Biomarkers in the proposed UK Longitudinal Household Study

1
Biomarkers in the proposed UK Longitudinal
Household Study

• Meena Kumari, Department of Epidemiology,
  University College London
• Mike Wadsworth, Director, National Survey for
  Health and Development, UCL
• Margaret Blake, National Centre for Survey
  Research
• John Bynner, Director, Longview
• Gert G. Wagner, Director, Socio-Economic Panel
  Study, Institute for Socio-Economic Research,
  Berlin

2
Background

• Increasingly social scientists are concerned with
  health because
• Changes in population health bring new social and
  economic policy challenges worldwide, e.g.
• Increased life expectancy
• Increased obesity
• Management of raised blood pressure
• Changes in social mores bring new social and
  economic policy questions relating to health
  risks, e.g.
• Postponement of marriage and increasingly later
  age at first birth
• High rates of partner change
• Changing social cohesion
• Changes in social and economic structures are
  associated with changes in health and well-being
• Unemployment
• Age at retirement

3
Background

• Increasingly biological sciences, especially
  epidemiology, are concerned with the social and
  economic environment
• Changes in the socio-economic environment are
  associated with changes in population health
  (e.g. in the ex-communist countries)
• The individuals interactions with the social
  environment are strongly associated with health
• Early life physical and mental development
  through to adolescence influence health
  opportunities throughout the life course
• Health and health related behaviour in an age
  defined cohort give good indications of the
  health of that cohort at later ages

4
Data/topic coverage

• Data required for such studies
• Data that describe the current state of health of
  the population (disease, functioning)
• Data that describe use of health care (NHS, other
  sources, own care)
• Data that describe future health potential
  (genetic predisposition, growth and development
  from early life to adolescence, health related
  habits, fitness,)

5
Data/topic coverage

• Health and biomarker data collected in the UKLHS
  will provide opportunities for innovative health
  studies to be undertaken because
• The population is large and representative
• The whole of the life span is included
• The social and economic data will be incomparably
  rich
• The household is the sampling unit

6
Data/topic coverage

• Examples of topics that might be addressed by
  social scientists include
• Population variation in accessibility to and
  personal and health service costs of preventive
  health measures for obesity and raised blood
  pressure
• Social integration and its association with
  health indicators (global and specific) across
  the life span
• Socio-economic wellbeing and its association with
  health

7
Data/topic coverage

• Examples of topics that might be addressed by
  health scientists include
• Geneenvironment interaction studies with the
  benefit of related and unrelated individuals in
  the same environment in relation to outcomes such
  as blood pressure, obesity, respiratory health
• Comparisons of health related prevalence and age
  related change (eg in obesity, blood pressure,
  short-term memory) in age cohorts across the life
  course
• Within household/family variation in prevalence
  of anxiety and depression

8
Proposed health and biomarker data

• The kind of health and biomarker data to be
  collected is likely to include
• Body size (e.g. height and weight)
• Biological function (e.g. blood pressure, grip
  strength)
• Self-assessed mental health and well being (e.g.
  CES-D)
• Use of NHS and other sources of health care
• Health related habits (e.g. diet, smoking)
• Experience of ill-health
• Screening questions for specific conditions (e.g.
  angina) that would be followed-up in health
  scientists studies
• Well-being inventory
• Cognitive functioning

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Proposed health and biomarker data

• Collection of data as part of the main survey
• Data collection to be begun in wave 1 cognitive
  function, health related behaviours, self rated
  health
• Data collection mostly by interviewers
• Some annual data collection (e.g. use of care
  services, experience of ill-health) others at
  longer intervals depending on age and likelihood
  of change (e.g. weight, height, blood pressure)
  
• Data sourced from national cancer register,
  mortality records

10
Proposed health and biomarker data

• Additional biomarker data for example
• Cardiovascular measures such as blood pressure
  assessment
• Anthropometry such as height, weight and waist
  circumference
• Functioning assessment such as lung function and
  hand grip strength assessment
• Blood sample (serum and plasma) collection for
  storage for subsequent analysis, for example
  genetic markers.

11
Proposed health and biomarker data

• Collection of data for health scientists
• These studies are likely to be hypothesis driven,
  developed by specialist groups, and separately
  funded
• Data collection is likely to be by research nurse

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Outstanding issues

• Data protection
• Confidentially
• Leadership and capacity

13
Conclusions and Recommendations

• We recommend
• The inclusion of a health module at the outset
  of the study
• The inclusion of a clinical assessment module
  which makes optimal use of the unique features of
  the study
• Recommended clinical measures are
• Cardiovascular, anthropometric, functioning and a
  blood sample
• Contents of both modules to be discussed with the
  appropriate science and policy specialists