Chronic kidney disease, albuminuria and socioeconomic status in the Health Surveys for England 2009 and 2010.

BACKGROUND: 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. METHODS: 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. RESULTS: 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 1.55 (1.14-2.11)], no vehicle [OR 1.38 (1.05-1.81)], renting [OR 1.31 [1.03-1.67)] and most deprived area-level quintile [OR 1.55 (1.07-2.25)]. CONCLUSIONS: CKD 3-5 and albuminuria were associated with low SES using several measures. For albuminuria this was not explained by known measured causal factors.

The contribution of active travel (walking and cycling) in children to overall physical activity levels: a national cross sectional study.

OBJECTIVE: To assess the contribution of active travel to and from school to children's overall physical activity levels in England. METHOD: Logistic regression models examining associations between active travel (walked, or cycled, to/from school at least once in the last week) and achievement of physical activity recommendations (≥60 min/d daily) in 4,468 children aged 5-15y (303 with valid accelerometry data) participating in the nationally-representative Health Survey for England 2008. RESULTS: The 64% of children who walked and the 3% who cycled to/from school were more active than the 33% who did neither. Typical walkers came from a deprived area and were less likely to have a limiting illness; typical cyclists were older, male, and most likely to meet the recommendations. For self-reported activity, time spent cycling to/from school contributed more to meeting the recommendations (OR1.31, 1.09-1.59) than time spent walking to/from school (OR1.08, 1.02-1.15) or in sports (OR1.17, 95% CI 1.14-1.20). Time spent walking to school (OR1.80, 1.41-2.30) and in sports (OR1.10, 1.01-1.20) were significantly associated with being in the highest tertile actigraph-measured activity. CONCLUSION: Children who reported walking or cycling to school were more active. Longitudinal studies are required to ascertain whether encouraging active travel affects less active children.

The effect of survey method on survey participation: analysis of data from the Health Survey for England 2006 and the Boost Survey for London.

BACKGROUND: There is a need for local level health data for local government and health bodies, for health surveillance and planning and monitoring of policies and interventions. The Health Survey for England (HSE) is a nationally-representative survey of the English population living in private households, but sub-national analyses can be performed only at a regional level because of sample size. A boost of the HSE was commissioned to address the need for local level data in London but a different mode of data collection was used to maximise participant numbers for a given cost. This study examines the effects on survey and item response of the different survey modes. METHODS: Household and individual level data are collected in HSE primarily through interviews plus individual measures through a nurse visit. For the London Boost, brief household level data were collected through interviews and individual level data through a longer self-completion questionnaire left by the interviewer and collected later. Sampling and recruitment methods were identical, and both surveys were conducted by the same organisation. There was no nurse visit in the London Boost. Data were analysed to assess the effects of differential response rates, item non-response, and characteristics of respondents. RESULTS: Household response rates were higher in the 'Boost' (61%) than 'Core' (HSE participants in London) sample (58%), but the individual response rate was considerably higher in the Core (85%) than Boost (65%). There were few differences in participant characteristics between the Core and Boost samples, with the exception of ethnicity and educational qualifications. Item non-response was similar for both samples, except for educational level. Differences in ethnicity were corrected with non-response weights, but differences in educational qualifications persisted after non-response weights were applied. When item non-response was added to those reporting no qualification, participants' educational levels were similar in the two samples. CONCLUSION: Although household response rates were similar, individual response rates were lower using the London Boost method. This may be due to features of London that are particularly associated with lower response rates for the self-completion element of the Boost method, such as the multi-lingual population. Nevertheless, statistical adjustments can overcome most of the demographic differences for analysis. Care must be taken when designing self-completion questionnaires to minimise item non-response.

The effect of mode and context on survey results: analysis of data from the Health Survey for England 2006 and the Boost Survey for London.

BACKGROUND: Health-related data at local level could be provided by supplementing national health surveys with local boosts. Self-completion surveys are less costly than interviews, enabling larger samples to be achieved for a given cost. However, even when the same questions are asked with the same wording, responses to survey questions may vary by mode of data collection. These measurement differences need to be investigated further. METHODS: The Health Survey for England in London ('Core') and a London Boost survey ('Boost') used identical sampling strategies but different modes of data collection. Some data were collected by face-to-face interview in the Core and by self-completion in the Boost; other data were collected by self-completion questionnaire in both, but the context differed. Results were compared by mode of data collection using two approaches. The first examined differences in results that remained after adjusting the samples for differences in response. The second compared results after using propensity score matching to reduce any differences in sample composition. RESULTS: There were no significant differences between the two samples for prevalence of some variables including long-term illness, limiting long-term illness, current rates of smoking, whether participants drank alcohol, and how often they usually drank. However, there were a number of differences, some quite large, between some key measures including: general health, GHQ12 score, portions of fruit and vegetables consumed, levels of physical activity, and, to a lesser extent, smoking consumption, the number of alcohol units reported consumed on the heaviest day of drinking in the last week and perceived social support (among women only). CONCLUSION: Survey mode and context can both affect the responses given. The effect is largest for complex question modules but was also seen for identical self-completion questions. Some data collected by interview and self-completion can be safely combined.

Under-reporting of tobacco use among Bangladeshi women in England.

BACKGROUND: This study investigates the prevalence of under-reported use of tobacco among Bangladeshi women and the characteristics of this group. METHODS: The 1999 and 2004 Health Survey for England included 996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without. The main outcome measure was the prevalence of under-reported tobacco use. RESULTS: Fifteen per cent of Bangladeshi women with a saliva sample under-reported their personal tobacco use. Under-reporters were very similar to self-reported users except for being much more likely to report chewing paan without tobacco (47% versus 9%, P < 0.001). Under-reporters differed significantly from cotinine-validated non-users in most respects. Regression analyses confirmed that under-reporters and self-reported users were similar in age, education level and exposure to passive smoking. Under-reporters were older and less educated than cotinine-validated non-users. Both self-reported users [odds ratio (OR): 0.11, 95% confidence interval (CI): 0.04-0.30] and cotinine-validated non-users (OR: 0.42, 95% CI: 0.20-0.89) were far less likely to report chewing paan without tobacco compared with under-reporters. CONCLUSIONS: Contrary to our a priori hypothesis, under-reporters were not young, British-born, English-speaking women likely to be concealing smoking but resembled self-reported tobacco users except for being much more likely to report chewing paan without tobacco.

Making meaningful connections: a profile of social isolation and health among older adults in small town and small city, British Columbia.

OBJECTIVE: The objectives of the study are: (a) to develop a profile of socially isolated older adults (SIOA) in British Columbia (BC) based on sociodemographic and health characteristics and (b) to examine whether SIOA under-or overutilize health care services. METHOD: This study uses telephone interview data collected from a random sample of 1,064 older adults (65+) in BC. The sample was identified using established criteria from the six-item Lubben Social Network Scale. RESULTS: The results indicate that 17% of the sample is socially isolated. To summarize, the strongest predictors of social isolation are income, gender, marital status, self-rated health, length of residence, and home ownership. Further analysis indicates that SIOA were not more inclined to overuse health services. DISCUSSION: The findings underscore the importance of understanding differential profiles of need and service use for SIOA within broader social contexts, and are discussed in terms of their implications for health care policy and program planning for this vulnerable population.

Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment.

OBJECTIVES: Ethnic inequalities in health (EIH) are unjust public health problem that emerge across societies. In Israel, despite uniform healthcare coverage, marked EIH persist between Arabs and Jews. METHODS: We draw on the ecosocial approach to examine the relative contributions of individual socioeconomic status (SES), psychosocial and health behavioral factors, and the living environment (neighborhood problems, social capital, and social participation) to explaining ethnic differences in self-rated health (SRH). Data were derived from two nationwide studies conducted in 2004-2005 of stratified samples of Arabs (N = 902) and Jews (N = 1087). RESULTS: Poor SRH was significantly higher among Arabs after adjustment for age and gender [odds ratio and 95% confidence interval (CI) = 1.94 (1.57-2.40)]. This association was reversed following adjustment for all possible mediators: OR (95% CI) = 0.70(0.53-0.92). The relative contribution of SES and the living environment was sizable, each attenuating the EIH by 40%, psychosocial factors by 25%, and health behaviors by 16%. CONCLUSIONS: Arabs in Israel have poorer SRH than Jews. Polices to reduce this inequality should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.

Who provides accelerometry data? Correlates of adherence to wearing an accelerometry motion sensor: the 2008 Health Survey for England.

BACKGROUND: Use of objective physical activity measures is rising. We investigated the representativeness of survey participants who wore an accelerometer. METHODS: 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). RESULTS: 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 younger, less likely to be in paid employment, and more likely to be a current smoker. Those who declined to wear an accelerometer did not differ significantly from those who wore it for sufficient time. CONCLUSIONS: We found response bias in wearing the accelerometers for sufficient time, but refusers did not differ from those providing sufficient data. Differences should be acknowledged by data users.

Linking young people's knowledge of public health guidelines to physical activity levels in England.

Using the 2007 Health Survey for England, we examine whether knowledge of guidelines is linked to physical activity levels for 1,954 children aged 11-15, and the correlates of adhering to the guidelines. For girls, knowing the guidelines was associated with meeting them, but was weak among boys, for whom only white ethnicity was associated with meeting the guidelines. For girls, being younger, white, and from a manual social class background was associated with meeting the guidelines. Findings support the call for physical activity-promoting policy and programs aimed at specific groups of children who are prone to lower levels of activity.

The use of complementary and alternative medicine among Chinese Canadians: results from a national survey.

This study examines the relationship between Chinese Canadian ethnicity and the use of complementary and alternative medicine (CAM) and explores some of the factors that contribute to CAM use among this visible minority group. Using data from cycle 2.1 of the Canadian Community Health Survey (2003), we use multivariate logistic regression to investigate the extent to which CAM use varies among Chinese Canadians and non-Chinese Canadians. Two three-way interactions, which demonstrate how the combination of certain identity markers increases their predictive value within the model, are also examined. The use of CAM varies according to ethnicity, with Chinese Canadians being more likely to use than non-Chinese Canadians. The findings also indicate that cultural factors play a key role in establishing the necessary conditions for increasing the likelihood of CAM use for Chinese Canadians. Findings are discussed in terms of their implications for health care policy and program development.