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Inequalities in Risk and Lifestyle Change in Later Life: A Secondary Analysis of the British Regional Heart Study 1978-2

This research aims to examine changes in the social patterning of lifestyle indicators among a cohort of men between 1978 and 2003 using Multiple Correspondence Analysis. The study focuses on the British Regional Heart Study and its findings.

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Inequalities in Risk and Lifestyle Change in Later Life: A Secondary Analysis of the British Regional Heart Study 1978-2

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  1. Inequalities in risk and lifestyle change in later life; a secondary analysis of the British Regional Heart Study 1978-2003. Ian Rees Jones 1, Olia Papacosta2, Richard Morris 2, Goya Wannamethee 2, Peter Whincup3 1 Bangor University 2 UCL 3 St George’s, London.

  2. Aims and Outline • Aim • This research aims to undertake a secondary analysis of the British Regional Heart study using Multiple Correspondence Analysis to examine changes in the social patterning of lifestyle indicators among a cohort of men between 1978 and 2003 • Outline • Lifestyles and later life • Background to the British Regional Heart Study • Findings • Discussion

  3. Lifestyles and Later Life • Ways of living, thinking and behaving that are a component of stratification and differentiation (Marx, Weber, Veblen, Bourdieu) • Feature of late modernity (Giddens) – cluster of habits providing ontological security in a world of uncertainty – ‘but we have no choice but to choose’

  4. Lifestyles and Later Life • Old age as lifestyle - part of postmodern lifecourse (Katz) • Marketing lifestyles: stages - Healthy Indulgers/Healthy Hermits/Ailing Outgoers/Frail Recluses (Moschis) • Health Lifestyles – largely based on discrete behaviours and risk factor epidemiology (Blaxter) • Messy and poorly conceptualised (Featherstone) • We know very little about how people, from different social locations, carry lifestyles and risky behaviour with them into later life

  5. British Regional Heart Survey (BRHS) • Prospective cohort study of 7735 British men drawn from general practices in 24 British towns. • Aged 40-59 when recruited in 1978-80 and followed with repeated questionnaires and medical record reviews. • This analysis focuses of questionnaires in 1978-80, 1992 and 1998-2000.

  6. MCA Active variables: Smoking Exercise Alcohol BMI>28 Supplementary: Social Class

  7. Less healthy Social Class I Social Class V Healthier

  8. CHANGES IN RISK FACTORS LONGITUDINAL ANALYSIS

  9. Variables of Changes in risk factors

  10. Dimension 2: 10.6% Dimension 2: Ex 21moving from light to inactive Dimension 1: 63.7% Dimension 1:Sm34 always smoked Ex 11 always non Dimension 1:Sm11 always non smoker Ex 33 always mod/vigorous Alc 22 (always light/mod) Dimension 2: Sm22 always ex smoker

  11. Dimension 2:lifestyle change Dimension 1: lifestyle persistence

  12. Active: Social activity questions Supplementary: Health status

  13. Social Activities –1992 • Q1 Do you have access to a telephone in your house? Yes=1 No=0 • Q2 Have you made a personal phone call in the last week? Yes=1 No=0 • Q3 Have you written a personal letter in the last week? Yes=1 No=0 • Q4 Do you take a weekly or monthly magazine or journal? Yes=1 No=0 • Q5 Do you attend religious services or meetings? Yes=1 No=0 • Q6 Did you vote in the last general or local elections? Yes=1 No=0 • Q7 Have you been on holiday in the last year? Yes=1 No=0 • Q8 Are you planning to go on holiday next year? Yes=1 No=0 • Q9 Do you use the public library? Yes=1 No=0 • Q10 Are you a member of any club, society or group? Yes=1 No=0 • Q11 In the past month have you attended a meeting of a club, • society or group? Yes=1 No=0

  14. Health Status - 1992:- Please indicate which statements best describe your health TODAY Excellent 1 Good 2 Fair 3 Poor 4

  15. Dim 2: holiday, no magazine Poor Health Excellent health Dim 1: No holiday plan, No holiday No phone call Dim 1: Wrote a letter, holiday Dim 2: No holiday, No holiday plan, wrote a letter

  16. More complex MCA - Variables • Active • Demographic: • Working wife (ww), Marital Status(MS), Housing Tenure(HT), Car owner(Cr), Education(E), Pension(P), number of childhood deprivation factors(CF) • Social activity: • Activities:1+2, 3−14(A), overnight trips(TR), holidays(H) • Supplementary • Social Class and Town

  17. Guildford Dimension 2:single/divorced Exeter Dimension 1: Trips often, voluntary work, classes and study and occ/pvt pension Grimsby Social class I Working class Dimension 1: No trips, holidays, car, gardening and state pension only Dimension 2: gardening, looking after children and watching tv

  18. The social field of BRHS men

  19. MCA - Variables • Active • Demographic • Working wife(ww), Marital Status(MS), Housing Tenure(HT) • Childhood factors(bedroom, hot water, sharing bedroom, car in family), Total number of factors(CF) • Activity • Activities:1+2, 3−14(A), overnight trips(TR), holidays(H), • Lifestyle • Changes(Q1−Q92):Smoking(S), Alcohol(Al), Exercise(X) • Supplementary • Social Class and Town

  20. Dimension 2: 5.8% Dimension 2: single/divorced Dimension 1: voluntary, cinemas education>18 Dimension 1: no Trips, No car, no holiday Dimension 1: 59.2% Dimension 2: gardening, pub, watching TV, non alcohol

  21. Dimension 2: single/divorced Guildford Grimsby Social class I Working class Dimension 1: voluntary, cinemas education>18 Dimension 1: no Trips, No car, no holiday Dimension 2: gardening, pub, watching TV, non alcohol

  22. Dimension 2: single/divorced Guildford Move from light to heavy alcohol Always heavy alcohol Grimsby Social class I Always smoked Working class Dimension 1: voluntary, cinemas education>18 Dimension 1: no Trips, No car, no holiday Dimension 2: gardening, pub, watching TV, non alcohol

  23. Discussion • This preliminary analysis found a predictable and steady ordering from “healthy” choices in social class I to “less healthy” choices for social class V. • Some evidence of ‘North-South’ gradient with towns with the lowest cardiovascular disease mortality aligned with healthy choices • This MCA analysis of categorical longitudinal data provides important insights into the relationship between dimensions of economic capital, social activity and changes in lifestyle risk in older men • Further work is required to refine the analysis

  24. Bibliography • Greenacre, M. (1993) Correspondence analysis in practice, London: Chapman & Hall. • Batista_Foguet, J.M. Mendoza, R. Perez-Perdigon, M. Rius, R. (2000) Life-Styles of Spanish School-Aged Children: Their evolution over time. Use of Multiple Correspondence Analysis to Determine Overall trends over time in a sequential, cross-sectional study, in A. Ferligoj and A, MrVar (Eds . ) New Approaches in Applied Statistics, Metodoloski zvezki, FDV. • Bourdieu, P (1984) Distinction: A Social Critique of the Judgement of Taste, London, Routledge. • Gatrell, A. Popay, J. Thomas, C. (2004) Mapping the determinants of health inequalities in social space: can Bourdieu help us? Health and Place, 10, 245-257. • Greenacre, M. (2002) Correspondence analysis of the Spanish National Health Survey, Gac Sanit, 16, 2, 16-70. • Phillips, D. (1995) Correspondence analysis, Social Research Update, 7, Winter 1995, Department of Sociology, University of Surrey. • Tomlinson, M. (2003) Lifestyle and Social Class, European Sociological Review, 19, 1, 97-111. • Veenstra, G. (2007) Social Space, social class and Bourdieu: Health inequalities in British Columbia, Canada, Health and Place, 13, 14-31.

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