RESUMO
PURPOSE: Existing evidence on the mental health consequences of disadvantaged areas uses cross-sectional or longitudinal studies with short observation periods. The objective of this research was to investigate this association over a 69-year period. METHODS: Data were obtained from the MRC National Survey of Health and Development (NSHD; the British 1946 birth cohort), which consisted of 2125 participants at 69 years. We assessed longitudinal associations between area disadvantage and mental health symptoms at adolescence and adulthood with use of multilevel modelling framework. RESULTS: After adjustment for father's social class, for each one percentage increase in area disadvantage at age 4, there was a 0.02 (95% CI 0.001, 0.04) mean increase in the total score of the neuroticism scale at age 13-15. After adjustment for father's social class, adult socio-economic position, cognitive ability and educational attainment, a one percentage increase in change score of area disadvantage between age 4 and 26 was associated with a mean increase in the total Psychiatric Symptom Frequency score (MD 0.06; 95% CI 0.007, 0.11). Similar associations were observed with change scores between ages 4, 53, 60 and total General Health Questionnaire-28 score at age 53 (MD 0.05; 95% CI 0.01, 0.11) and 60-64 (MD 0.06; 95% CI 0.009, 0.11). CONCLUSIONS: Cohort members who experienced increasing area disadvantage from childhood were at increased risk of poor mental health over the life course. Population-wide interventions aiming at improving social and physical aspects of the early neighbourhood environment could reduce the socio-economic burden of poor mental health.
Assuntos
Saúde Mental , Classe Social , Adulto , Adolescente , Humanos , Criança , Pré-Escolar , Pessoa de Meia-Idade , Adulto Jovem , Estudos de Coortes , Estudos Prospectivos , Estudos Transversais , Fatores SocioeconômicosRESUMO
BACKGROUND: Inequalities between different areas in the United Kingdom (UK) according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population. METHODS: We used the Office for National Statistics (ONS) Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Seven health indicators from local-authority census and vital records data were chosen to represent the older working age population (self-rated health 50-74y, long-term illness 50-74y, Age-specific mortality rate 50-74y, avoidable mortality, life expectancy at birth and 65 years, disability-free life expectancy at 50 years, and healthy life expectancy at 50 years). An additional two health indicators (life expectancy at birth and infant mortality rate) were included as test indicators to determine if associations were limited to the health of older people in a place. These nine health indicators were then linked with the LS sample aged 16-74y with data on employment outcomes and pertinent demographic and individual health information. Interactions by gender and age category (16-49y vs. 50-74y) were also tested. FINDINGS: For all health-in-a-place measures, LS members aged 16-74 who resided in the tertile of local authorities with the 'unhealthiest' older population, had higher odds of not being in paid work, including all four types of economic inactivity. The strongest associations were seen for the health-in-a-place measures that were self-reported, long-term illness (Odds Ratio 1.60 [95% Confidence Intervals 1.52, 1.67]) and self-rated health (1.60 [1.52, 1.68]). Within each measure, associations were slightly stronger for men than women and for the 16-49y versus 50-74y LS sample. In models adjusted for individual self-rated health and gender and age category interactions, health-in-a-place gradients were apparent across all economic inactivity's. However, these same gradients were only apparent for women in part-time work and men in full-time work. CONCLUSION: Improving health of older populations may lead to wider economic benefits for all.
Assuntos
Emprego , Aposentadoria , Recém-Nascido , Lactente , Masculino , Feminino , Humanos , Idoso , Estudos Transversais , Estudos Longitudinais , DesempregoRESUMO
BACKGROUND: The adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples. METHODS: Data on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971-2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age2, gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings. RESULTS: Adults who had been in care at any census (maximum of two) had an adjusted all-cause mortality hazard ratio 1.62 (95% CI 1.43, 1.86) times higher than adults who had never been in care. The excess mortality was mainly attributable to deaths categorised as self-harm, accidents and mental & behavioural causes. Mortality risk was elevated if the LS member was initially assessed in 1981 or 2001, compared to 1971. There was no significant variation in mortality risk for those in care by age or gender. The main findings were consistent irrespective of choice of comparison group (whole population, disadvantaged population), care placement (residential, non-residential) and age at death (all ages, adulthood only). CONCLUSIONS: In this large, nationally representative study of dependent children resident in England and Wales, those who had been in care during childhood had a higher risk of mortality long after they had left care on average, mainly from unnatural causes. No differences by age or gender were found. Children in care have not benefitted from the general decline in mortality risk over time.
Assuntos
Causas de Morte , Cuidado da Criança , Características de Residência , Instituições Residenciais , Acidentes/mortalidade , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Transtornos Mentais/mortalidade , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Comportamento Autodestrutivo/mortalidade , Reino Unido/epidemiologia , Populações Vulneráveis , País de Gales/epidemiologia , Adulto JovemRESUMO
BACKGROUND: In this review article, we detail a small but growing literature in the field of health geography that uses longitudinal data to determine a life course component to the neighbourhood effects thesis. For too long, there has been reliance on cross-sectional data to test the hypothesis that where you live has an effect on your health and well-being over and above your individual circumstances. METHODS: We identified 53 articles that demonstrate how neighbourhood deprivation measured at least 15 years prior affects health and well-being later in life using the databases Scopus and Web of Science. RESULTS: We find a bias towards US studies, the most common being the Panel Study of Income Dynamics. Definition of neighbourhood and operationalization of neighbourhood deprivation across most of the included articles relied on data availability rather than a priori hypothesis. CONCLUSIONS: To further progress neighbourhood effects research, we suggest that more data linkage to longitudinal datasets is required beyond the narrow list identified in this review. The limited literature published to date suggests an accumulation of exposure to neighbourhood deprivation over the life course is damaging to later life health, which indicates improving neighbourhoods as early in life as possible would have the greatest public health improvement.
Assuntos
Características de Residência , Estudos Transversais , Humanos , Fatores SocioeconômicosRESUMO
BACKGROUND: Children who spend time in non-parental care report worse health later in life on average, but less is known about differences by type of care. We examined whether self-rated health of adults who had been in non-parental care up to 30 years later varied by type of care. METHODS: We used longitudinal data from the office for National Statistics Longitudinal Study. Participants were aged <18 and never-married at baseline of each census year from 1971 to 2001. Separately for each follow-up period (10, 20 and 30 years later), multi-level logistic regression was used to compare self-rated health outcomes by different care types. RESULTS: For combined census years, sample sizes were 157 896 dependent children with 10 years of follow-up, 166 844 with 20 years of follow-up and 173 801 with 30 years of follow-up. For all follow-up cohorts, longitudinal study members who had been in care in childhood, had higher odds of rating their health as 'not good' vs. 'good'; with highest odds for residential care. For example, 10-year follow-up odds ratios were 3.5 (95% confidence interval: 2.2-5.6) for residential care, 2.1 (1.7-2.5) for relative households and 2.6 (2.1-3.3) for non-relative households, compared with parental households after adjustment for childhood demographics. Associations were weakest for 10-year, and strongest for 20-year, follow-up. Additional adjustment for childhood social circumstances reduced, but did not eliminate, associations. CONCLUSION: Decades after children and young people are placed in care, they are still more likely to report worse health than children who grew up in a parental household.
Assuntos
Características da Família , Pais , Adolescente , Adulto , Criança , Humanos , Modelos Logísticos , Estudos Longitudinais , Razão de ChancesRESUMO
OBJECTIVES: Past studies have identified socioeconomic inequalities in the timing and route of labour market exit at older ages. However, few studies have compared these trends cross-nationally and existing evidence focuses on specific institutional outcomes (such as disability pension and sickness absence) in Nordic countries. We examined differences by education level and occupational grade in the risks of work exit and health-related work exit. METHODS: Prospective longitudinal data were drawn from seven studies (n=99 164). Participants were in paid work at least once around age 50. Labour market exit was derived based on reductions in working hours, changes in self-reported employment status or from administrative records. Health-related exit was ascertained by receipt of health-related benefit or pension or from the reported reason for stopping work. Cox regression models were estimated for each study, adjusted for baseline self-rated health and birth cohort. RESULTS: There were 50 003 work exits during follow-up, of which an average of 14% (range 2-32%) were health related. Low level education and low occupational grade were associated with increased risks of health-related exit in most studies. Low level education and occupational grade were also associated with an increased risk of any exit from work, although with less consistency across studies. CONCLUSIONS: Workers with low socioeconomic position have an increased risk of health-related exit from employment. Policies that extend working life may disadvantage such workers disproportionally, especially where institutional support for those exiting due to poor health is minimal.
Assuntos
Escolaridade , Emprego/estatística & dados numéricos , Ocupações/estatística & dados numéricos , Fatores Socioeconômicos , Adulto , Fatores Etários , Idoso , Feminino , Finlândia , França , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Aposentadoria/estatística & dados numéricos , Reino Unido , Estados UnidosRESUMO
BACKGROUND: In many developed countries, associations have been documented between higher levels of area unemployment and workforce exit, mainly for disability pension receipt. Health of individuals is assumed to be the primary driver of this relationship, but no study has examined whether health explains or modifies this relationship. METHODS: We used data from 98 756 Office for National Statistics Longitudinal Study members who were aged 40-69 and working in 2001, to assess whether their odds of identifying as sick/disabled or retired in 2011 differed by local authority area unemployment in 2001, change in local area unemployment from 2001 to 2011 and individual reported health in 2001 (self-rated and limiting long-term illness). RESULTS: Higher local area unemployment and worse self-rated health measures in 2001 were independently related to likelihood of identifying as sick-disabled or retired, compared to being in work, 10 years later, after adjusting for socio-demographic covariates. Associations for local area unemployment were stronger for likelihood of identification as sick/disabled compared to retired in 2011. Associations for changes in local area unemployment from 2001 to 2011 were only apparent for likelihood of identifying as retired. For respondents that identified as sick/disabled in 2011, effects of local area unemployment in 2001 were stronger for respondents who had better self-rated health in 2001. CONCLUSIONS: Strategies to retain older workers may be most effective if targeted toward areas of high unemployment. For persons in ill health, local area unemployment interventions alone will not be as efficient in reducing their exit from the workforce.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Nível de Saúde , Aposentadoria/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Adulto , Idoso , Inglaterra , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , País de GalesRESUMO
We used the UK Household Longitudinal Study to examine whether community type (inland or coastal) in adolescence (10-15 years) was associated with five adult health outcomes assessed over 11 waves of follow-up (2009-22). When the analyses were stratified on area deprivation, four of the five health outcomes - self-rated, long-standing illness, psychological distress and mental functioning - showed worse health in increasingly more deprived communities, and to a greater extent in the most deprived communities that are coastal. For all but self-rated health, associations were robust to additional adjustment for adolescent gender, ethnicity, household income, tenure, and life satisfaction.
Assuntos
Nível de Saúde , Humanos , Adolescente , Masculino , Feminino , Estudos Longitudinais , Inquéritos e Questionários , Características de Residência , Seguimentos , Adulto Jovem , Criança , Reino Unido , InglaterraRESUMO
Physical capability in later life is influenced by factors occurring across the life course, yet exposures to area conditions have only been examined cross-sectionally. Data from the National Survey of Health and Development, a longitudinal study of a 1946 British birth cohort, were used to estimate associations of area deprivation (defined as percentage of employed people working in partly skilled or unskilled occupations) at ages 4, 26, and 53 years (residential addresses linked to census data in 1950, 1972, and 1999) with 3 measures of physical capability at age 53 years: grip strength, standing balance, and chair-rise time. Cross-classified multilevel models with individuals nested within areas at the 3 ages showed that models assessing a single time point underestimate total area contributions to physical capability. For balance and chair-rise performance, associations with area deprivation in midlife were robust to adjustment for individual socioeconomic position and prior area deprivation (mean change for a 1-standard-deviation increase: balance, -7.4% (95% confidence interval (CI): -12.8, -2.8); chair rise, 2.1% (95% CI: -0.1, 4.3)). In addition, area deprivation in childhood was related to balance after adjustment for childhood socioeconomic position (-5.1%, 95% CI: -8.7, -1.6). Interventions aimed at reducing midlife disparities in physical capability should target the socioeconomic environment of individuals-for standing balance, as early as childhood.
Assuntos
Envelhecimento/fisiologia , Disparidades nos Níveis de Saúde , Pessoa de Meia-Idade/fisiologia , Aptidão Física/fisiologia , Equilíbrio Postural/fisiologia , Adulto , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Feminino , Força da Mão/fisiologia , Humanos , Estudos Longitudinais , Masculino , Modelos Estatísticos , Ocupações/classificação , Resistência Física/fisiologia , Exame Físico , Vigilância da População , Classe Social , Fatores Socioeconômicos , Reino Unido , População BrancaRESUMO
All aspects of public health research require longitudinal analyses to fully capture the dynamics of outcomes and risk factors such as ageing, human mobility, non-communicable diseases (NCDs), climate change, and endemic, emerging, and re-emerging infectious diseases. Studies in geospatial health are often limited to spatial and temporal cross sections. This generates uncertainty in the exposures and behavior of study populations. We discuss a research agenda, including key challenges and opportunities of working with longitudinal geospatial health data. Examples include accounting for residential and human mobility, recruiting new birth cohorts, geoimputation, international and interdisciplinary collaborations, spatial lifecourse studies, and qualitative and mixed-methods approaches.
Assuntos
Envelhecimento , Saúde Pública , Humanos , Fatores de RiscoRESUMO
A scoping review was performed to identify how Organisation for Economic Co-operation and Development (OECD) countries measure overall health for sub-national geographies within each country. Sixty publications were selected from MEDLINE, Scopus and Google Scholar, plus information extracted from 37 of 38 OECD countries statistical agency and/or public health institute websites that were available in English. Data sources varied by categorisation into national statistical agency mortality (n = 7) or population-level survey morbidity (n = 5) health indicators. Region was the most common geographic scale (e.g., eight indicators for 26 countries), slightly fewer indicators for urban areas (max countries per most frequent indicator = 24), followed by municipality (range of 1-14 countries per indicator). Other geographies, particularly those at smaller granularity, were infrequently available across health indicators and countries. Wider availability of health indicators at smaller, and non-administrative, geographies is needed to explore the best way to measure comparative population health in local areas.
Assuntos
Organização para a Cooperação e Desenvolvimento Econômico , Grupos Populacionais , Coleta de Dados , HumanosRESUMO
Neighborhood effects research is plagued by the inability to circumvent selection effects -the process of people sorting into neighborhoods. Data from two British Birth Cohorts, 1958 (ages 16, 23, 33, 42, 55) and 1970 (ages 16, 24, 34, 42), and structural equation modelling, were used to investigate life course relationships between body mass index (BMI) and area deprivation (addresses at each age linked to the closest census 1971-2011 Townsend score [TOWN], re-calculated to reflect consistent 2011 lower super output area boundaries). Initially, models were examined for: (1) area deprivation only, (2) health selection only and (3) both. In the best-fitting model, all relationships were then tested for effect modification by residential mobility by inclusion of interaction terms. For both cohorts, both BMI and area deprivation strongly tracked across the life course. Health selection, or higher BMI associated with higher area deprivation at the next study wave, was apparent at three intervals: 1958 cohort, BMI at age 23 y and TOWN at age 33 y and BMI at age 33 y and TOWN at age 42 y; 1970 cohort, BMI at age 34 y and TOWN at age 42 y, while paths between area deprivation and BMI at the next interval were seen in both cohorts, over all intervals, except for the association between TOWN at age 23 y and BMI at age 33 y in the 1958 cohort. None of the associations varied by moving status. In conclusion, for BMI, selective migration does not appear to account for associations between area deprivation and BMI across the life course.
Assuntos
Características de Residência , População Branca , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Coortes , Humanos , Adulto JovemRESUMO
There is an overreliance on concurrent neighbourhood deprivation as a determinant of health. Only a small section of the literature focuses on the cumulative exposure of neighbourhood deprivation over the life course. This paper uses data from the 1958 National Child Development Study, a British birth cohort study, linked to 1971-2011 Census data at the neighbourhood level to longitudinally model self-rated health between ages 23 and 55 by Townsend deprivation score between ages 16 and 55. Change in self-rated health is analysed using ordinal multilevel models to test the strength of association with neighbourhood deprivation at age 16, concurrently and cumulatively. The results show that greater neighbourhood deprivation at age 16 predicts worsening self-rated health between ages 33 and 50. The association with concurrent neighbourhood deprivation is shown to be stronger compared with the measurement at age 16 when both are adjusted in the model. The concurrent association with change in self-rated health is explained by cumulative neighbourhood deprivation. These findings suggest that neglecting exposure to neighbourhood deprivation over the life course will underestimate the neighbourhood effect. They also have potential implications for public policy suggesting that neighbourhood socioeconomic equality may bring about better population health.
Assuntos
Características de Residência , Adolescente , Adulto , Criança , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Análise Multinível , Fatores Socioeconômicos , Adulto JovemRESUMO
The authors used data from the Multi-Ethnic Study of Atherosclerosis and latent trajectory class modeling to determine patterns of neighborhood poverty over 20 years (1980-2000 residential history questionnaires were geocoded and linked to US Census data). Using these patterns, the authors examined 1) whether trajectories of neighborhood poverty were associated with differences in the amount of subclinical atherosclerosis (common carotid intimal-media thickness) and 2) associated risk factors (body mass index, hypertension, diabetes, current smoking) at baseline (January 2000-August 2002). The authors found evidence of 5 stable trajectory groups with differing levels of neighborhood poverty ( approximately 6%, 12%, 20%, 30%, and 45%) and 1 group with 29% poverty in 1980 and approximately 11% in 2000. Mostly for women, higher cumulative neighborhood poverty was generally significantly associated with worse cardiovascular outcomes. Trends generally persisted after adjustment for adulthood socioeconomic position and race/ethnicity, although they were no longer statistically significant. Among women who had moved during the 20 years, the long-term measure had stronger associations with outcomes (except smoking) than a single, contemporaneous measure. Results indicate that cumulative 20-year exposure to neighborhood poverty is associated with greater cardiovascular risk for women. In residentially mobile populations, single-point-in-time measures underestimate long-term effects.
Assuntos
Doenças das Artérias Carótidas/epidemiologia , Artéria Carótida Primitiva/patologia , Doença da Artéria Coronariana/epidemiologia , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Doenças das Artérias Carótidas/etnologia , Doenças das Artérias Carótidas/patologia , Intervalos de Confiança , Doença da Artéria Coronariana/etnologia , Doença da Artéria Coronariana/patologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Análise Multivariada , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Estatística como Assunto , Inquéritos e Questionários , Túnica Íntima/patologia , Túnica Média/patologia , Estados Unidos/epidemiologiaRESUMO
Since the turn of the century there has been an explosion in the number of epidemiological studies that have analysed neighbourhood effects on health and wellbeing. The vast majority of these studies are cross-sectional in nature and assume that a contemporaneous place of residence captures a meaningful neighbourhood effect. Over the same time frame, social epidemiology has focussed increasingly on life course effects. This paper aims to bring these two areas of study together and tests whether there a certain ages during the life course when neighbourhoods are more important for our health and wellbeing than others. We use two British birth cohort studies (1958 National Child Development Study and British Cohort Study 1970) each comprising approximately 6,000 sample members at midlife linked to historic census measures used to derived Townsend neighbourhood deprivation scores over the life course. We find little evidence to support our hypothesis that adolescence is a key period of neighbourhood effect, rather we find late-early-adulthood neighbourhood deprivation and midlife neighbourhood deprivation are more strongly related to mid-life health and wellbeing. We are not able to conclude whether these effects are causal and encourage further investigation of selection mechanisms into neighbourhoods and mediation throughout the life course using our newly created dataset.
Assuntos
Disparidades nos Níveis de Saúde , Acontecimentos que Mudam a Vida , Características de Residência , Fatores Socioeconômicos , Adolescente , Adulto , Envelhecimento , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Apoio Social , Reino UnidoRESUMO
BACKGROUND: UK state pension eligibility ages are linked to average life expectancy, which ignores wide socioeconomic disparities in both healthy and overall life expectancy. OBJECTIVES: Investigate whether there are occupational social class differences in the amount of time older adults live after they stop work, and how much of these differences are due to health. METHODS: Participants were 76 485 members of the Office for National Statistics Longitudinal Study (LS), who were 50-75 years at the 2001 census and had stopped work by the 2011 census. Over 10 years of follow-up, we used censored linear regression to estimate mean differences in years between stopping work and death by occupational social class. RESULTS: After adjustment for age, both social class and health were independent predictors of postwork duration (mean difference (95% CI): unskilled class vs professional: 2.7 years (2.4 to 3.1); not good vs good health: 2.4 years (1.9 to 2.9)), with LS members in the three manual classes experiencing ~1 additional year of postwork duration than professional workers (interaction p values all <0.001). Further adjustment for gender and educational qualifications was reduced but did not eliminate social class and postwork duration associations. We estimate the difference in postwork years between professional classes in good health and unskilled workers not in good health as 5.1 years for women (21.0 vs 26.1) and 5.5 years for men (19.5 vs 25.0). CONCLUSIONS: Lower social class groups are negatively affected by uniform state pension ages, because they are more likely to stop work at younger ages due to health reasons.
Assuntos
Morte , Nível de Saúde , Expectativa de Vida , Ocupações/estatística & dados numéricos , Aposentadoria , Classe Social , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pensões , Distribuição por Sexo , Fatores Socioeconômicos , TempoRESUMO
Several studies have documented that older workers who live in areas with higher unemployment rates are more likely to leave work for health and non-health reasons. Due to tracking of area disadvantage over the life course, and because negative individual health and socioeconomic factors are more likely to develop in individuals from disadvantaged areas, we do not know at what specific ages, and through which specific pathways, area unemployment may be influencing retirement age. Using data from the MRC National Survey of Health and Development, we use structural equation modelling to investigate pathways linking local authority unemployment at three ages (4y, 26y and 53y) to age of retirement (right-censored). We explored five hypothesized pathways: (1) residential tracking, (2) health, (3) employment status, (4) occupational class, and (5) education. Initially, pathways between life course area unemployment, each pathway and retirement age were assessed individually. Mediation pathways were tested in the full model. Our results showed that area unemployment tracked across the life course. Higher area unemployment at ages 4 and 53 were independently associated with earlier retirement age [1% increaseâ¯=â¯mean -0.64 (95% CI: -1.12, -0.16) and -0.25 (95% CI: -0.43, -0.06) years]. Both were explained by adjustment for individual employment status at ages 26 and 53 years. Higher area unemployment at age 26 was associated with poorer health and lower likelihood of employment at aged 53; and these 2 individual pathways were identified as the key mediators between area unemployment and retirement age. In conclusion, these results suggest that interventions designed to create local employment opportunities for young adults should lead to extended working through improved employment and health at mid-life.
Assuntos
Escolaridade , Emprego/tendências , Aposentadoria/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Emprego/normas , Inglaterra , Feminino , Nível de Saúde , Humanos , Longevidade , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Aposentadoria/estatística & dados numéricos , Classe Social , Desemprego/estatística & dados numéricosRESUMO
BACKGROUND AND AIMS: This study examined associations between leisure-time physical activity (LTPA) across adulthood (from age 36) and cardiovascular disease (CVD) biomarkers at age 60-64. METHODS: LTPA was reported by study participants from the MRC National Survey of Health and Development at ages 36, 43, 53 and 60-64 (n = 1754) and categorised as inactive, moderately active (1-4/month) or most active (5+/month) at each age. Linear regression was used to examine associations between a cumulative adulthood LTPA score (range = 0-8), and change in LTPA between ages 36 and 60-64 (i.e. always inactive, became inactive, became active, always active) and inflammatory [C-reactive protein (CRP), interleukin-6 (IL-6)], endothelial [tissue-Plasminogen Activator (t-PA), E-selectin] and adipokine [leptin, adiponectin] measures extracted from overnight fasting blood samples at age 60-64. RESULTS: The more active a participant was over adulthood, the better their biomarker profile, e.g. fully-adjusted difference in t-PA (both sexes) and adiponectin (women) per unit increase in the LTPA score (95% confidence interval) = -2.2% (-3.6; -0.8) and 2.0% (0.2; 3.8). Those that became active at age 60-64 showed slightly healthier biomarker profiles than those that became inactive [e.g. fully-adjusted difference in IL-6 = -9.9% (-23.9; 4.1) vs. -3.8% (-12.4; 4.8)], although the best profiles were seen for those always active [IL-6: -15.0% (-24.2; -5.7)], when compared with the always inactive group. CONCLUSIONS: Greater accumulation of LTPA across adulthood was associated with a more favourable CVD biomarker profile in early old age. Earlier uptake and long-term maintenance of LTPA may provide the greatest benefits for CVD prevention.
Assuntos
Adipocinas/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/prevenção & controle , Exercício Físico , Estilo de Vida Saudável , Mediadores da Inflamação/sangue , Atividades de Lazer , Comportamento de Redução do Risco , Adulto , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Comportamento Sedentário , Fatores de Tempo , Reino Unido/epidemiologiaRESUMO
Objective: This study investigated associations between informal caregiving and exit from paid employment among older workers in the United Kingdom. Method: Information on caregiving and work status for 8,473 older workers (aged 50-75 years) was drawn from five waves of Understanding Society (2009-2014). We used discrete-time survival models to estimate the associations of caring intensity and type on the probability of exiting paid work (from >0 to 0 hours/week) in the following year. Models were stratified by sex and working hours, and adjusted for age, self-rated health, long-standing illness, occupation, and partner's employment status. Results: No association was found between caregiving intensity and exit from paid work. Full-time employees who provided care within the household (women and men) or cared for a partner/spouse (women only) more likely to stop working, compared to those not providing care. Women who entered a caregiving role (more than 10 hours/week) were between 2.64 (95% confidence interval [CI]: 1.46, 4.79) and 4.46 (95% CI: 2.53, 7.88) times more likely to exit work (for part-time and full-time workers, respectively), compared to women providing no care. Discussion: This study highlights the onset of caregiving as a key period for older workers. Ensuring that caregiving responsibilities are adequately recognized and supported may help extend working life.