Assessing neighbourhood effects on the health of older people using ELSA Iain Lang Epidemiology &...
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Transcript of Assessing neighbourhood effects on the health of older people using ELSA Iain Lang Epidemiology &...
Assessing neighbourhood effects on the health of older people using ELSA
Iain LangEpidemiology & Public Health Group,
Peninsula Medical School
Two of ELSA’s strongest components: health/functioning and micro-economics
Neighbourhood context is associated with poor health in later life – is this simply a “compositional effect”?
Linkage of ELSA data to quintiles of the Index of Multiple Deprivation (IMD 2004) available from NatCen on request
Outcomes assessed
Mobility: change in gaitspeed from Wave to Wave 2; incident self-reported walking problems
Cognition: standardized cognitive function score
Obesity and waist circumference
Frailty: frailty index score
Potential confounders(differ by analysis)
• Age, sex, rural-urban, population density, duration of residence, level of education, number of comorbidities, smoking status, BMI, level of physical activity, visual problems, hearing loss, eyesight, depressive symptoms, alcohol consumption,
Standardized cognition score by level of neighbourhood deprivation, unadjusted
-0.6
-0.4
-0.2
0
0.2
0.4
0.6
leas
t dep
rived
2nd
3rd
4th
mos
t dep
rived
IMD by quintile
Sta
nd
ard
ized
co
gn
itio
n s
core
Men aged <70
Women aged <70
Men aged 70+
Women aged 70+
Standardized cognition score by level of neighbourhood deprivation, fully adjusted,
ages 70+
-0.6
-0.4
-0.2
0
0.2
least
dep
rived 2n
d3r
d 4th
mos
t dep
rived
IMD by quintile
Sta
nd
ard
ize
d c
og
nit
ion
sc
ore
s
men aged 70+
women aged 70+
0
50
100
150
200
250
Level of neighbourhood deprivation
Inci
den
ce p
er 1
000
Self-reported mobilitydifficulties
Impaired gaitspeed
Rate of incident mobility problems after 2-year follow-up by level of neighbourhood
deprivation, unadjusted, ages 70+
Odds ratios of having incident mobility problems after 2 years,
by level of neighbourhood deprivation (adjusted)
Self-reported Measured
0
1
2
3
Least deprived 2 3 4 Most deprived0
1
2
3
Least deprived 2 3 4 Most deprived
0
1
2
3
4
5
6
Leas
t dep
rived 2n
d3r
d4t
h
Mos
t dep
rived
Obesity Waist circumference
Odds ratios of obesity and high waist circumference by level of neighborhood
education deprivation
Frailty index score by IMD and SES
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
0.18
0.2
Wealthiest 2 3 4 Leastwealthy
Level of wealth
Fra
ilty
Ind
ex
Least deprived
2
3
4
Most deprived
What’s going on here?
Do differences by level of neighbourhood deprivation represent uncontrolled confounding by individual- or household-level differences?
What’s going on here?
Do differences by level of neighbourhood deprivation represent uncontrolled confounding by individual- or household-level differences?
What are the mechanisms by which neighbourhood deprivation influences individual health and well-being in older people?
What’s going on here?
Do differences by level of neighbourhood deprivation represent uncontrolled confounding by individual- or household-level differences?
What are the mechanisms by which neighbourhood deprivation influences individual health and well-being in older people?
What are the effects of subjective perceptions about neighbourhoods?
I.A.Lang, D.J.Llewellyn, R.B.Wallace, K.M.Langa, D.Melzer. 2008. Neighborhood deprivation and incident mobility disability among older adults. Age and Ageing, 37(4):403-10.
I.A.Lang, D.J.Llewellyn, K.M.Langa, F.A.Huppert, R.B.Wallace, D.Melzer. 2008. Neighborhood deprivation, individual socioeconomic status, and cognitive function in older people: analyses from the English Longitudinal Study of Ageing. Journal of the American Geriatrics Society, 56(2):191-8.
I.A.Lang, D.J.Llewellyn, D.Melzer. Low levels of neighborhood educational attainment are associated with obesity in adults. Under review.
I.A.Lang, R.E.Hubbard, M.K. Andrew, D.J.Llewellyn, D.Melzer, K.Rockwood. Neighborhood Deprivation, Individual Socioeconomic Status, and Frailty in Older Adults. Under review.