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?

iain.lang@pms.ac.uk

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.