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Author: search.filters.author.Allen JSubject: search.filters.subject.1117 Public Health and Health Services

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    Trajectories of material living standards, physical health and mental health under a universal pension
    (BMJ Publishing Group, 10/03/2020) Allen J; Alpass FM
    Objective Aged pension schemes aim to support material and non- material well- being of older populations. The current work aimed to describe dominant trajectories of material living standards in the decades prior to and following eligibility for an aged pension, and describe associated trajectories of physical and mental health. Methods Longitudinal data on living standards and indices of health Short Form 12 were collected over 2–12 years follow- up from 4811 New Zealand adults aged 55–76. Growth mixture models were used to identify dominant trajectories of living standards with age. Latent growth curve models were used to describe trajectories of physical and mental health associated with each living standards trajectory class. results A group characterised by good living standards with age (81.5%) displayed physical and mental health scores comparable to those of the general adult population. Smaller groups experienced hardship but increasing living standards (11.8%) and hardship and declining living standards (6.8%). While both groups in hardship experienced poor health in the decade prior pension eligibility, mental health improved among those with increasing living standards, while physical and mental health declined among those with declining living standards. Conclusion Under the current policy settings, a majority of older adults in New Zealand maintain a good level of living standards and health in later life. However, significant proportions experience material hardship and poor health in the decade prior to pension eligibility. Alleviation of material hardship may reduce health inequalities in later life.
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    Quality of life impact of cardiovascular and affective conditions among older residents from urban and rural communities.
    (14/08/2013) Allen J; Inder KJ; Harris ML; Lewin TJ; Attia JR; Kelly BJ
    BACKGROUND: The demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness. METHODS: Data from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness. RESULTS: Physical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty. CONCLUSIONS: Cardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes.
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    Integrating and extending cohort studies: lessons from the eXtending Treatments, Education and Networks in Depression (xTEND) study.
    (5/10/2013) Allen J; Inder KJ; Lewin TJ; Attia JR; Kay-Lambkin FJ; Baker AL; Hazell T; Kelly BJ
    BACKGROUND: Epidemiologic studies often struggle to adequately represent populations and outcomes of interest. Differences in methodology, data analysis and research questions often mean that reviews and synthesis of the existing literature have significant limitations. The current paper details our experiences in combining individual participant data from two existing cohort studies to address questions about the influence of social factors on health outcomes within a representative sample of urban to remote areas of Australia. The eXtending Treatments, Education and Networks in Depression study involved pooling individual participant data from the Australian Rural Mental Health Study (T0 N = 2639) and the Hunter Community Study (T0 N = 3253) as well as conducting a common three-year follow-up phase (T1 N = 3513). Pooling these data extended the capacity of these studies by: enabling research questions of common interest to be addressed; facilitating the harmonization of baseline measures; permitting investigation of a range of psychosocial, physical and contextual factors over time; and contributing to the development and implementation of targeted interventions for persons experiencing depression and alcohol issues. DISCUSSION: The current paper describes the rationale, challenges encountered, and solutions devised by a project aiming to maximise the benefits derived from existing cohort studies. We also highlight opportunities for such individual participant data analyses to assess common assumptions in research synthesis, such as measurement invariance, and opportunities for extending ongoing cohorts by conducting a common follow-up phase. SUMMARY: Pooling individual participant data can be a worthwhile venture, particularly where adequate representation is beyond the scope of existing research, where the effects of interest are small though important, where events are of relatively low frequency or rarely observed, and where issues are of immediate regional or national interest. Benefits such as these can enhance the utility of existing projects and strengthen requests for further research funding.