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AbstractObjectiveTo examine whether physical inactivity is a risk factor for dementia, with attention to the role of cardiometabolic disease in this association and reverse causation bias that arises from changes in physical activity in the preclinical (prodromal) phase of dementia.DesignMeta-analysis of 19 prospective observational cohort studies.Data sourcesThe Individual-Participant-Data Meta-analysis in Working Populations Consortium, the Inter-University Consortium for Political and Social Research, and the UK Data Service, including a total of 19 of a potential 9741 studies.Review methodThe search strategy was designed to retrieve individual-participant data from prospective cohort studies. Exposure was physical inactivity; primary outcomes were incident all-cause dementia and Alzheimer’s disease; and the secondary outcome was incident cardiometabolic disease (that is, diabetes, coronary heart disease, and stroke). Summary estimates were obtained using random effects meta-analysis.ResultsStudy population included 404 840 people (mean age 45.5 years, 57.7% women) who were initially free of dementia, had a measurement of physical inactivity at study entry, and were linked to electronic health records. In 6.0 million person-years at risk, we recorded 2044 incident cases of all-cause dementia. In studies with data on dementia subtype, the number of incident cases of Alzheimer’s disease was 1602 in 5.2 million person-years. When measured <10 years before dementia diagnosis (that is, the preclinical stage of dementia), physical inactivity was associated with increased incidence of all-cause dementia (hazard ratio 1.40, 95% confidence interval 1.23 to 1.71) and Alzheimer’s disease (1.36, 1.12 to 1.65). When reverse causation was minimised by assessing physical activity ≥10 years before dementia onset, no difference in dementia risk between physically active and inactive participants was observed (hazard ratios 1.01 (0.89 to 1.14) and 0.96 (0.85 to 1.08) for the two outcomes). Physical inactivity was consistently associated with increased risk of incident diabetes (hazard ratio 1.42, 1.25 to 1.61), coronary heart disease (1.24, 1.13 to 1.36), and stroke (1.16, 1.05 to 1.27). Among people in whom cardiometabolic disease preceded dementia, physical inactivity was non-significantly associated with dementia (hazard ratio for physical activity assessed >10 before dementia onset 1.30, 0.79 to 2.14).ConclusionsIn analyses that addressed bias due to reverse causation, physical inactivity was not associated with all-cause dementia or Alzheimer’s disease, although an indication of excess dementia risk was observed in a subgroup of physically inactive individuals who developed cardiometabolic disease.

The association between overtime work and depression is still unclear. This study examined the association between overtime work and the onset of a major depressive episode (MDE). Prospective cohort study with a baseline examination of working hours, psychological morbidity (an indicator of baseline depression) and depression risk factors in 1991-1993 and a follow-up of major depressive episode in 1997-1999 (mean follow-up 5.8 years) among British civil servants (the Whitehall II study; 1626 men, 497 women, mean age 47 years at baseline). Onset of 12-month MDE was assessed by the Composite International Diagnostic Interview (CIDI) at follow-up. In prospective analysis of participants with no psychological morbidity at baseline, the odds ratio for a subsequent major depressive episode was 2.43 (95% confidence interval 1.11 to 5.30) times higher for those working 11+ hours a day compared to employees working 7-8 hours a day, when adjusted for socio-demographic factors at baseline. Further adjustment for chronic physical disease, smoking, alcohol use, job strain and work-related social support had little effect on this association (odds ratio 2.52; 95% confidence interval 1.12 to 5.65). Data from middle-aged civil servants suggest that working long hours of overtime may predispose to major depressive episodes.

BackgroundSocial support is associated with better health. However, only a limited number of studies have examined the association of social support with health from the adult life course perspective and whether this association is bidirectional.MethodsParticipants (n=6797; 30% women; age range from 40 to 77 years) who were followed from 1989 (phase 2) to 2006 (phase 8) were selected from the ongoing Whitehall II Study. Structural and functional social support was measured at follow-up phases 2, 5 and 7. Mental and physical health was measured at five consecutive follow-up phases (3–8).ResultsSocial support predicted better mental health, and certain functional aspects of social support, such as higher practical support and higher levels of negative aspects in social relationships, predicted poorer physical health. The association between negative aspects of close relationships and physical health was found to strengthen over the adult life course. In women, the association between marital status and mental health weakened until the age of approximately 60 years. Better mental and physical health was associated with higher future social support.ConclusionsThe strength of the association between social support and health may vary over the adult life course. The association with health seems to be bidirectional.

Governments need to increase the proportion of the population in work in most developed countries because of ageing populations. We investigated longitudinally how self-perceived health is affected by work and retirement in older workers. We examined trajectories of self-rated health in 14 714 employees (11 581 [79%] men) from the French national gas and electricity company, the GAZEL cohort, for up to 7 years before and 7 years after retirement, with yearly measurements from 1989 to 2007. We analysed data by use of repeated-measures logistic regression with generalised estimating equations. Overall, suboptimum health increased with age. However, between the year before retirement and the year after, the estimated prevalence of suboptimum health fell from 19·2% (95% CI 18·5–19·9) to 14·3% (13·7–14·9), corresponding to a gain in health of 8–10 years. We noted this retirement-related improvement in men (odds ratio 0·68, 95% CI 0·64–0·73) and women (0·74, 0·67–0·83), and across occupational grades (low 0·72, 0·63–0·82; high 0·70, 0·63–0·77), and it was maintained throughout the 7 years after retirement. A poor work environment and health complaints before retirement were associated with a steeper yearly increase in the prevalence of suboptimum health while still in work, and a greater retirement-related improvement; however, people with a combination of high occupational grade, low demands, and high satisfaction at work showed no such retirement-related improvement. These findings suggest that the burden of ill-health, in terms of perceived health problems, is substantially relieved by retirement for all groups of workers apart from those with ideal working conditions, and that working life for older workers needs to be redesigned to achieve higher labour-market participation. Swedish Council for Working Life and Social Research, Academy of Finland, INSERM (France), BUPA Foundation (UK), European Science Foundation, and Economic and Social Research Council (UK).

Studies of diet and depression have focused primarily on individual nutrients. To examine the association between dietary patterns and depression using an overall diet approach. Analyses were carried on data from 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: 'whole food' (heavily loaded by vegetables, fruits and fish) and 'processed food' (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). Self-reported depression was assessed 5 years later using the Center for Epidemiologic Studies - Depression (CES-D) scale. After adjusting for potential confounders, participants in the highest tertile of the whole food pattern had lower odds of CES-D depression (OR = 0.74, 95% CI 0.56-0.99) than those in the lowest tertile. In contrast, high consumption of processed food was associated with an increased odds of CES-D depression (OR = 1.58, 95% CI 1.11-2.23). In middle-aged participants, a processed food dietary pattern is a risk factor for CES-D depression 5 years later, whereas a whole food pattern is protective.

Job strain is associated with an increased coronary heart disease risk, but few large-scale studies have examined the relationship of this psychosocial characteristic with the biological risk factors that potentially mediate the job strain - heart disease association. We pooled cross-sectional, individual-level data from eight studies comprising 47,045 participants to investigate the association between job strain and the following cardiovascular disease risk factors: diabetes, blood pressure, pulse pressure, lipid fractions, smoking, alcohol consumption, physical inactivity, obesity, and overall cardiovascular disease risk as indexed by the Framingham Risk Score. In age-, sex-, and socioeconomic status-adjusted analyses, compared to those without job strain, people with job strain were more likely to have diabetes (odds ratio 1.29; 95% CI: 1.11-1.51), to smoke (1.14; 1.08-1.20), to be physically inactive (1.34; 1.26-1.41), and to be obese (1.12; 1.04-1.20). The association between job strain and elevated Framingham risk score (1.13; 1.03-1.25) was attributable to the higher prevalence of diabetes, smoking and physical inactivity among those reporting job strain. In this meta-analysis of work-related stress and cardiovascular disease risk factors, job strain was linked to adverse lifestyle and diabetes. No association was observed between job strain, clinic blood pressure or blood lipids.

Little is known about the effect of retirement on alcohol consumption. The objectives were to examine changes in alcohol consumption following retirement, and whether these patterns differ by gender and socioeconomic status. We assessed alcohol consumption annually from 5 years before to 5 years after retirement among 10,023 men and 2,361 women of the French Gazel study. Data were analyzed separately for men and women, using repeated-measures logistic regression analysis with generalized estimating equations. Five years prior to retirement, the prevalence of heavy drinking was about 16% among men, and not patterned by socioeconomic status. Among women, this prevalence was 19.5% in managers, 14.7% in intermediate occupations, and 12.8% in clerical workers. Around retirement, the estimated prevalence of heavy drinking increased in both sexes. In men, this increase was 3.1 percentage points for managers, 3.2 in intermediate occupations, 4.6 in clerical workers, and 1.3 in manual workers. In women, this increase was 6.6 percentage points among managers, 4.3 in intermediate occupations, and 3.3 among clerical workers. In men the increase around retirement was followed by a decrease over the following four years, not significant among manual workers; among women such a decrease was also observed in the non-managerial occupations. It is difficult to assess the extent to which the results observed in this cohort would hold for other working populations, other conditions of employment, or in other cultural settings. A plausible explanation for the increase in heavy drinking around retirement could be that increased leisure time after retirement provides more opportunities for drinking, and not having to work during the day after may decrease constraints on drinking. Our findings of increased consumption around retirement suggest that information about negative effects of alcohol consumption should be included in pre-retirement planning programs.

The importance of chronic inflammation as a determinant of aging phenotypes may have been underestimated in previous studies that used a single measurement of inflammatory markers. We assessed inflammatory markers twice over a 5-year exposure period to examine the association between chronic inflammation and future aging phenotypes in a large population of men and women. We obtained data for 3044 middle-aged adults (28.2% women) who were participating in the Whitehall II study and had no history of stroke, myocardial infarction or cancer at our study's baseline (1997–1999). Interleukin-6 was measured at baseline and 5 years earlier. Cause-specific mortality, chronic disease and functioning were ascertained from hospital data, register linkage and clinical examinations. We used these data to create 4 aging phenotypes at the 10-year follow-up (2007–2009): successful aging (free of major chronic disease and with optimal physical, mental and cognitive functioning), incident fatal or nonfatal cardiovascular disease, death from noncardiovascular causes and normal aging (all other participants). Of the 3044 participants, 721 (23.7%) met the criteria for successful aging at the 10-year follow-up, 321 (10.6%) had cardiovascular disease events, 147 (4.8%) died from noncardiovascular causes, and the remaining 1855 (60.9%) were included in the normal aging phenotype. After adjustment for potential confounders, having a high interleukin-6 level (> 2.0 ng/L) twice over the 5-year exposure period nearly halved the odds of successful aging at the 10-year follow-up (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.38–0.74) and increased the risk of future cardiovascular events (OR 1.64, 95% CI 1.15–2.33) and noncardiovascular death (OR 2.43, 95% CI 1.58–3.80). Chronic inflammation, as ascertained by repeat measurements, was associated with a range of unhealthy aging phenotypes and a decreased likelihood of successful aging. Our results suggest that assessing long-term chronic inflammation by repeat measurement of interleukin-6 has the potential to guide clinical practice.

How much the successful implementation of the most effective (ie, best-practice) interventions could reduce socioeconomic inequalities of coronary heart disease mortality is not known. We assessed this issue in an occupational cohort study comparing low with high socioeconomic groups. We undertook a prospective cohort study on 17 186 male civil servants aged 40–69 years between 1967 and 1970 in the UK (the Whitehall study). Socioeconomic position was based on employment grade. We compared the potential reduction in excess coronary heart disease mortality in men of low with those of high socioeconomic position with either best-practice interventions (reduction of systolic blood pressure by 10 mm Hg, of total cholesterol by 2 mmol/L, and of blood glucose by 1 mmol/L in pre-diabetic people; halving the prevalence of non-insulin-dependent diabetes; and complete cessation of cigarette smoking) or primordial prevention. 15-year absolute risk of death due to coronary heart disease per 100 men, standardised to age 55 years, was 11·0 for men in the low employment grade group and 7·5 for those in the high grade group. Population-wide best-practice interventions would reduce coronary heart disease mortality by 57%, and the difference in mortality between socioeconomic groups by 69%. For primordial prevention, the corresponding reductions would be 73% and 86%, respectively. Our results suggest that current best-practice interventions to reduce classic coronary risk factors, if successfully implemented in both high and low socioeconomic groups, could eliminate most of the socioeconomic differences in coronary heart disease mortality. Modest further benefits would result if the classic coronary risk factors could be reduced to primordial levels for the whole population. Department of Health and Social Security (UK), Tobacco Research Council (UK), British Heart Foundation (UK), Medical Research Council (UK), European Science Foundation (EU), Wellcome Trust (UK), and Academy of Finland (Finland).

Abstract Objective To examine the association between sickness absence and mortality compared with associations between established health indicators and mortality. Design Prospective cohort study. Medical examination and questionnaire survey conducted in 1985-8; sickness absence records covered the period 1985-98. Setting 20 civil service departments in London. Participants 6895 male and 3413 female civil servants aged 35-55 years. Main outcome measure All cause mortality until the end of 1999. Results After adjustment for age and grade, men and women who had more than five medically certified absences (spells > 7 days) per 10 years had a mortality 4.8 (95% confidence interval 3.3 to 6.9) and 2.7 (1.5 to 4.9) times greater than those with no such absence. Poor self rated health, presence of longstanding illness, and a measure of common clinical conditions comprising diabetes, diagnosed heart disease, abnormalities on electrocardiogram, hypertension, and respiratory illness were all associated with mortality—relative rates between 1.3 and 1.9. In a multivariate model including all the above health indicators and additional health risk factors, medically certified sickness absence remained a significant predictor of mortality. No linear association existed between self certified absence (spells 1-7 days) and mortality, but the findings suggest that a small amount of self certified absence is protective. Conclusion Evidence linking sickness absence to mortality indicates that routinely collected sickness absence data could be used as a global measure of health differentials between employees. However, such approaches should focus on medically certified (or long term) absences rather than self certified absences.