Showing papers by "George Davey-Smith published in 1996"

Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study

Abstract: Objective : To assess the relation between forced expiratory volume in one second (FEV1) and subsequent mortality. Design : Prospective general population study. Setting : Renfrew and Paisley, Scotland. Subjects : 7058 men and 8353 women aged 45-64 years at baseline screening in 1972-6. Main outcome measure : Mortality from all causes, ischaemic heart disease, cancer, lung and other cancers, stroke, respiratory disease, and other causes of death after 15 years of follow up. Results : 2545 men and 1894 women died during the follow up period. Significant trends of increasing risk with diminishing FEV1 are apparent for both sexes for all the causes of death examined after adjustment for age, cigarette smoking, diastolic blood pressure, cholesterol concentration, body mass index, and social class. The relative hazard ratios for all cause mortality for subjects in the lowest fifth of the FEV1 distribution were 1.92 (95% confidence interval 1.68 to 2.20) for men and 1.89 (1.63 to 2.20) for women. Corresponding relative hazard ratios were 1.56 (1.26 to 1.92) and 1.88 (1.44 to 2.47) for ischaemic heart disease, 2.53 (1.69 to 3.79) and 4.37 (1.84 to 10.42) for lung cancer, and 1.66 (1.07 to 2.59) and 1.65 (1.09 to 2.49) for stroke. Reduced FEV1 was also associated with an increased risk for each cause of death examined except cancer for lifelong nonsmokers. Conclusions : Impaired lung function is a major clinical indicator of mortality risk in men and women for a wide range of diseases. The use of FEV1 as part of any health assessment of middle aged patients should be considered. Smokers with reduced FEV1 should form a priority group for targeted advice to stop smoking. Key messages These increased risks, with the exception of the cancers, are apparent for lifelong non-smokers FEV1 is second in importance to cigarette smoking as a predictor of subsequent all cause mortality and is as important as cholesterol in predicting mortality from ischaemic heart disease FEV1 should be included in health assessment of middle aged men and women Smokers with a reduced FEV1 should be targeted with advice to stop smoking

Deprivation andcausespecific morbidity: evidence fromthe Somerset andAvonsurveyofhealth

Abstract: Objective-To investigate the association between causespecific morbidity anddeprivation in order toinform thedebates oninequalities inhealth andhealth services resource allocation. Design-Cross sectional postalquestionnaire survey ascertaining self reported health status, with validation ofa20!/o sample through general practitioner andhospital records. Setting-Inner city, urban, andrural areasof AvonandSomerset. Subjects-Stratified randomsampleof28080 people aged35andoverfrom40general practices. Mainoutcomemeasures-Age andsexstandardisedprevalence ofvarious diseases; Townsend deprivation scores wereassigned bylinking postcodes toenumeration districts. Relative indices of inequality werecalculated toestimate themagnitude oftheassociation between socioeconomic position andmorbidity. Results-The response ratewas853%.Theprevalence ofmostoftheconditions rosewithincreasingmaterial deprivation. Therelative indexof inequality, forbothsexescombined, wasgreater than1 forallconditions exceptdiabetes. The conditions moststrongly associated withdeprivation werediabetic eyedisease (relative indexofinequality 3*21; 95%confidence interval 184to5.59), emphysema (2.72; 167to4.43) andbronchitis (2.27; 1-92to2.68). Therelative index ofinequality was significantly higher inwomenforasthma(P<0.05) andinmen fordepression (P<0.01). Themean reporting ofprevalent conditions was107forthe mostdeprived fifth ofrespondents and0*77in themostaffluent fifth (P<0.001). Conclusions-Material deprivation isstrongly linked withmanycommondiseases. NHS resource allocation should bemodified toreflect suchmorbidity differentials.