Search PubMed⌕ Search

Biomedical subjects

P O Goldblatt

Publications and source records attributed to P O Goldblatt.

17 recordsLinked to original sources
PubMed1993

Marital stability and cancer of the uterine cervix: changing patterns in post-war Britain.

This study investigates the extent to which the distinctive cross-sectional marital status picture of risk for cancer of the uterine cervix (single, married, widowed, divorced in ascending order of risk) has persisted in post-war Britain. Incidence and mortality due to invasive cervical cancer amongst single women now exceeds that of the married, and for both has become much closer to that of the widowed and divorced. A dramatic increase in carcinoma in situ in Scotland, seen particularly in the single since 1982, must partly reflect changes in screening and diagnostic classification, but is also consistent with the later occurrence of the sexual revolution in Scotland. Overall in Britain, the distribution of screening and hysterectomy cannot account for the present day pattern of the disease. Available data on patterns of smoking and oral contraceptive use are broadly consistent with a role for them in determining the current disease pattern associated with marital status but their possible involvement cannot be disentangled from the more likely effect of changing levels of sexual activity increasing the risk of sexually transmitted disease. As marital status becomes a less important social indicator of sexual behaviour, it has also become a much less reliable marker of cervical cancer risk.

Carcinoma↗
PubMed1992

Social class, marital status, and cancer of the uterine cervix in England and Wales, 1950-1983.

STUDY OBJECTIVE: The aim was to investigate whether trends in mortality from cancer of the cervix uteri by age, marital status, and social class are compatible with current beliefs about the epidemiology of the disease. DESIGN: Data on mortality from cancer of the cervix for single and married women by age and social class were obtained from the Registrar General's Decennial Supplements on occupational mortality for the years 1950-53, 1959-63, 1970-72, and 1979, 1980, 1982, and 1983. Age standardised mortality rates were calculated directly by social class and marital status. SETTING: The data relate to all cases of carcinoma of the cervix reported in England and Wales in the years studied. MAIN RESULTS: There was a marked convergence of mortality between single and married women over the period within every social class grouping examined. The social class differential, however, remained essentially unchanged for both single and married women considered separately. CONCLUSIONS: Trends in mortality by marital status appear to reflect accurately the changes in the pattern of marriage and sexual behaviour that have taken place in the post-war period, whereas the patterns of other risk and protective factors such as screening explain these trends less well. In contrast, it seems likely that factors other than patterns of sexual behaviour and screening operate to maintain the social class differential in England and Wales.

Adolescent↗
PubMed1991

Occupational mortality of women aged 15-59 years at death in England and Wales.

STUDY OBJECTIVE: The aim was to analyse occupational mortality differences among women using follow up data from a large nationally representative sample. DESIGN: Occupational information was obtained from the 1971 census records of women in the Longitudinal Study carried out by the Office of Population Censuses and Surveys (OPCS) and related to their subsequent mortality in the period between the 1971 and 1981 censuses. SETTING: In the Longitudinal Study, census, vital statistics, and other OPCS records are linked for a 1% sample of the population of England and Wales. The women studied in this paper were drawn from the 513,071 persons in the 1971 census who were included in the Longitudinal Study and whose entries were traced at the National Health Service Central Register by 1977. PARTICIPANTS: The analysis was based on 77,081 women aged 15-59 years in the Longitudinal Study for whom occupational information was collected in the 1971 census (99% of whom were in paid employment in the week before the census). There were 1553 deaths among these women in the follow up period analysed here. MEASUREMENTS AND MAIN RESULTS: Numbers of deaths in each occupational group at census were compared to those expected on the basis of age specific death rates among all women in the study. "Professional, technical workers, and artists" had significantly low mortality while "Engineering and allied trades workers nec" had significantly high mortality. Among the latter, cancer mortality of electrical production process workers was extremely high. A number of other cause specific associations (which appear to confirm proportionate Decennial Supplement analyses) were suggested by the data; examples include high levels of mortality from ischaemic heart disease among cooks, lung cancer and respiratory disease among charwomen and cleaners, and accidents, poisonings, and violence among several groups of professional and technical workers. CONCLUSIONS: By using prospective follow up from the census, occupational differences in mortality can be identified among women in paid employment. As follow up of this study continues, numbers of deaths available for analysis will increase, allowing increasingly comprehensive analyses to be undertaken.

Adolescent↗
PubMed1991

Socioeconomic differences in cancer survival.

STUDY OBJECTIVE: The aim was to investigate the relationship between socioeconomic status and cancer survival. DESIGN: This was a prospective study, linking census and vital registration records for an approximate 1% representative sample of those enumerated in England and Wales in the 1971 census. SETTING: The study population is nationwide. PARTICIPANTS: The study sample consists of 250,588 men and 262,484 women. During 1971-81, 17,844 cases of cancer were registered, and of those registered, 13,532 died during 1971-1983. MEASUREMENTS AND MAIN RESULTS: Socioeconomic status was assessed in terms of housing tenure. Council tenants, the low socioeconomic group, had poorer survival than owner occupiers, the high socioeconomic group, for the combined group of all neoplasms, and for 11 out of 13 neoplasms examined in males, and 12 out of 15 neoplasms examined in females. Differences were found irrespective of age, cause of death and prognosis of the cancer. Survival analysis by length of follow up indicated that council tenants were more likely to present at a later stage than owner occupiers. CONCLUSIONS: Wide survival differentials were observed between socioeconomic groups. Differences in survival for cancers of poor prognosis (eg, oesophagus, pancreas, lung) where treatment has little effect, cannot be attributed to socioeconomic differences in treatment. The survival differences for cancers of good prognosis (eg, corpus uteri, bladder, skin) could, in part, be due to differences in treatment. It is probable that delay in seeking care is one of the major contributing causes.

Adult↗
PubMed1989

Parental age and motor neuron disease.

A case-control approach was used to study the relationship between parental age and motor neuron disease (MND) in a nationally representative sample of men. [The method, involving a search for parents' records in the NHS Central Register, is new and may be of interest in other conditions where parental age is thought to play a part.] The parents of men who died of MND in 1979 were not older than the parents of sex, age and regionally standardised controls who died in the same year.

Adult↗
PubMed1988

Inequalities in women's health: looking at mortality differentials using an alternative approach.

Data obtained from follow up of the 1971 census sample in the Office of Population Censuses and Surveys longitudinal study of England and Wales were used to look at women's mortality differentials at ages 15-59. Women were grouped by combining information on marital state, own occupation, husband's occupation (if married), economic activity, and indicators of household wealth (housing tenure and access to a car). Large groups were found with considerable differences in mortality. High mortality was associated with working in manual occupations and living in rented housing with no car in the household. In contrast, low mortality was associated with non-manual occupations and living in owner occupied housing with a car. Among married housewives and single women these extreme groups contributed 44% of expected deaths, the disadvantaged group experiencing death rates two and a half times that of the advantaged group. Smaller differences were found among married women with an occupational class. These findings are further evidence of the "health divide" in England and Wales and show that accurately to reflect the relation between a woman's life circumstances and mortality it is necessary to utilise other measures than those based solely on occupation.

Adolescent↗
PubMed1988

Twenty years' screening for cancer of the uterine cervix in Great Britain, 1964-84: further evidence for its ineffectiveness.

The effects of the screening programme for cancer of the uterine cervix in Great Britain are disputed, and the subject has been underexplored. Accordingly, we have related routinely available data on screening effort in Scotland, Wales, and the 14 English Health Regions to various incidence and mortality outcome measures, from 1967 to the present day. Although such an approach is imperfect, the results support the belief that the screening programme has been largely unsuccessful.

Adolescent↗
PubMed1987

Unemployment and mortality: comparison of the 1971 and 1981 longitudinal study census samples.

Mortality in the period 1981-3 among men in the Office of Population Censuses and Surveys longitudinal study who were seeking work in 1981 was examined to investigate whether the finding of a high mortality rate among a comparable group of men who were followed up from the 1971 Census was repeated despite appreciable changes in the size and structure of the labour force over the intervening years. The pattern of mortality shortly after both censuses suggests that sick unemployed men were not categorised as seeking work, and it is concluded that for both samples the mortality of those who were reported to be seeking work was raised for reasons other than initial poor health. Other findings from the two censuses are also broadly similar. If confirmed after longer follow up this will add considerably to the evidence of the adverse health consequences of unemployment.

Adolescent↗
PubMed1986

Stress and heart disease: evidence of associations between unemployment and heart disease from the OPCS Longitudinal Study.

The OPCS Longitudinal Study has been used to study both overall and cause-specific mortality patterns in 1971-1981 among men and women directly or indirectly affected by unemployment in April 1971. Groups studied included men seeking work in 1971, the wives of men seeking work in 1971 and other women in the same households as a man seeking work in 1971. The findings of this project are summarized here and attention is focused on mortality from circulatory diseases, in particular ischaemic heart disease. The study provides evidence which could be seen as supporting hypotheses about relationships between stress and overall mortality, with a marked excess for suicides. The evidence with respect to ischaemic heart disease is positive but less convincing with excess mortality from this cause principally occurring among younger unemployed men and among the wives of men who were seeking work in 1971. Given the sharp contrasts in the pattern and levels of unemployment between 1971 and 1981 it is difficult to extrapolate from these findings to the present day.

Adolescent↗
PubMed1985

Social class mortality differentials: artefact, selection or life circumstances?

Data from 10 years follow up of mortality in the OPCS Longitudinal Study are used to relate deaths of men in 1976-81 to their social class as recorded by the 1971 census. Explanations of social class mortality differentials are critically reviewed in the light of these new data. The similarity between the class differentials observed for men aged 15-64 years in this study and those reported in the 1970-2 Decennial Supplement on Occupational Mortality indicate that the published gradients were not in fact grossly distorted by numerator denominator biases. Distortions to gradients observed in the early years of the longitudinal study and ascribed to selective health related mobility out of employment from the principal social classes to the permanently sick had largely worn off after five years of follow up. Sharp gradients at ages over 75 years, similar to those at younger ages, suggest that, for men aged over 50 years, selective health related mobility between social classes does not contribute to differentials in mortality.

Adolescent↗
PubMed1984

Bereavement and cancer: some data on deaths of spouses from the longitudinal study of Office of Population Censuses and Surveys.

Registration of cancer and mortality after the death of a spouse were assessed using data from the longitudinal study of the Office of Population Censuses and Surveys (OPCS). The study population comprised 1% of the people counted in England and Wales in the 1971 census, for whom data on subsequent vital events were linked with their census records. There was little evidence of an increase in registrations of cancer after the death of a spouse and only a slight suggestion of increased mortality from cancer. For other causes of death there was some evidence of increases in mortality during widow(er)hood. In so far as the death of a spouse is often a very stressful event, these data may be interpreted as providing little support for the hypothesis that stress is implicated in the aetiology of cancer.

Death↗
PubMed1982

Selection and mortality differentials.

The Office of Population Censuses and Surveys Longitudinal Study provides reliable mortality data by a much wider range of characteristics than are available for other national sources. Although it is based on only a 1% sample of the population, it broadens the scope of mortality analysis and permits study of changes in relationships using different aspects of the time dimension. Data from this study have made us increasingly aware of the importance of selection to the interpretation and understanding of observed mortality differentials. Here we focus on that aspect of selection called "health-related mobility," which is associated with the relative health of people acquiring or losing individual characteristics. It is suggested that, for characteristics affected by health-related mobility, mortality differentials would narrow or widen with increased duration of follow-up. One of the basis of this argument the contribution of health-related mobility to mortality differentials by economic position and social class, to regional differentials, and to family and household differentials is investigated. Selection can thus be shown to operate when people change economic position, when they migrate, or when they change marital status. While the effects of these selection processes can be shown to contribute to social class gradients they do not explain regional differentials and contribute only to a limited degree to differentials by marital status. Differentials by household circumstances also reflect the product of selection processes.

Employment↗
PubMedDate not supplied

Inequalities in women's health in England and Wales: mortality among married women according to social circumstances, employment characteristics and life-cycle stage.

"Data obtained from follow-up of the Office of Population Censuses and Surveys Longitudinal Study 1971 Census sample have been used to look at women's mortality differentials at ages 15-59 in England and Wales....In this paper we focus on married women and use age of youngest child as a measure of life-cycle stage. We relate this to whether the woman was a housewife, or was in full or part-time paid employment, so as to examine how these affect differences in mortality by social class. We find that socio-economic mortality differences persist irrespective of life-cycle stage.... Housewives married to men in manual occupations experienced death rates over one and a half times as high as those married to men in non-manual occupations. For women in employment the differences by husbands' social class are of a lesser magnitude.... Differences in the mortality of those in full and part-time work depend on the woman's own social class and are greater for non-manual than manual classes." (SUMMARY IN FRE AND ITA)

Demography↗