mrc national survey of health

MRC National Survey of Health and Development: an update

Diana Kuh & LHA & data collection teamsDirector, MRC National Survey of Health and Development

MRC Unit for Lifelong Health and AgeingLongview, Oxford, October 2nd 2008

Unit for Lifelong Health and Ageing

MRC NSHD Review 2005-2008: NSHD has a research and resource function

Sept 2005: Review of NSHD

2005- 2006: Search for new Director.

Sept 2006: DK appointed. MRC agrees to set up new Unit

Jan 2007: Mike Wadsworth Diana Kuh

May 2007: Submission of 5-year strategic & scientific

plans

Nov 2007: HSPHRB Board approve funding of Unit &

clinic data collection

Jan 2008: MRC Unit for Lifelong Health and Ageing


MRC Unit for Lifelong Health & Ageing

Mission: To develop the MRC National Survey of Health & Development into a world class, interdisciplinary life course study of ageing


Maximising the scientific potential of NSHD

Scientific discovery of life course influences on normal and healthy ageing• Physical and cognitive capability – the capacity to undertake the physical and mental tasks of daily living

• Musculoskeletal and cardiovascular function on which capability depends

New initiatives on which the scientific plans depend• Enriching the NSHD: clinic data collection 2008-2010 • Expanding collaborations & capacity building• More inter-cohort research – secured additional funding• Facilitate genetic studies of lifelong health and ageing

• New DNA repository 2008 • Develop e-science capability to facilitate data sharing• Governance arrangements


Seven interdisciplinary & integrated NSHD scientific programmes

• Physical capability & musculoskeletal ageing

• Cognitive capability & ageing

• Cardiovascular ageing

• Mental health & wellbeing

• Growth, functional trajectories

• Lifetime lifestyles & social environment

• Nutrition through the life course


19 follow ups 1948-1977 (2-31 years)

• Heights & weights at 2,4,6,7,11,15, 26y

• Cognitive development assessed at 8,11,15y & educational achievement

• Diet: Breastfeeding , weaning, 24 hr recall at 2y

• Developmental milestones, physical co-ordination

• Behaviour & temperament• Mortality, hospital admissions,

reported health• Marital, fertility histories & work

histories• Social & physical environment at all

contacts• Study of offspring children 4 & 8 y

Dr James DouglasKey texts• Children under five 1958• The home and the school 1964• All our future 1968

MRC Unit for the Study of EnvironmentalFactors in Mental & PhysicaI Illness established 1962


NSHD follow ups since 1982focus on life course social & biological risks for adult

health & function and age related change

• Blood pressure, lung function, body size, mental health at 36,43,53y

• Cognitive performance at 43 & 53 years• Verbal memory, search speed

& concentration, general ability

• Physical performance at 53y• Grip strength, balance, chair

rises• Age at menopause 47-53,57y• Blood samples at 53 y for DNA &

cell lines, HbA1c, lipids• Mortality & cancer registrations,

hospital admissions, health• Diet, lifestyle, life circumstances

Professor Mike Wadsworth


Clinic data collection 60-64 yrsFeasibility study 2006-2007

Main study 2008-2010

• Repeat measures of function, body size, & life circumstances

• Cardiac & vascular structure & function

• Musculoskeletal function

• Fasting blood & overnight urine samples (energy metabolism, kidney function, Inflammation, oxidative stress, bone resorption & formation, neuro-endocrine function)

Manchester clinical research facility


NSHD clinic data collection Clinical Research Facilities

Cardiff


Summary of clinic data collection

Postal questionnaire (80% response to date)

Pre-assessment questionnaire Pre-assessment questionnaire+ Clinic visit + Home visit (>60% in Manchester) (additional 20%)

Send out clinic invitation (CRF)


NSHD new clinic data collection: questionnaire-based data and performance tests

• Household size• Housing tenure• Own/partner SEP • Work status & retirement• Household income & sources• Financial hardship• Marital & fertility histories• Spare time activities• Social networks & life events• Caring for others• Smoking & drinking habits• Exercise assessment (EPAC2)• Edinburgh wellbeing Q• Neighbourhood satisfaction• Life satisfaction

• SF36• Self reported health problems CVD

events, signs & symptoms (incl. Rose angina)

• Bronchitis questionnaire• Fracture history• Medication• Hospital admissions• Close persons questionnaire• GHQ28• Anthropometry• ADLs• Grip strength, chair rises, balance

stand, timed get up & go• Reaction time, word list memory,

visual search• Spirometry


NSHD clinic data collection:cardiac & vascular measuresProfessor John Deanfield & Dr Denis Pellerin, UCL

Cardiac measures include:Global LV diastolic functionGlobal systolic functionLV MeasurementsProximal aorta measurements

Vascular measures include:Carotid-femoral pulse wave velocity (arterial stiffness)

Radial pulse wave analysis (indirect measure of arterial stiffness)

Carotid distensibility (local measure of arterial compliance)

Carotid Intima-Media Thickness (IMT) (local measures of vessel wall)


NSHD clinic data collection: other CVD measures

ECG (Professor Peter MacFarlane, Glasgow University)

Heart rate variability: beat to beat alterations in heart rate - indicator of autonomic regulation of circulatory function (Professor Peter Friberg, Gothenburg University)

Blood pressure: 4th repeated measure since 36 years

Step test (sub-maximal): MRC Epidemiology Unit, Cambridge

Free living activity (over 5 days)


NSHD clinic data collection: bone measuresProfessor Judith Adams, Manchester University

Bone measures include:

• DXA hip• total, femoral neck,

trochanter, Ward’s• Lumbar spine (L1-4)• Whole body & region BMD,

fat & lean mass• vertebral fracture

assessment• Aortic calcification score

• pQCT radius• 4%• 50%


NSHD clinic data collection: challenges

• Balance between number of sites and participant travel

• Complexity

• Integration of nurses, echotechnicians, bone technicians

• Clinically relevant results: duty of care

• Increased regulatory environment

• Raised awareness of security issues by participants

• Secure transfer of clinical and other data

• Volume of data for checking, co-ordinating with core reading labs & merging into NSHD data base

• Strategies for maximising the scientific investment


WTCRF

MRC HNRMRC Epi

MRC NSHD

Cardiology/DXA/

hosp lab

Participants

Postal

Clinicor home

visit

GOS Heart

hospital

ManchesterCRF,

ImagingScience

GP practice

ECG Glasgow


Flow Chart for processing of NSHD blood & urine samples (Dr Alison Lennox, MRC HNR)

1 x Lithium Heparin 2 x EDTA 1 x EDTA 2 x Plain Serum 1 x Citrate 1 x Fluoride 1 X CPDA

1 EDTA for FBC haematology

CMMC laboratories

1 EDTA to Addenbrooke’s for HbA1c and red cell folate

Rest of tubes spun 1 Lithium Heparin 1 EDTA 2 Serum 1 Citrate 1 Fluoride

Dipstick test

2 aliquots VITC, Insulin + 4 aliquots

5 aliquots 3 aliquots 1 aliquot

EDTA Plasma Serum

Citrate Plasma Fluoride Plasma Lithium Heparin Plasma

Overnight urine sample in 1 l wide mouth plastic bottle

3 aliquots

CPDA tube to ECACC for cell

lines

17 blood aliquots stored at –80º and 3 urine at -20Cº until shipped to HNR every 2-3 weeks


Expanding collaborations & capacity building

•Key collaborators sharing responsibility for NSHD

programmes & data collection

•Externally funded initiatives with collaborators

•NSHD based

•Inter-cohort comparative research

• Genetic studies of lifelong health & ageing

•Funding of 3 NIA life course fellowships

•Shared fellowships & studentships


HALCyon Healthy Ageing across the Life Course

LHA is leading a collaborative programme: • 9 UK cohorts born 1921 to 1958 • 23 investigators, 19 collaborators • 8 projects

Aim is to improve the lives of older people by understanding how healthy ageing is influenced by factors operating across the whole of life.

Indicators of healthy ageing being studied include:

• the ability to undertake the physical and cognitive tasks of daily living;

• social and psychological wellbeing;• genetic and other biological ageing

processes.


HALCyon cohorts

Cohort & birth yr Birth Child Early A Mid A Late A

Lothian 1921

Herts 1920-30

Boyd Orr 1925-37

Aberdeen/Lothian 1936

Herts 1931-39

NSHD 1946

NCDS 1958

ELSA/Caerphilly


FALCon Function Across the Life Course

Funded by Population Health Sciences Research Network

LHA are leading this project which uses data from cohorts based at MRC Units and Centres.

The aims are:

•to develop statistical methods to allow pooling of data from several cohorts

•to apply the methodology to model physical, cognitive and cardiovascular trajectories across the whole of life

•to recommend appropriate measures of function at different ages and their timing.


NSHD E-science initiatives

• Manage and preserve the ever expanding data resource:• Existing NSHD data collected over 60

years (15,000 variables)• New clinic and genetic data• Data from other cohorts for comparative

research.• Facilitate data discovery and use• Maintain data security and study reputation.

The new LHA Web Data Access system will:• Integrate the various sources of data,

metadata and semantic classifications• Manage data requests and analysis• Act as an exemplar for the MRC Data

Preservation and Sharing Initiative.


LHA/NSHD Organisational Structure

Governance structure Operational structure

Director

Steering Committee Executive Team

Risk management Cardiac/Vascular & Bone/Muscle Sub-Committee Project Management Groups

UCL Genetics Advisory GroupSamples Access Advisory Group


Acknowledgements

• My predecessors• LHA team• LHA/NSHD Collaborators• Lifelong study participants

Thank you for listening!

mrc national survey of health

Documents

adult health function

health marital

health diet

mrc nshd review

cardiovascular function

lifelong health ageing

kidney function

lung function