Enabling the examination of long-term mortality trends by educational level for England and Wales in a time-consistent and internationally comparable manner

BACKGROUND

Studying long-term trends in educational inequalities in health is important for monitoring and policy evaluation. Data issues regarding the allocation of people to educational groups hamper the study and international comparison of educational inequalities in mortality. For the UK, this has been acknowledged, but no satisfactory solution has been proposed.

OBJECTIVE

To enable the examination of long-term mortality trends by educational level for England and Wales (E&W) in a time-consistent and internationally comparable manner, we propose and implement an approach to deal with the data issues regarding mortality data by educational level.

METHODS

We employed 10-year follow-ups of individuals aged 20+ from the Office for National Statistics Longitudinal Study (ONS-LS), which include education information from each decennial census (1971-2011) linked to individual death records, for a 1% representative sample of the E&W population. We assigned the individual cohort data to single ages and calendar years, and subsequently obtained aggregate all-cause mortality data by education, sex, age (30+), and year (1972-2017). Our data adjustment approach optimised the available education information at the individual level, and adjusts-at the aggregate level-for trend discontinuities related to the identified data issues, and for differences with country-level mortality data for the total population.

RESULTS

The approach resulted in (1) a time-consistent and internationally comparable categorisation of educational attainment into the low, middle, and high educated; (2) the adjustment of identified data-quality related discontinuities in the trends over time in the share of personyears and deaths by educational level, and in the crude and the age-standardised death rate by and across educational levels; (3) complete mortality data by education for ONS-LS members aged 30+ in 1972-2017 which aligns with country-level mortality data for the total population; and (4) the estimation of inequality measures using established methods. For those aged 30+ , both absolute and relative educational inequalities in mortality first increased and subsequently decreased.

CONCLUSION

We obtained additional insights into long-term trends in educational inequalities in mortality in E&W, and illustrated the potential effects of different data issues. We recommend the use of (part of) the proposed approach in other contexts.

Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries

BACKGROUND

Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages.

METHODS

We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique.

RESULTS

We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982-2008; Finnish women, 1985-2017; and Italian men, 1976-1999) were driven by faster mortality declines among the high-educated aged 65-84, and by mortality increases among the low-educated aged 30-59. The long-term decreases (British men, 1976-2008, and Italian women, 1972-2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30-54.

CONCLUSION

Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30.

P-486 Fertility in the workplace: The emotional, physical and psychological impact of infertility in the workplace

Study question

How can a supportive workplace environment influence the emotional and physical wellbeing of those Impacted by fertility issues?

Summary answer

Implementing a supportive environment and workplace fertility policies can substantially improve physical and emotional wellbeing and is indeed best practice benefiting both employees and employers.

What is known already

Most people facing fertility issues are in some form of employment. Trying to conceive, fertility investigations and fertility treatment, can impact physical and emotional wellbeing causing distress, anxiety and affect relationships with family, friends and colleagues. This can lead to a detrimental effect on workplace performance, job satisfaction, career progression and an increase in absence or sick time for those employees who are actively trying to conceive. The demands of navigating treatment whilst working can cause immense emotional stress on an individual as well as potentially affecting the wider organisation as a whole unless best practice in support is shown.

Study design, size, duration

During October 2021, two surveys were conducted to explore and make the link between the personal / human experience of infertility and the corporate impact / responsibility in supporting someone through it. The first survey was disseminated to 503 workers who were either trying to conceive, currently pregnant, or who have conditions related to fertility and the second survey was sent to 1054 workers who did not identify that they were on a fertility journey.

Participants/materials, setting, methods

Two online anonymous surveys were conducted, the first contained 18 questions and were aimed at 503 workers who identified that they were either trying to conceive, currently pregnant or who had conditions related to fertility. The second questionnaire contained 9 questions and was aimed at 1054 respondents who were not on a fertility journey, 508 of which were in senior or management positions. All respondents were in current employment in various roles.

Main results and the role of chance

The main results of the combined surveys showed that nearly 2 in 3 women have felt overwhelmed by their fertility journey. Over half of respondents feel that their fertility journey has made them feel depressed and/or anxious and the majority of those who have had miscarriages say that their fertility journey has been traumatic (79%). Almost two thirds (63%) have not been offered fertility counselling or support by their workplace.

Employees who are on their fertility journey are often? unable to work to their full potential, with 40% having considered leaving their job entirely. Reduced working hours, a change in career path and passing up important career opportunities are all actions respondents have taken whilst on their fertility journey. This remains equal across both male and females, with 31% of those who have reduced their hours/ gone part time having had a partner experience miscarriage.

61% have told their employer about their fertility journey, 23% have spoken about it in detail.

24% of those on their journey have had to lie to colleagues/ managers in order to attend/ manage fertility appointments and/or treatment.

Limitations, reasons for caution

No limitations identified. Male, female and gender neutral/ non-binary respondents were included in the survey, along with those who identified as single or were in heterosexual or same sex relationships.

Wider implications of the findings

These study findings support the research conducted by Fertility Network UK which highlights that supporting workers and employees, signposting to specialist fertility counselling, implementation of flexible working, fertility workplace policies, a supportive workplace and education is recommended for all organisations. To benefit both employer and employee alike

Trial registration number

not applicable

The Office for National Statistics Longitudinal Study

Background and Rationale The ONS Longitudinal Study (‘the LS’) covers England and Wales and includes individual data from the 1971 – 2011 decennial censuses and linked information on births, deaths and cancer registrations. It is representative of the population of England and Wales. Aim This presentation describes the LS and the linked administrative data, and showcases recent/ prominent examples of research. Methods and Approach The LS is built around samples drawn from decennial censuses, with its initial sample drawn from the 1971 Census. It also contains information about other people living in a sample-member’s household. Substantial emphasis is placed on security of access to the data and its responsible use. All research outputs are checked and are only released to users once disclosure control requirements are met. Linkage of study members from one census to another and vital events is carried out by ONS. Results The LS has been used for a variety of research. Using linked census and death records occupational differences in mortality rates have been researched. Individual records from all five censuses have been used to contribute to research social mobility, and research has also investigated the effects of long-term exposure to air pollution. Research has provided evidence of impact for social policy issues, e.g. health inequalities and the State Pension Age Review. Discussion The main strength of the LS is its large sample size (>1 million), making it the largest nationally representative longitudinal dataset in the UK. This allows analysis of small areas and specific population groups. Sampling bias is almost nil, and response rates are very high relative to other cohort and panel studies. Conclusion The ONS Longitudinal Study is a vital UK research asset, providing access to a large sample of census data linked across five censuses. It is strengthened through linkage to events data.

Identifying the lifetime cognitive and socioeconomic antecedents of cognitive state: seven decades of follow-up in a British birth cohort study

OBJECTIVES

The life course determinants of midlife and later life cognitive function have been studied using longitudinal population-based cohort data, but far less is known about whether the pattern of these pathways is similar or distinct for clinically relevant cognitive state. We investigated this for Addenbrooke's Cognitive Examination third edition (ACE-III), used in clinical settings to screen for cognitive impairment and dementia.

DESIGN

Longitudinal birth cohort study.

SETTING

Residential addresses in England, Wales and Scotland.

PARTICIPANTS

1762 community-dwelling men and women of European heritage, enrolled since birth in the Medical Research Council (MRC) National Survey of Health and Development (the British 1946 birth cohort).

PRIMARY OUTCOME

ACE-III.

RESULTS

Path modelling estimated direct and indirect associations between apolipoprotein E (APOE) status, father's social class, childhood cognition, education, midlife occupational complexity, midlife verbal ability (National Adult Reading Test; NART), and the total ACE-III score. Controlling for sex, there was a direct negative association between APOE ε4 and the ACE-III score (β=-0.04 [-0.08 to -0.002], p=0.04), but not between APOE ε4 and childhood cognition (β=0.03 [-0.006 to 0.069], p=0.10) or the NART (β=0.0005 [-0.03 to 0.03], p=0.97). The strongest influences on the ACE-III were from childhood cognition (β=0.20 [0.14 to 0.26], p<0.001) and the NART (β=0.35 [0.29 to 0.41], p<0.001); educational attainment and occupational complexity were modestly and independently associated with the ACE-III (β=0.08 [0.03 to 0.14], p=0.002 and β=0.05 [0.01 to 0.10], p=0.02, respectively).

CONCLUSIONS

The ACE-III in the general population shows a pattern of life course antecedents that is similar to neuropsychological measures of cognitive function, and may be used to represent normal cognitive ageing as well as a screen for cognitive impairment and dementia.

Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: case report

This is the second case in literature of posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia. A 27-year-old primigravida with dichorionic diamniotic twin pregnancy was admitted at 36 weeks of gestation for induction of labour due to preeclampsia. On the second day postpartum, the patient developed severe hypertension, visual symptoms, confusion, headache, and eclamptic fits. Head computed tomography (CT) showed hypodense basal ganglia lesions. The patient was treated in the intensive treatment unit with hydralazine and labetalol infusions and anticonvulsants. Five days later, there was complete clinical improvement and follow-up magnetic resonance imaging (MRI) was normal. The patient was discharged 11 days post-delivery. Diagnosis of PRES is based on the presence of clinical features of acute neurologic compromise, abnormal neuroimaging findings, and complete reversibility of findings after prompt treatment. Early recognition and proper treatment result in complete reversibility of this condition.