Health and Biomarkers: data and plans Michaela Benzeval Institute for Social and Economic Research University of Essex
Overview Health is just one topic Understanding Society: the UK Household Longitudinal Study (UKHLS) is a multi-purpose panel survey begun in 2009 Funded by the UK Economic and Social Research Council and a range of government departments, and is available at UK Data Service Brings together information on many life course domains, to allow for interdisciplinary - both within social sciences and between social science and biomedical sciences Wide ranging geographical linkage Consent for health administrative linkage
Design aims: Large sample representative of the UK (40,000 households, 100,000 people) Allows examination of small sub-populations, such as teenage parents and opportunity to explore rarer events All age panel study but the size allows pseudo cohorts to be constructed and hence examination of age, cohort and period effects Basic design similar to that of British Household Panel Survey, which it replaces and incorporates...and to panel studies in other countries eg PSID (USA), HILDA (Australia), SOEP (Germany) so allows international comparisons www.understandingsociety.ac.uk
Initial sample consists of: General Population Sample: 30,000 UK households in 2009 (58% household response; 82% adult response = 41,047 interviews) Ethnic Minority Boost: 1,000 adult individuals across five main ethnic groups (Indian, Pakistani, Bangladeshi, Caribbean, African) (52% household response; 72% adult response = 6,685 interviews) British Household Panel Survey (1991 - ): approximately 8,000 households, 13,454 adults consented to continue in UKHLS An Innovation Panel: 1500 households, 2500 adults for methodological research (refreshment samples) TOTAL: 39,805 households: 101,087 individuals: 63,755 adults, 5,788 youths NEW: Immigrant and Ethnic Minority Boost sample in 2015 = 3000 households www.understandingsociety.ac.uk
Understanding Society: Survey and data release timeplan waves 1-8 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 IP 1 * Wave 1 * IP 2 * Wave (Incorporating 2 BHPS) * Nurse int (UKHLS Sample) * G,B IP 3 * Wave 3 * Nurse int (BHPS sample) * G,B IP 4 C * Wave 4 * IP 5+ C * Wave 5 * IP 6 + C * Wave (Year 6 2: Additional IEMB sample) * IP 7+ C * Wave 7+ * IP 8+ C * Wave 8+ * KEY Preparation: Fieldwork: IP * Multi-mode data collection Main IEMB Immigrant and Ethnic Minority Boost Nurse C Competition for experiments Planned data release for: Questionnaire B Blood analytes G Genotype data
Understanding Society: Survey and data release timeplan waves 1-8 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 IP 1 * Wave 1 * IP 2 * Wave (Incorporating 2 BHPS) * Nurse int (UKHLS Sample) * G,B IP 3 * Wave 3 * Nurse int (BHPS sample) * G,B IP 4 C * Wave 4 * IP 5+ C * Wave 5 * IP 6 + C * Wave (Year 6 2: Additional IEMB sample) * IP 7+ C * Wave 7+ * IP 8+ C * Wave 8+ * KEY Preparation: Fieldwork: IP * Multi-mode data collection Main IEMB Immigrant and Ethnic Minority Boost Nurse C Competition for experiments Planned data release for: Questionnaire B Blood analytes G Genotype data
Questionnaire Questionnaire (same format as BHPS) Household questionnaire (inc roster) of 15 minutes Individual interview for all adults aged 16 and over (32.5 minutes) (As part of this) Parents asked key development for children under 10 Self-completion questionnaire for all adults (7 minutes) Proxy questionnaire for adults 16+ unable to be interviewed (10 minutes) Youth questionnaire for children aged 10 15 years Ethnic Minority Boost sample as above with extra 5 minutes of questions Translations into 9 languages inc Welsh (further 3 with IEMB) Topics: core annual content and rotating modules ISER JESS Seminar, 11/11/09
(Non health) content Annual questions Basic demographic characteristics Changes between waves education, employment, fertility, partnering, geographic mobility Current job characteristics Childcare, other caring within and outside household Income and earnings Life satisfaction Transport and communication access Consumption expenditure Housing Household facilities, car ownership Rotating content Environmental attitudes & behaviour Psychological attributes Quality of marital relationships Risk and trust Collection of data about younger children < 10 Social support Wealth Parent & child future expectations and relations
Overview of health survey questions w1-6 Population group Overall health Disease &illness Physical, mental and cognitive functioning Positive wellbeing Health behaviours Adults 16+ Global health Health satisfaction Doctor diagnosis of 17 conditions SF-12 generic physical and mental functioning Limiting illness and specific functional limitations. GHQ-12 psychological health WEMWBS (3yrs) Smoking (annual w6) (3yrs) Alcohol use Diet Physical activity Sleep Measures of cognition (once). Young adults 15-21 Extra annual - smoking, alcohol, illegal drug Youth 10-15 Global health (2yrs) Strength and difficulties questionnaire (SDQ) psychological behaviours (2yrs) Self esteem(2yrs) Smoking Alcohol consumption Diet Physical activity Illegal drugs (2yrs) Children <10 (completed by mother) Global health Age-appropriate SDQ at 3,5&8 Broad development stages Pregnancy and birth (completed by mother) Birthweight and gestation www.understandingsociety.ac.uk Smoking and drinking in pregnancy; Breast feeding; crying, sleeping and eating behaviour
Content review: health question from wave 7 Improve measures of disability severity and activities of daily life Better measures of health behaviours: -alcohol: AUDIT C -physical activity: IPAQ -ecigs (from age 10) Health care utilisation questions (BHPS) Social care module (shorter version HSE) Other Review youth questions for Wave 8 Improve health data in proxy interviews Consider end of life interview, special module on disability, subsample on pregnant women
Nurse interview (wave 2 UKHLS, Wave 3 BHPS) Eligibility: took part in main wave, Great Britain, English speaking interview, 0.81 sampling fraction wave 2 year 2 Nurse visit approx 5 months after main interview 21,411 households approached, 13,290 households (76.7%) had assessments 20,699 individuals aged 16 and over assessed Of these,18,775 were eligible to give blood (91%) Of these,14,458 gave consent to give blood (77%) and 14,186 (76%) to give DNA Whole blood obtained for 13,284 (92% of those giving consent/ 71% of those eligible to give blood)
Nurse assessments Measure Height and weight Waist circumference Percent body-fat (bioelectrical impedance) Respiratory function (Spirometry) (FVC,FEV 1, PF, FEV 1 /FVC) Diastolic and systolic blood pressure, resting pulse rate Applications BMI and assessment of excess body fat: obesity and risk factor for range of major chronic conditions and social outcomes To detect both obstructive and restrictive respiratory diseases including COPD. Risk factor for stroke and heart conditions Risk cardio-vascular disease Grip strength Blood samples (non-fasting), 19.8ml) Indicator muscle strength. Functional limitations and disability in older ages. For the extraction of analytes and DNA Short questionnaire on health on day of measurement, medications etc Factors that may need to be considered in analysing physical measures and bloods
Blood samples and genetics Blood currently being analysed for 21 different analytes Results to be deposited (with end user licence) in Data Archive by end 2014 DNA - lluminia core and exome chip currently being run on approx 10,500 respondents Results to be deposited at the European Genomephenome Archive (EGA) repository (by end 2014) Access to genetic data overseen by UKHLS DAC protocol and processes being developed Significant blood samples remain frozen access protocol currently being developed by UKHLS DAC www.understandingsociety.ac.uk
Criteria for choice of blood analytes Environmental (socioeconomic, physical, psychosocial) and/or behavioural effect on marker Evidence of pathways to important health outcomes Affects reasonable proportion of general population Has reasonable prevalence among those affected Can be measured given the way our blood was collected and stored Core markers for main diseases Useful as individual measures and/or in combined risk scores Some novel markers around biological ageing and stress
Blood analytes Measure Cholesterol & triglycerides Glucose intolerance - HbA1c Inflammatory markers - c- reactive protein, fibrinogen Anaemia haemoglobin, ferritin Liver function - ALP, ALT, AST, GGT, albumin kidney function creatinine Hormones testosterone, IGF1, DHEAS CMV seropositivity Applications Fat in the blood associated heart disease (CVD) Undiagnosed or poorly managed diabetes Measures of inflammation due injury or infection acute or chronic response to stress Marker for poor nutrition; increases with age, sig. health consequences Associated alcohol, drugs, obesity, consequence of other diseases Kidney diseases increase age, associated other diseases associated with stress processes, building muscles, ageing Testosterone - marker aggression IGF1 associated diet, diabetes and cancer DHEAS -associated CVD, muscle strength, cognition Immunoscenence - wear & tear immune system, chronic stress, associated diabetes
Plans Launch biomarkers data by end of year, user guide and biomarker glossary, new training module in November Discussing with ESRC plans for exemplar projects, workshops, etc Joint genetics for social scientists event with ELSA Health linkage in England, Scotland and Wales for mortality and hospital episodes Investigating use of new technologies in social interview hair samples, smartphone data collection (questionnaires & physical/objective measures), point of care testing.. Plan to repeat cognition module Discussing with ESRC another biomarker round nurse visit, clinics etc
Accessing the data Study documentation: Protocols, fieldwork reports, questionnaires, variable level metadata User guides, technical reports Findings, news and publications Data are available at the UK Data Service, University of Essex: Wave 1-3 data, including nurse assessments Innovation Panel data waves 1-6 (this week) By end 2014: blood analytes, genetics, wave 4 and net equivalent income See UK Data Service website: http://ukdataservice.ac.uk/ Provision for special or secure access for small geographic information www.understandingsociety.ac.uk