Transcript Slide 1

The English Longitudinal Study of Ageing
(ELSA) including some information
on the Whitehall Studies
The Presenter
• Professor Anthea Tinker, member of the
Advisory Committee of ELSA since it started
• Participant in 3 longitudinal studies including
the Whitehall II study
• PI for research on the Retention of
Participants in Longitudinal Studies
The ELSA team
• The research is a collaborative one between
Epidemiology, University College London, the Institute
for Fiscal Studies and the National Centre for Social
Research (NatCen) with additional contributions from
the University of Manchester.
• Presentation on behalf of the team: PIs Professor Sir
Michael Marmot, Professor James Banks, Professor
James Nazroo and with particular thanks to Professor
Andrew Steptoe and Dr Panos Demakakos
1. ELSA Funders
• National Institute on Aging (USA)
• UK Government departments (co-ordinated by the Office for
National Statistics)
- Department of Health
- Department for Work and Pensions
- Department for Transport
- Department for Environment, Food and Rural
Affairs
- Department for Communities and Local Government
- Her Majesty’s Inland Revenue and Customs
2. The objectives
1. To collect longitudinal data on health,
disability, economic circumstances, social
participation and networks, and well-being
from a representative sample of the English
population aged 50 and over
2. The objectives (ctd)
2. To explore the dynamic relationships between
health and functioning, social participation
and economic position and well-being as
people plan for, and move into, retirement
3. The sample – successive waves
2002/3
Original sample
interviewed in
HSE 1998/1999/2001
Wave 1
12,099
(Age 50+ on 1 Mar 2002)
2004/5
Wave 2
Nurse visit
9,432
7,666
New cohort sample
HSE 2001/02/03/04
2006/7
2008/9
2010/11
Wave 3
Life-history
9,771
7,855
(Age 50-52 on 1 Mar 2006)
Refreshment sample
from HSE 2006
Wave 4
Nurse visit
11,050
8,643
Wave 5
Risk module
10,326 (approx)
1,063
(Age 50-74 on 1 Mar 2008)
4. Data collection
Interviewer visit:
- CAPI (computer assisted personal interview)
- Self completion
- Measurements – e.g. timed walk
Nurse visit (waves 2 and 4)
- Measurements (e.g. blood pressure)
- Measures of functioning (e.g. grip strength, balance)
- Blood sample (e.g. testing for blood sugar)
4. Data collection (also used)
• NHS Central Registry (mortality)
• National Insurance contributions
• Benefits including state pensions and tax
credits
• Tax records, savings, private pensions
5. Measures used
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Demographic data and household composition
Employment
Income, wealth and pensions
Physical health (symptoms and diagnosed disease)
Mental health (depression, anxiety, diagnosed disease)
Physical function (objective and self report)
DNA (through the ELSA DNA repository)
5. Measures used (ctd)
• Cognitive function (objective and self reported)
• Social engagement (social participation, volunteering,
caring)
• Social support, social capital, loneliness
• Cultural engagement
• Expectations
• Quality of life/well-being
• End of life interview with a relative, friend or carer of the
deceased respondent
5. Measures used – additional
measures at some waves
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Life history interviews
Vignettes on general health and work disability
Salivary cortisol
Perceptions of ageing
Religion
Experience of discrimination
5. Measures used – additional
measures at even waves
Nurse assessment:
- Anthropometric measures
- Grip strength, balance, chair rise
- Lung function
- Blood pressure
- Blood measures (lipids, haemoglobin, ferritin,
blood sugar, glycated haemoglobin,(HbA1c),
fibrinogen, C- reactive protein)
6. Major findings on health
• Note that the inclusion of biomarkers has added
to the understanding of the biology of ageing and
a clear social gradient can be seen. Those in the
less wealthy quartiles had lower HDL cholesterol
(this is associated with increased risk of coronary
heart disease), low IGF-1 and low DHEAS. High
levels of the latter are associated with improved
health and well-being and better cognitive
function
6. Major findings on health (ctd)
Over successive waves:
• Increases in weight and waist indicating
obesity
• Increases in sedentary behaviour
Wealth and impaired activities of
daily living
40
Impaired ADL (%)
35
30
Men
25
Women
20
15
10
5
0
Richest
4th
3rd
Wealth quintile
2nd
Poorest
6. Major findings on health (ctd)
• Clear social gradients in health with less wealthy
participants having higher levels of limitations in
ADL/IADL, higher rates of elevated depressive
symptoms, more hypertension and diabetes,
lower levels of physical activity, and poorer diet
(measured using consumption of fruit and
vegetables). However the proportion of more
wealthy participants drank more than the
recommended limits of alcohol.
Wealth and depression
Prevalence %
35
Men
30
25
Women
20
15
10
5
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Richest
4th
3rd
Wealth quintile
2nd
Poorest
6. Major findings on health (ctd):
Sleep
• Sleep deprivation and problems with sleep have
considerable economic ramifications. Disturbed
sleep is also linked to several health conditions
and poorer quality of life. Information on sleep
was collected in ELSA for the first time in Wave 4
• Women had worse sleep patterns
• The more wealthy reported better sleep patterns
than those less wealthy
6. Major findings on health (ctd):
well-being
• In ELSA measured by depression, life satisfaction,
quality of life and loneliness.
- Depressive symptoms and loneliness rose with age
- Women aged 75+ and older had particularly poor wellbeing with high rates of depression, low life
satisfaction, poor quality of life and high ratings of
loneliness
- Those who were limited in their activities had poorer
well-being on all 4 indicators irrespective of age
6. Major findings on health (ctd):
well-being
- Wealth is associated with all aspects of wellbeing
- Levels of well-being were positively associated
with the number of close personal
relationships
7. Conclusion
• A well funded study which has produced
significant findings in its own right and given
other researchers access to the data
In the public domain
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Wave 1 2002-3; report Marmot et al 2003
Wave 2 2004-5; report Banks et al 2006
Wave 3 2006-7; report Banks et al 2008
Wave 4 2008-9; report Banks et al 2010
www.ifs.org.uk/elsa
http://www.esds.ac.uk/longitudinal/access/elsa/l5050.asp
8. Whitehall I and Whitehall II
(with thanks to Professor Michael Marmot and Professor Mika Kivimaki)
• Whitehall I 1967 study of 18,000 male civil
servants aged 20 - 64
• Whitehall II 1985 – continuing. Study of 10,308
civil servants aged 35 – 55 in London (one third
were women). Original aim to investigate social
and occupational influences on health and illness
but has become a study of healthy ageing
Whitehall II – key findings
• Steep gradient in health outcomes – the less control and
status the more likely to have poor health and die early
• Those in the lowest employment grades most likely to have
many of the risk factors for coronary heart disease.
• Social gradient in health (Professor Marmot subsequently
chaired the WHO Commission on Social Determinants of
Health)
• Ageing is not characterised by universal decline
ELSA and Whitehall II
- Similar sizes (ELSA 12,000 and numbers refreshed)
Whitehall II 10,308)
- ELSA from the Health Survey for England which was
representative and Whitehall II only from civil servants
- Both used medical screening, blood samples, measures
of mental health, physical and cognitive functioning.
Whitehall II also used validated disease
9. The future: funding
• Lack of research funds generally in the UK and
specially for expensive studies such as
longitudinal studies
9. The future – problems of attrition
In ELSA
• A decline in response rates:
• Wave 2 (eligible in W2 and respondent in W1) =
82%
• Wave 3 (eligible in W2 and W3 and respondent in
W1) = 73%
• Wave 4 (eligible in W2, W3 and W4 and
respondent in W1) = 74%
9. The future – problems of attrition
In Whitehall II response rate of 73%. Research
on those who had dropped out compared
with those who had remained showed that
they had a lower occupational social grade,
were older, female, unmarried at baseline,
engaged in fewer social activities, rented their
home, were less educated
8. The future – problems of attrition:
ways to overcome this in ELSA
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Telephone interview with refusers (from W3)
Proxy interviews with refusers from W3
Increased incentive from £10 to £20 (W5)
‘Expert’ ELSA interviewers
Finding out why people take part
Self completion before interview
Give respondents more info before interview and about the study
Improve tracing of movers
Changed how respondents are asked to update
8. The future – problems of attrition:
ways to overcome this in Whitehall II
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Newsletters with FAQs
Reminders
Home visits
Pay travel
Response to suggestions about facilities and
refreshments