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Diana Kuh

Publications and source records attributed to Diana Kuh.

At least 37 records · Page 2Linked to original sources
PubMed2005

Grip strength, postural control, and functional leg power in a representative cohort of British men and women: associations with physical activity, health status, and socioeconomic conditions.

BACKGROUND: Understanding the health, behavioral, and social factors that influence physical performance in midlife may provide clues to the origins of frailty in old age and the future health of elderly populations. The authors evaluated muscle strength, postural control, and chair rise performance in a large representative prospective cohort of 53-year-old British men and women in relation to functional limitations, body size, health and activity, and socioeconomic conditions. METHODS: Nurses interviewed 2984 men and women in their own homes in England, Scotland, and Wales and conducted physical examinations in 2956 of them. Objective measures were height, weight, and three physical performance tests: handgrip strength, one-legged standing balance time, and time to complete 10 chair rises. Functional limitations (difficulties walking, stair climbing, gripping, and falls), health status, physical activity, and social class were obtained using a structured questionnaire. RESULTS: Those with the worst scores on the physical performance tests had higher rates of functional limitations for both upper and lower limbs. Women had much weaker handgrip strength, somewhat poorer balance time, and only slightly poorer chair rise time compared with men. In women, health problems and low levels of physical activity contributed to poor physical performance on all three measures. In men, physical activity was the predominant influence. Heavier weight and poorer socioeconomic conditions contributed to poorer balance and chair rise times. CONCLUSIONS: In this representative middle-aged group, physical performance levels varied widely, and women were seriously disadvantaged compared with men. In general, physical performance was worse for men and women living in poorer socioeconomic conditions with greater body weight, poorer health status, and inactive lifestyles. These findings support recommendations for controlling excess body weight, effective health interventions, and the maintenance of active lifestyles during aging.

Cohort Studies↗
PubMed2005

Social and environmental conditions across the life course and age at menopause in a British birth cohort study.

OBJECTIVE: To assess whether socio-economic status, environmental stress and hardship throughout the life course are associated with age at menopause. DESIGN: Birth cohort study. SETTING: England, Scotland, Wales. SAMPLE: A total of 1515 women from a stratified sample of all births in one week in 1946. METHODS: Age at menopause was collected using annual postal questionnaires from age 47 to 53 years. Information on socio-economic conditions and hardship were collected at contacts throughout life from age 2 to 43 years. Socio-economic indicator variables were defined to represent cumulative exposure to hardship in childhood and in adulthood. MAIN OUTCOME MEASURES: Age at menopause. RESULTS: Cox's proportional hazard models indicated that women whose fathers were in a manual social class occupation at three time points during her childhood had an earlier age at menopause than those whose fathers were in non-manual occupations at all three (HR: 1.51; 95% CI: 0.93-2.47). Similar findings were seen for household crowding. These socio-economic gradients could not be explained by adult socio-economic status, behaviour and lifestyle or by psychological health and stress, but were attenuated by other early life factors. Women who experienced parental divorce early in life (before five years of age) had double the rate of menopause of those whose parents did not divorce (HR: 2.14; 95% CI: 1.33-3.42). There were no consistent findings with adult socio-economic indicators. CONCLUSIONS: There is some evidence of a cumulative effect of socio-economic circumstances in childhood, but not in adulthood, on age at menopause. Childhood nutrition, cognition and emotional stress possibly underlie the social gradient.

Adult↗
PubMed2005

Socio-economic position across the life course and hysterectomy in three British cohorts: a cross-cohort comparative study.

OBJECTIVE: To examine the association between indicators of lifetime socio-economic position and rates of hysterectomy in three British cohorts. DESIGN: Cross-cohort comparative study. SETTING: Two cohorts: England, Scotland and Wales. Third cohort: Aberdeen, Scotland. POPULATION: Three thousand two hundred and eight women born between 1919 and 1940, participating in the British Women's Heart and Health Study (BWHHS); 1394 women from the MRC National Survey of Health and Development (NSHD), followed up since birth in 1946; 3208 women born between 1950 and 1955, participating in the Aberdeen Children of the 1950s study, all with complete information on lifetime socio-economic position and hysterectomy status. METHODS: Relative indices of inequality were derived for markers of socio-economic position in childhood and adulthood. Cox's regression models were used to test the association between these markers and hysterectomy. MAIN OUTCOME MEASURE: Self-reported hysterectomy with or without oophorectomy. RESULTS: Adverse socio-economic position in childhood and as indicated by educational status was associated with reduced rates of hysterectomy in the oldest of the three cohorts (BWHHS), whereas conversely in the NSHD and Aberdeen cohorts it was associated with increased rates of hysterectomy. The unadjusted hazards ratios for hysterectomy comparing worst to best socio-economic position for father's social class were 0.73 (0.56, 0.96) for women from the BWHHS, 1.77 (1.19, 2.65) for those from the NSHD and 2.06 (1.46, 2.89) for those from the Aberdeen cohort. Associations between markers of adult socio-economic position and hysterectomy tended to be weaker in all three cohorts and often did not reach conventional levels of statistical significance. CONCLUSIONS: Our results show that hysterectomy rates are influenced by childhood socio-economic position and educational attainment, but that the nature of this association varies across these three British cohorts born in different decades of the 20th century. That there were no consistent or strong associations between adult SEP and hysterectomy rates suggest that social factors influencing rates of hysterectomy are likely to be those experienced or which develop in early life rather than those which develop later.

Adult↗
PubMed2004

Women's body dissatisfaction, social class, and social mobility.

Several studies indicate that socially advantaged women are more dissatisfied with their bodies than socially disadvantaged women. These findings have been based on women's current social class, and no attention has been paid to the social class of her family of origin or to intergenerational social mobility. In the present research 912 54-year-old women from a prospective birth cohort study provided self-report data on current body esteem (appearance and weight dimensions). Childhood and adult social class (manual versus non-manual) were defined based on father's occupation and own or partner's occupation, respectively. This information and the highest educational qualifications recorded by age 26 were gathered prospectively. Indicators of current and adolescent body mass index (BMI) were computed from height and weight values collected at ages 15 (or 11) and 53-54 years. Multiple regression was used to examine the relationship between midlife body esteem and childhood social class, adult social class, educational qualifications, and social mobility, unadjusted and adjusted for BMI. Women from the non-manual classes as adults were more dissatisfied with their weight than women from the manual classes as adults, for a given BMI. Adjusting for BMI, downwardly mobile women were more satisfied with their appearance than stable non-manual women. Adjusting for BMI, higher educational qualifications were associated with more dissatisfaction with weight and with appearance, and education appears to be more important than occupationally defined social class in explaining body dissatisfaction. A clearer understanding of the relationship between socio-economic position and body dissatisfaction demands that the following distinctions are made: weight versus appearance satisfaction, education versus occupation, and current social class versus intergenerational social mobility.

Body Image↗
PubMed2004

Birthweight, childhood growth, and blood pressure at 43 years in a British birth cohort.

BACKGROUND: Low birthweight is associated with high blood pressure in later life, but it is unclear whether the association is confounded with or modified by maternal and socioeconomic factors or childhood growth. METHODS: A total of 3157 men and women from a British birth cohort study where the survey members have been followed up regularly since their birth in 1946 were included in analyses. The associations between birthweight, childhood growth and blood pressure at 43 years of age were assessed using multiple regression models. RESULTS: Systolic blood pressure (SBP) decreased by 2.3 mmHg (95% CI: 0.8, 3.5) for men and 1.8 mmHg (95% CI: 0.1, 3.5) for women per 1-kg increase in birthweight. The effect was stronger in first born or those born to younger mothers. There was no confounding with any maternal, socioeconomic, or childhood growth variable. SBP increased by 1.45 mmHg (95% CI: 0.11, 2.78) in women and 0.46 mmHg (95% CI: -0.70, 1.62) in men per standard deviation of body mass index (BMI) change between ages 7 and 15 years. Among women this effect was not completely accounted for by adult size and was independent of birthweight. CONCLUSIONS: The determinants of birthweight, possibly related to maternal health during pregnancy, may impact on the relationship with SBP in middle life. The importance of tackling the increasing levels of childhood obesity seen in later cohorts is highlighted by the detrimental impact on SBP of large increases in BMI during adolescence.

Adolescent↗
PubMed2004

Childhood cognitive ability and deaths up until middle age: a post-war birth cohort study.

BACKGROUND: Childhood IQ has been related to mortality in later life in four studies. Cognitive ability may be a mediator between early disadvantage and mortality, a marker of the efficiency of information processing in the central nervous system, or predict entry to safe adult environments or healthy behaviours. We examined mortality in relation to cognitive ability at age 8 years in a birth cohort and investigated these possible reasons. METHODS: Cox's proportional hazards models were used to investigate the effect of early cognitive ability on all-cause mortality in 2057 women and 2192 men born in England, Scotland, and Wales in March 1946 and followed until age 54 years. We tested whether the relationship was accounted for by childhood socioeconomic conditions or serious illness, education, adult socioeconomic conditions, or smoking. RESULTS: Cognitive ability was related to mortality in men but not women. The excess mortality rate in men was concentrated in the bottom quarter of the cognitive score (hazard ratio [HR] for bottom versus top quarter 1.8, 95% CI: 1.0, 3.0) and there was no gradient across the range of ability. Adjustment for childhood socioeconomic conditions and serious illness had a small effect on the HR for deaths between 9 and 54 years while adjustment for education or early adult socioeconomic conditions halved the HR for deaths from age 26 years. Smoking was not a mediator of the effect of early ability on adult mortality. CONCLUSIONS: Greater cumulative exposure to poor lifetime socioeconomic conditions is the most likely explanation for the observed relationship between low cognitive ability in childhood and mortality. This relationship may therefore be elucidated further by studying the causes of lifelong socioeconomic inequalities in health.

Adult↗
PubMed2004

Country of birth, country of residence, and menopausal transitions and symptoms: British birth cohort and Australian Longitudinal Study on Women's Health.

OBJECTIVE: To explore endocrine-related and general symptoms among three groups of middle-aged women defined by country of birth and country of residence, in the context of debates about biological, cultural and other factors in menopause. METHODS: British-born women participating in a British birth cohort study (n=1,362) and age-matched Australian-born (n=1,724) and British-born (n=233) Australian women selected from the Australian Longitudinal Study on Women's Health (ALSWH) responded to two waves of surveys at ages 48 and 50. RESULTS: Australian-Australian and British-Australian women report reaching menopause later than British-British women, even after accounting for smoking status and parity. Hormone replacement therapy (HRT) use was lower and hysterectomy was more common among both Australian groups, probably reflecting differences in health services between Britain and Australia. The Australian-Australian and British-Australian groups were more likely to report endocrine-related symptoms than the British-British group, even after adjusting for menopausal status. British-British women were more likely to report some general symptoms. CONCLUSIONS: Symptom reporting is high among Australian and British midlife women and varies by country of residence, country of birth and menopausal status. IMPLICATIONS: The data do not support either a simple cultural or a simple biological explanation for differences in menopause experience.

Australia↗
PubMed2004

Body dissatisfaction in midlife women.

We examined the extent and correlates of body dissatisfaction among 1026 54-year-old women from the MRC National Survey of Health and Development. Weight dissatisfaction was reported by nearly 80% of the sample and by over 50% of 'normal weight' women (BMI < 25). Women indicated being most dissatisfied with their bodies currently, relative to their younger years, including their forties. Adjusting for BMI, dissatisfaction was highest in higher social class women and in those who rated themselves in poorer health. Women with poor body esteem, regardless of body size, were likely to avoid various everyday situations because of how they felt about their bodies. Adjusting for BMI, women who were happy with their weight were more likely to report distress about other aspects of their appearance. We suggest that body dissatisfaction in women of this age group merits further attention.

Body Image↗
PubMed2003

Birthweight, childhood social class, and change in adult blood pressure in the 1946 British birth cohort.

BACKGROUND: The negative effect of birthweight on systolic blood pressure has been suggested to be initiated in utero and amplified with age. We aimed to investigate this hypothesis. METHODS: A sample of 3634 people from a birth cohort study of men and women born in Britain in 1946 were included in analyses. Cohort members have been contacted regularly since birth, and systolic and diastolic blood pressures were measured at ages 36, 43, and 53 years. Multilevel models, with blood pressure as a repeated outcome, were used to test the amplification hypothesis and to compare results for birthweight with those for childhood social class. FINDINGS: Considering both men and women together, a consistent negative association between birthweight and systolic blood pressure was noted from age 36 to 53 years, but no evidence was recorded of substantial amplification with age. A 1 kg higher birthweight was associated with a slower mean increase in systolic blood pressure by -0.4 mm Hg (95% CI -1.3 to 0.4; p=0.3) per 10-year increase in age. Birthweight was not associated with diastolic blood pressure at any age. People from a manual social class in childhood had higher systolic and diastolic blood pressure than did those from a non-manual class. The effect on systolic blood pressure rose with age, by 1.0 mm Hg (95% CI 0.1 to 2.0; p=0.03) per 10 years, but was largely accounted for by current body-mass index, which was an increasingly strong determinant of blood pressure. INTERPRETATION: These findings suggest that weight control throughout life is key to prevention of raised blood pressure during middle age. Understanding the link between the early childhood socioeconomic environment and adult obesity could make this strategy more effective.

Adolescent↗
PubMed2003

Patterns of interphalangeal hand joint involvement of osteoarthritis among men and women: a British cohort study.

OBJECTIVE: To characterize the pattern of involvement of osteoarthritis (OA) of the hand among men and women of the same age. METHODS: Structured hand examinations were performed on 1,467 men and 1,519 women who were age 53 years and born in England, Scotland, or Wales during the first week of March 1946 (identified through the United Kingdom National Survey of Health and Development). OA at each joint site was characterized using a previously validated examination schedule. The interrelationship of involvement of different hand joints was analyzed by logistic regression and cluster analyses. RESULTS: There was clear evidence of polyarticular involvement in the hand joints of both the men and the women. Among the women, 161 subjects had >/=4 joints involved, compared with only 41 subjects expected in this category (P < 0.001). Among the men, 87 subjects were observed to have >/=4 joints involved, in contrast with only 7 subjects expected (P < 0.001). The pattern of hand joint involvement (characterized by clustering primarily by row and symmetric joint involvement, rather than clustering by ray) was found to be almost identical between the men and the women. CONCLUSION: This study confirms the existence of a polyarticular subset of OA among men that has characteristics similar to those of the variant observed among women. The data suggest that the genetic or metabolic influences underlying this particular variant of OA acts similarly in both sexes.

Cluster Analysis↗
PubMed2003

Women's body satisfaction at midlife and lifetime body size: a prospective study.

The relationship between past body size and current body dissatisfaction among 933 middle-aged women from a prospective birth cohort study was examined. Women provided self-report data on weight esteem at age 54. Height and weight data were collected at ages 7, 11, 15, 20, 26, 36, 43, and 54. Data on reproductive variables were also collected prospectively. Hierarchical linear modeling and multiple regression analyses were used. Women who were dissatisfied at midlife were heavier at age 7 and showed a more rapid increase in body mass index with age. A late menarche, being postmenopausal, and having started hormone replacement therapy before menopause were associated with less dissatisfaction. Attention to these factors across the life span is necessary to understand body dissatisfaction in women at midlife.

Adolescent↗
PubMed2003

Influence of height, leg and trunk length on pulse pressure, systolic and diastolic blood pressure.

OBJECTIVE: To compare the effects of height, leg and trunk length on pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP) in men and women. DESIGN: Prospective, population-based, birth cohort study. SETTING: England, Scotland and Wales. PARTICIPANTS: A total of 1472 men and 1563 women aged 53 years and followed since their birth in 1946. MAIN OUTCOME MEASURES: PP, SBP and DBP at age 53 years. RESULTS: PP increased linearly with decreasing height and leg length in men and women [shortest compared with the tallest height (leg length) group, men 54.6 versus 51.0 mmHg (55.8 versus 50.7 mmHg), women 52.9 versus 48.4 mmHg (53.3 versus 48.6 mmHg); P for trend < or = 0.001 in each case]. Adjustment for adult confounding factors and childhood social class or birth weight only slightly weakened these results (P for trend < or = 0.01 in each case). SBP, but not DBP, showed similar but weaker trends in men and women, except for the association with height in men, which lost statistical significance after adjustment. Trunk length was not associated with any outcome measure in men or women. CONCLUSIONS: Short height and leg length are associated with increased PP and SBP, but not DBP, in middle-aged men and women. PP is a potential mediator between short height and leg length and increased risk of coronary heart disease. Future studies of the association between shortness and coronary heart disease should consider the role of arterial hemodynamics.

Blood Pressure↗
PubMed2003

Women's health in midlife: findings from a British birth cohort study.

The Medical Research Council's National Survey of Health and Development (MRCNSHD) is a prospective cohort study of 2547 women and 2815 men, a sample of all the births that took place in England, Scotland and Wales between 3-9 March 1946. It is one of the longest running large-scale studies of human development in the world, aiming to identify lifetime biological, social and psychological pathways to health and disease, from early life to ageing. A special study of women's health in midlife and the menopausal transition in this cohort was undertaken by sending to women study members eight annual postal questionnaires from when they were 47 to when they were 54 years old. The findings from the women's health study so far have highlighted associations between multiple risk factors at each life stage, and women's health and disease in later life. The authors suggest that a life course approach may provide a better understanding of women's health during the middle years of life than an approach which restricts itself to contemporary social or hormonal experiences. Of particular interest are their results linking ovarian ageing to developmental factors. Replication of these findings in other life course cohorts is being sought.

Aging↗
PubMed2002

Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study.

OBJECTIVE: To examine premature mortality in adults in relation to socioeconomic conditions in childhood and adulthood. DESIGN: Nationally representative birth cohort study with prospective information on socioeconomic conditions. SETTING: England, Scotland, and Wales. STUDY MEMBERS: 2132 women and 2322 men born in March 1946 and followed until age 55 years. MAIN OUTCOME MEASURES: Deaths between 26 and 54 years of age notified by the NHS central register. RESULTS: Study members whose father's occupation was manual at age 4, or who lived in the worst housing, or who received the poorest care in childhood had double the death rate during adulthood of those living in the best socioeconomic conditions. All indicators of socioeconomic disadvantage at age 26 years, particularly lack of home ownership, were associated with a higher death rate. Manual origins and poor care in childhood remained associated with mortality even after adjusting for social class in adulthood or home ownership. The hazard ratio was 2.6 (95% confidence interval 1.5 to 4.4) for those living in manual households as children and as adults compared with those living in non-manual households at both life stages. The hazard ratio for those from manual origins who did not own their own home at age 26 years was 4.9 (2.3 to 10.5) compared with those from non-manual origins who were home owners. CONCLUSIONS: Socioeconomic conditions in childhood as well as early adulthood have strongly influenced the survival of British people born in the immediate post war era.

Adult↗
PubMed2002

Birth weight, childhood size, and muscle strength in adult life: evidence from a birth cohort study.

Environmental influences during gestation may have long-term effects on adult muscle strength. It is not known how early in adult life such effects are manifest and whether they are modified by childhood body size. The authors examined the relation between birth weight and hand grip strength in a prospective national birth cohort of 1,371 men and 1,404 women from the Medical Research Council National Survey of Health and Development who were aged 53 years in 1999. A positive relation between birth weight and adult grip strength remained after adjustment first for adult height and weight and then additionally for childhood height and weight (p = 0.006 for men and p = 0.01 for women). The effects of birth weight on grip strength did not vary by childhood or current body size and were not confounded by social class. To the authors' knowledge, this is the first study to show that birth weight has an important influence on muscle strength in midlife independent of later body size and social class. It suggests that birth weight is related to the number of muscle fibers established by birth and that even in middle age compensating hypertrophy may be inadequate. As the inevitable loss of muscle fibers proceeds in old age, a deficit in the number of fibers could threaten quality of life and independence.

Birth Weight↗
PubMed2002

Lifetime risk factors for women's psychological distress in midlife.

Research on the causes of psychological distress in women in midlife has focused on current adversity and hormonal changes associated with menopause and paid less attention to possible risk factors across the life course. We examined the factors in childhood, adolescence and earlier adult life that show persisting effects on psychological symptoms reported annually over a 6 year period (47-52 years) using prospective data on a cohort of 1500 British women who have been followed since their birth in 1946. Even after taking into account the powerful effect of recent life stress, this study found that women with a high level of psychological distress had different life course trajectories than those with less distress. They were more likely to have scored highly on the neuroticism scale or exhibited antisocial behaviour when they were teenagers, and to have had prior experience of mental and physical health problems in adult life. Those whose parents had divorced reported more distress in midlife, particularly if they too had experienced marital breakdown. These factors accounted for the associations between some of the adult sources of risk, particularly those to do with interpersonal difficulties or poor adult socioeconomic circumstances, and psychological distress in midlife. There was no evidence that concurrent menopausal status had any effect on the level of psychological symptoms except for those women on hormone replacement therapy who had a small and independent additional risk. More attention to a long term temporal perspective is warranted in research on the causes of psychological distress in women at midlife.

Adolescent↗
PubMed2002

Change in psychological and vasomotor symptom reporting during the menopause.

There remains uncertainty regarding what health symptoms can be directly attributed to the menopause. The association between changes in menopausal status and changes in vasomotor symptom and psychological symptom reporting was investigated and the effects of changing menopausal status were compared with those related to life events and difficulties. Reports of common health symptoms, menopausal status and life events and difficulties have been collected prospectively from 1572 British women followed up since their birth in 1946, every year between 47 and 52 years. Regression models for repeated measures were fitted with the change in symptom scores between consecutive years as the outcome. Estimates from these models were obtained using generalised estimating equations, thus allowing appropriately for the correlation between repeated measures on the same woman. Vasomotor symptoms were found to be strongly related to changes in menopausal status with increases being observed as women move through the menopause. Psychological symptoms were more strongly associated with current life events and difficulties, particularly those experienced in family life, than with menopausal status. An increase in symptoms was, however, observed in premenopausal and perimenopausal women starting hormone replacement therapy. These effects were not confounded or modified by previous psychological morbidity, social or behavioural factors. The findings suggest that vasomotor symptoms are dependent on changing hormone levels associated with the menopause, while psychological symptoms are not. The possibility that there is a small subgroup of women who experience increased psychological problems at the time of the menopause, and who in this cohort are identified by their use of HRT, is suggested. The mechanism behind this rise remains unclear. Factors other than the menopause should be considered, such as concurrent life events and past experiences and behaviours, when considering the treatment of psychological symptoms in women during middle life.

Cohort Studies↗