̽��ֱ�� of Cambridge - Robert Luben

Moderate exercise in middle and older age cuts time spent in hospital

ta385 — Thu, 07 May 2020 13:00:00 +0000

Inactive participants in the study spent just over four days more in hospital over the next ten years than those who did at least some physical activity, whether for work or leisure. And similar results were observed ten years later when the same participants were 50–90 years old.

̽��ֱ��study, by researchers at the ̽��ֱ�� of Cambridge’s Department of Public Health and Primary Care and MRC Epidemiology Unit, calculates that for every inactive person who started to take at least some exercise, the NHS could save around £247 per year. This would equate to around 7% of the UK’s per capita health expenditure.

̽��ֱ��findings, published in BMC Geriatrics, are based on a general British population cohort study of 25,639 men and women aged 40–79 living in Norfolk and recruited from general practices between 1993 and 1997 ( ̽��ֱ��European Prospective Investigation into Cancer in Norfolk).

̽��ֱ��researchers found that in the first ten years active participants were 25–27% less likely than inactive participants to have more than twenty hospital days or more than seven admissions per year with similar results over the subsequent ten years. They also reported that in 9,827 study participants with repeated measurements, those who remained physically active or increased their activity were 34% less likely to spend twenty days in hospital.

Lead author Robert Luben from the Institute of Public Health says:

“Our study provides some of the clearest evidence yet that small, feasible increases in usual physical activity substantially reduce the future hospital usage of middle-aged and older people, and would significantly ease pressure on the NHS.”

̽��ֱ��study is one of relatively few to examine the physical activity (both occupational and leisure-time) of middle-aged and older men and women – validated against heart rate monitoring with individual calibration – and their subsequent healthcare use. As well as studying a large cohort over a long follow-up period, the researchers used record linkage to hospital data and took a range of demographic and lifestyle factors into account.

When recruited, participants completed a lifestyle questionnaire where they were asked about their physical activity. Occupational activity was assessed using a four category question (“sedentary”, “standing”, “moderate physical work” and “heavy manual work”) with examples such as office worker, shop assistant, plumber and construction worker respectively.

Leisure activity in both summer and winter was assessed from the number of hours per week spent cycling, attending keep fit classes or aerobics and swimming or jogging. Estimated average hours of leisure activity was calculated as the mean of summer and winter activities. Based on a score (validated using heart rate monitoring with individual calibration) combining leisure and occupational elements, individuals were categorised as “inactive”, “moderately inactive”, “moderately active” and “active”.

̽��ֱ��study found that those with a physical activity score of at least “moderately inactive” had fewer hospital admissions and fewer days in hospital, than those who were “inactive”.

While previous studies have suggested that pre-admission physical activity programmes may lower duration of hospital stay, these are short term, require funding and are targeted at a limited number of individuals. But these new findings indicate that usual physical activity patterns in the general population predict hospital usage over the next two decades.

̽��ֱ��researchers acknowledge that participants may be physically inactive because of known or preclinical illness which may also predispose them to increased later hospitalisation. But sensitivity analyses excluding those with a self-reported chronic disease at baseline (heart attack, stroke or cancer), and excluding hospital admissions occurring in the first five years of follow-up, did not differ materially from the main findings.

Reference

R. Luben, S. Hayat, N. Wareham, P. Pharoah, K-T. Khaw, ‘Usual physical activity and subsequent hospital usage over 20 years in a general population: the EPIC-Norfolk cohort’. BMC Geriatrics, 6 May 2020). DOI: 10.1186/s12877-020-01573-0.10.1186/s12877-020-01573-0.

Men and women aged 40–79 are at significantly lower (25–27%) risk of long or frequent hospital admissions if they do some form of physical activity, a new study suggests.

Small, feasible increases in usual physical activity substantially reduce the future hospital usage of middle-aged and older people

Robert Luben

MabelAmber

A couple cycling

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Deprivation strongly linked to hospital admissions

cjb250 — Wed, 18 Dec 2019 09:48:59 +0000

Despite increases in overall life expectancy there is still an inequality, with lower life expectancy observed more often in disadvantaged groups. It is well known that those in higher social classes have a typical life expectancy several years longer than those with the lowest. Similarly, life expectancy and levels of good health vary between UK cities and regions, with large variations in expected years of life in good health.

In research published in BMJ Open, a team led by researchers at the Cambridge Institute of Public Health examined whether there was a link between living in an area of deprivation and subsequent hospital use. To do so, they examined data from almost 25,000 individuals (11,000 men and 14,000 women) from the EPIC-Norfolk cohort across almost two decades, between 1999 and 2018.

̽��ֱ��researchers used the Townsend Index to measure the deprivation of individuals’ residential areas, stratifying people into five levels. ̽��ֱ��Index looks at levels of unemployment, number of households without a car, the percentage of households not owner-occupied, and the percentage of households with more than one person per room.

Participants completed a lifestyle questionnaire that included questions about their own and their partner’s current and past employment and a list of qualifications. ̽��ֱ��researchers used the employment information to assign each participant to either non-manual or manual social classes. Non-manual social class included those individuals who worked in professional, managerial, technical and non-manual skilled occupations; manual social class included those who worked in skilled, partly skilled and unskilled manual occupations. ̽��ֱ��qualifications marked were used to assign participants to lower or higher educational attainment categories.

̽��ֱ��researchers found that people who lived in areas of highest deprivation spent the most time in hospital, but the risk of a long hospital stay is seen disproportionately in people who also had low educational attainment or were in manual social class. While the average amount of time spent in hospital over the two decade period was around 28 days for people with high educational attainment, for those with low educational attainment, the average was around 37 days, rising steeply to 43 days in the group living in areas of highest deprivation.

̽��ֱ��picture relating to social class was similar, though the differences between social classes was not as pronounced as those between educational attainments. Those individuals in non-manual social classes spent between 29 and 31.5 days in hospital; in manual social classes, people in areas of less deprivation spent around 32 days in hospital, rising to 39.5 days in areas of highest deprivation.

“Regardless of your age and gender, or even lifestyle factors such as smoking and obesity, living in an area of high deprivation is a significant risk factor for spending time in hospital,” said Dr Robert Luben from the Department of Public Health and Primary Care at the ̽��ֱ�� of Cambridge, the study’s first author. “People living in areas at or below the national average for deprivation were more likely to spend more than 20 days in hospital or be admitted to hospital on more than seven occasions during the two decades that we examined.”

Senior author Professor Kay-Tee Khaw, also from the Department of Public Health and Primary Care, said: “People working in a manual occupation or with lower education level and living in more deprived areas had the greatest risk of hospitalisation. This suggests that hospitalisation is greatest when poorer individual socioeconomic factors are combined with residential deprivation.

“It isn’t clear why this should be the case, though we can speculate that it could in part be down to better education improving an individual’s ability to live a healthier life.”

Previous research from the group has examined the link between lifestyle factors, education and hospitalisation. This is the first to look at the link between deprivation at an area level and hospitalisation.

“It clearly is not enough just to focus on educating people and improving lifestyle factors at an individual level,” added Dr Luben. “A poor environment affects those least able to cope. Effective NHS and government policy also needs to address deprivation infrastructural levels – improving housing, transport, access to recreation and green space, for example.”

̽��ֱ��research was funded by the Medical Research Council and Cancer Research UK.

Reference
Luben, R et al. Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort. BMJ Open; 16 Dec 2019; DOI: 10.1136/bmjopen-2019-031251

People who live in areas of higher than average deprivation are more likely to be admitted to hospital and to spend longer in hospital, according to new research from the ̽��ֱ�� of Cambridge. ̽��ֱ��difference was particularly pronounced among manual workers and those with lower education level.

Regardless of your age and gender, or even lifestyle factors such as smoking and obesity, living in an area of high deprivation is a significant risk factor for spending time in hospital

Robert Luben

Rosmarie Voegtli

urban welcome

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