social factors, with the possibility that an advantaged social environment protects against the development of behavioural problems, and a disadvantaged environment increases the risk of behavioural problems, regardless of birthweight.

Association of spatial distribution of childhood respiratory morbidity with environmental dust pollution.

The objective of this study was to investigate the spatial distribution of respiratory morbidity and asthma in children in relation to high levels of airborne dust pollution. A cross-sectional survey of 2035 children (aged 5-11 yr) by parent-completed questionnaire, with concurrent monitoring of dust deposition rates in the vicinity of children's homes, was performed in 15 primary schools (5 in each of 3 areas of Merseyside). The main outcome measures were (1) doctor-diagnosed asthma, (2) parent-reported respiratory symptoms of recent excess cough, wheeze, and breathlessness, and (3) school absenteeism due to respiratory ill health. Proximity to the source of dust pollution was associated with increased prevalence of excess cough, breathlessness, school absence due to respiratory ill health, and doctor-diagnosed asthma, after adjusting for a range of socioeconomic, environmental, and other confounding factors. The adjusted odds for excess cough and breathlessness for children living within 2 km of the source (dock area) are estimated to be almost twice those for children living more than 2 km away: excess cough 1.9 (95% CI 1.4-2.6); breathlessness 1.9 (1.3-2.7); school absence 1.5 (1.2-1.9); and doctor-diagnosed asthma 1.5 (1.1-2.0). Excess cough was significantly associated with the mean annual dust deposition recorded in the vicinity of the child's home. The adjusted odds ratio for excess cough corresponding to an increase in mean annual dust deposition of 50 mg/m2/d was 3.1 (95% CI 1.1-8.2). These results suggest that airborne dust was associated with respiratory morbidity in these children, which could relate to the high prevalence of childhood doctor-diagnosed asthma in this community.

Clinical significance of cough and wheeze in the diagnosis of asthma.

OBJECTIVES: (1) To determine the prevalence of cough, wheeze, and breathlessness, both as single symptoms and in combination, in primary schoolchildren and their relation to doctor diagnosed asthma. (2) To identify in areas with different levels of dust pollution whether questionnaire reported 'cough alone' (without wheeze or breathlessness) had similar risk factors to the questionnaire reported triad of 'cough, wheeze, and breathlessness'. SUBJECTS AND METHODS: Two cross sectional community surveys of primary schoolchildren (5-11 years) were performed in 1991 and 1993. Parent completed questionnaires related to socioeconomic and respiratory factors were distributed through 15 schools in three areas of Merseyside, one of which had a relatively high level of dust pollution. Data were analysed to determine the prevalence of different respiratory symptom patterns. Univariate and multiple logistic regressions were used to investigate the associations between respiratory symptom profiles and potential risk factors. RESULTS: The proportions of completed questionnaires that were returned were similarly high in both surveys, 92% in 1991 (1872 of 2035) and 87% in 1993 (3746 of 4288). The proportions of children with different respiratory symptom patterns were similar in the two surveys: in 1991, asymptomatic children 70.1% (1109 of 1583), those with cough alone 8.9% (141 of 1583), and children with the symptom triad of cough, wheeze, and breathlessness 8.3% (132 of 1583); the figures for 1993 were 69.5% (2144 of 3083), 9.2% (284 of 3083), and 7.3% (224 of 3083) respectively. The prevalence of doctor diagnosed asthma increased from 17.4% in 1991 to 22.1% in 1993. The symptom of cough alone was associated with going to school in an area of increased air pollution. The symptom triad of cough, wheeze, and breathlessness was associated with reported allergies, familial history of atopy and preterm birth. In 1991, of children with the symptom of cough alone one in eight were diagnosed asthmatic; twice as many doctors made the diagnosis on this basis in 1993. CONCLUSION: The respiratory symptom of cough alone and cough, wheeze, and breathlessness represent clinical responses to different specific risk factors. Cough alone was associated with the environmental factors of school in the dust exposed zone and dampness in the home, whereas cough, wheeze, and breathlessness related to allergic history and preterm birth, and may be the best surrogate of asthma. Diagnosis of asthma on the basis of cough alone partly explains the increased prevalence of doctor diagnosed asthma, especially in dust polluted areas.

Maternal asthma, premature birth, and the risk of respiratory morbidity in schoolchildren in Merseyside.

BACKGROUND: A study was carried out to analyse the impact of maternal asthma on the risk of preterm delivery and the contribution of preterm delivery to the development of childhood asthma. METHODS: Two cross sectional community studies of 1872 children (5-11 years) in 1991 and 3746 children in 1993 were performed. A respiratory health questionnaire was distributed throughout 15 schools in Merseyside and completed by the parents of the children. RESULTS: Asthmatic mothers were more likely to have a preterm delivery than non-asthmatic mothers (odds ratio (OR) 1.49; 95% CI 1.10 to 2.02). Smoking was a separate risk factor for preterm delivery (OR 1.35; 95% CI 1.10 to 1.65). Asthmatic mothers did not have an increased risk of delivering small, growth retarded babies. Maternal asthma, paternal asthma, and premature birth, in that order, increased the risk of later childhood respiratory morbidity (OR 3.13, 95% CI 2.36 to 4.16; 2.23, 95% CI 1.62 to 3.05; 1.40, 95% CI 1.10 to 1.79). Conversely, babies who were small for gestational age appeared less likely to develop doctor diagnosed asthma or the symptom triad of cough, wheeze, and breathlessness in childhood, although this was not statistically significant (OR 0.63, 95% CI 0.28 to 1.41). CONCLUSIONS: Maternal smoking during pregnancy and maternal asthma are independent risk factors associated with preterm delivery. Asthma in mothers predisposes to preterm delivery but not fetal growth retardation. Preterm birth, but not growth retardation, predisposes the child to the development of subsequent asthma.

Critical evaluation of computerised x ray planimetry for the measurement of lung volumes.

BACKGROUND: Computerised x-ray planimetry has been advocated as an alternative to body plethysmography and helium dilution for measuring static lung volumes. The accuracy and reproducibility of this method has been assessed in comparison with these standard methods. METHODS: Plethysmographic and planimetric measurements of total lung capacity (TLC) and functional residual capacity (FRC) were made in 10 normal subjects and in 12 patients with chronic obstructive pulmonary disease (COPD), with additional helium dilution measurements in the latter 12 patients. RESULTS: Mean lung volumes (TLC and FRC) for groups of subjects measured by planimetry and by plethysmography were similar in both groups and larger than the helium dilution measurement in patients with COPD. Intraindividual agreement between planimetry and plethysmography was poor, however, with a wide confidence interval (-2.2 to +2.31). The planimeter did not measure reliably changes in volume from TLC to FRC in individuals. CONCLUSIONS: Mean lung volumes measured by planimetry in a group of patients probably reflect a regression to the mean of the computer algorithm rather than accurate TLC estimation. The technique is not yet robust enough to replace the established techniques of helium dilution or plethysmography.