The NILS mortality study a new tool for research

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The Northern Ireland Longitudinal Study (NILS-mortality study) a new tool for research D. O’Reilly Department of Epidemiology & Public Health Queen’s University Belfast

Two NILS datasets: 

Two NILS datasets NILS 28% census population links to deaths (16,000) births cancer registration other censuses ?others HPSS data SS benefits data NILS mortality study Full census population links to deaths (56,396)

Benefits of NILS mortality data: 

Benefits of NILS mortality data Size 6.5 million person-years Study rarer diseases & population groups finer geographical levels Proximity to census Cross-sectional analysis

Layout of talk: 

Layout of talk Denomination & mortality Suicides Informal carers Other examples of ongoing research

Study 1:  Religious affiliation and mortality : 

Study 1: Religious affiliation and mortality

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Composition of the Northern Ireland population aged 25-74; n = 928,080

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Variation in mortality levels (hazard ratios) *** = P<0.001; ** = P<0.01; * = P<0.05

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Variations by cause of death

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Distribution of denomination by electoral ward across Northern Ireland: 2001 census % Roman Catholic > 80 % 60 – 79 % 40 - 59 % 20 – 39 % < 20 %

Study 2:  Suicide in Northern Ireland:Individual, household and area factors associations: 

Study 2: Suicide in Northern Ireland: Individual, household and area factors associations

Trends in (0-74y) age-standardised rates of suicide in N. Ireland 1970-2005: 

Trends in (0-74y) age-standardised rates of suicide in N. Ireland 1970-2005

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Study Aims To describe the variations in suicides according to the socio-demographic and socio-economic factors and … To test the hypothesis that area characteristics are also independently important in determining the levels of suicide

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Recent Studies Congdon, P. (1996) Suicide and Parasuicide in London: A Small-area Study Whitley E, Gunnell D, Dorling D., and Smith G. D. (1999) Ecological Study of Social Fragmentation, Poverty, and Suicide

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Individual and household factors Age/sex/Marital status/Econ. activity/Health status/ HH composition / deprivation Area factors - Urban-rural (population density) - Income domain (Noble Index) - Social fragmentation (Congdon & Whitley) - % not married - % single person households - % private renting - % population turnover Data:

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Cox’s proportional hazards modeling A: Individual & Household factors Risk of suicide is highest in … Younger adults Males (three-fold increase) People who are not married People living alone Unemployed & permanently sick People who had ‘poor’ general health at census More deprived households

Relationship between suicide rates and area deprivation: 

Relationship between suicide rates and area deprivation *** = P<0.001; ** = P<0.01; * = P<0.05

Relationship between suicide rates and social fragmentation: 

Relationship between suicide rates and social fragmentation *** = P<0.001; ** = P<0.01; * = P<0.05

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Relationship between suicide rates and population density *** = P<0.001; ** = P<0.01; * = P<0.05

Conclusions:: 

Conclusions: Suicide risk is strongly related socio-economic disadvantage and social support at an individual level Area factors no independent effect The findings suggest that, policies targeted at area-level factors are unlikely to significantly influence rates of suicide.

Study 3: Morbidity and mortality of unpaid carers in the community: 

Study 3: Morbidity and mortality of unpaid carers in the community Aims: To describe the self-reported health status of carers in Northern Ireland by the amount of time spent caring; To examine their mortality experience over the subsequent four years

Distribution of carers by age & sexn = 163,340 (14.1% population): 

Distribution of carers by age & sex n = 163,340 (14.1% population)

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Who cares? (results of logistic regression) Carers were most likely to be Female “Middle-aged” (45 – 64) Married Public sector renters & no car access Area deprivation U-shaped relation with all carers Positively associated with caring for carers >20 hours/week

Odds ratio of “LLTI” adjusted for confounders: 

Odds ratio of “LLTI” adjusted for confounders ***P<0.001; **P<0.01; *P<0.05

Odds ratio of “fairly good or not good” general health adjusted for confounders: 

Odds ratio of “fairly good or not good” general health adjusted for confounders ***P<0.001; **P<0.01; *P<0.05

Probability of death adjusted for confounders: 

Probability of death adjusted for confounders ***P<0.001; **P<0.01; *P<0.05

Conclusions: 

Conclusions Lower levels of LLTI: Requirement for physical robustness Higher levels of poor GH: Adverse effects of caring on mental health Lower mortality: Companionship & positive attributes of caring

Other NILS-based studies: 

Other NILS-based studies Relationship between LLTI and GH and mortality Relative health of urban & rural areas Methodological issues Health selection effects Non-linkage problems Exploring association between NILS & HPSS

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Determinants of admission to Nursing & Residential homes for older people in N. Ireland 2001 CENSUS Demography SES HH composition Carers Health status Area characteristics 2001 2005 N/R home CSA Address change HH change N.I.L.S

Acknowledgements:NILS coordinators and supportMaire BrollyAndrew KerrDavid MarshallRobert BeattyCo-researchersMichael RosatoSheelah Connolly: 

Acknowledgements: NILS coordinators and support Maire Brolly Andrew Kerr David Marshall Robert Beatty Co-researchers Michael Rosato Sheelah Connolly