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This study was designed to investigate the relationship between a systematic inflammatory biomarker measure, concurrent and later cognitive performance, and future dementia risk. The literature has reported the potential involvement of inflammation in cognitive performance as well as Alzheimer’s Disease, but not consistently. We used a population-based cohort of 500,000 people in the UK and assessed the association between a composite inflammatory biomarker and cognitive performance measures across five domains measured concurrently and 4–13 years later, taking advantage of the large sample size. We also assessed the same biomarker’s association with dementia diagnosis 3–11 years later in the initially dementia-free sample. We report small but significant associations between elevated biomarker levels and worsened cognitive performance at baseline for four cognitive tasks (OR = 1.204, p<0.001 for Prospective memory, β = -0.366, p<0.001 for Fluid intelligence, β = 8.819, p<0.001 for Reaction time, and β = -0.224, p<0.001 for Numeric memory), comparing the highest quartile of the biomarker to the lowest. We also found that for one measure (Pairs matching) higher biomarker levels were associated with fewer errors, i . e . better performance (β = -0.096, p<0.001). We also report that the 4 th quartiles of the baseline biomarker levels were significantly associated with cognitive task scores assessed years later on the p< = 0.002 level, except for the Pair matching test, for which none of the quartiles remained a significant predictor. Finally, the highest biomarker quartile was significantly associated with increased dementia risk compared to the lowest quartile (HR = 1.349, p<0.001). A case-only analysis to assess disease subtype heterogeneity suggested probable differences in the association with the highest biomarker quartile between vascular dementia and Alzheimer disease subtypes (OR = 1.483, p = 0.055). Our results indicate that systemic inflammation may play a small but significant part in dementia pathophysiology, especially in vascular dementia.

ObjectivesIn the absence of robust direct data on ethnic inequalities in COVID-19-related mortality in the UK, we examine the relationship between ethnic composition of an area and rate of mortality in the area.DesignEcological analysis of COVID-19-related mortality rates occurring by 24 April 2020 and ethnic composition of the population. Account is taken of age, population density, area deprivation and pollution.SettingLocal authorities in England.ResultsFor every 1% rise in proportion of the population who are ethnic minority, COVID-19-related deaths increased by 5·12, 95% CI (4·00 to 6·24), per million. This rise is present for each ethnic minority category examined, including the white minority group. The size of this increase is a little reduced in an adjusted model to 4·42, 95% CI (2·24 to 6·60), suggesting that some of the association results from ethnic minority people living in more densely populated, more polluted and more deprived areas.This estimate suggests that the average England COVID-19-related death rate would rise by 25% in a local authority with two times the average number of ethnic minority people.ConclusionsWe find clear evidence that rates of COVID-19-related mortality within a local authority increases as the proportion of the population who are ethnic minority increases. We suggest that this is a consequence of social and economic inequalities driven by entrenched structural and institutional racism and racial discrimination. We argue that these factors should be central to any investigation of ethnic inequalities in COVID-19 outcomes.

Background The level of frailty in the older population across age cohorts and how this changes is a factor in determining future care costs and may also influence the extent of socioeconomic and gender inequalities in frailty. Methods We model cohort-specific trajectories in frailty among the community dwelling population older than 50 years, using five waves (2002–2010) of the English Longitudinal Study of Ageing. We stratify our analysis by wealth and gender and use a frailty index, based on accumulation of ‘deficits’. Results For males and females between the ages of 50 and 70 in 2002, frailty trajectories for adjacent age cohorts converge. However, levels of frailty are higher in recent compared with earlier cohorts at the older ages (for cohorts aged over 70 in 2002). These cohort differences are largest in the poorest wealth group, while for the most affluent, frailty trajectories overlap across all adjacent cohorts suggesting no change across cohorts. Conclusions A key driver of the cohort differences in frailty that we observe is likely to be increased survival of frail individuals. Importantly, this paper illustrates that the social conditions experienced across the wealth distribution impacts on the rate of deficit accumulation in older populations. Our results on trajectories of frailty between 2002 and 2010 are pessimistic and, in the context of rising life expectancies, suggest that poorer older people in particular spend additional years of life in a frail state.

Differences in health across ethnic groups have been documented in the United States and the United Kingdom. The extent to which socioeconomic inequalities underlie such differences remains contested, with many instead focusing on cultural or genetic explanations. In both the United States and the United Kingdom, data limitations have greatly hampered investigations of ethnic inequalities in health. Perhaps foremost of these is the inadequate measurement of ethnicity, but also important is the lack of good data on socioeconomic position, particularly data that address life-course issues. Other elements of social disadvantage, particularly experiences of racism, are also neglected. The author reviews existing evidence and presents new evidence to suggest that social and economic inequalities, underpinned by racism, are fundamental causes of ethnic inequalities in health.

Population ageing and air pollution have emerged as two of the most pressing challenges in China. However, little evidence has explored the impact of air pollution on obesity among older adults in China. The China Health and Retirement Longitudinal Study-a nationally representative sample of middle-aged and older Chinese was linked to the air pollution data at the city level. Multilevel logistic models were fitted on obesity status among older people in relation to different air quality measures such as chronic exposures to severities of air pollution and pollutants. Air pollution was positively associated with increased risks of general obesity and abdominal obesity among older adults (N = 4,364) especially for those with disability. The marginal effects of average air quality index (AQI) on obesity suggest that one standard deviation increase in AQI is associated with increased risks of central obesity by 2.8% (95%CI 1.7% 3.9%) and abdominal obesity by 6.2% (95%CI 4.4% 8.0%). The risk of chronic exposures to light (and moderate), heavy and severe pollution on obesity elevated in a graded fashion in line with the level of pollution. Durations of exposure to PM2.5 and PM10 were significantly associated with increased risk of obesity among older people in China. Chronic exposures to severe air pollution and certain pollutants such as PM2.5 and PM10 raise the risk of obesity among older people in China and the relationships were stronger for those with disability. Future policies that target these factors might provide a promising way of enhancing the physical health of older people.

Background As part of a national programme to tackle ethnic inequalities, we conducted a systematic review and meta-analysis of research on ethnic inequalities in pathways to care for adults with psychosis living in England and/or Wales. Methods Nine databases were searched from inception to 03.07.17 for previous systematic reviews, including forward and backward citation tracking and a PROSPERO search to identify ongoing reviews. We then carried forward relevant primary studies from included reviews (with the latest meta-analyses reporting on research up to 2012), supplemented by a search on 18.10.17 in MEDLINE, Embase, PsycINFO and CINAHL for primary studies between 2012 and 2017 that had not been covered by previous meta-analyses. Results Forty studies, all conducted in England, were included for our updated meta-analyses on pathways to care. Relative to the White reference group, elevated rates of civil detentions were found for Black Caribbean (OR = 3.43, 95% CI = 2.68 to 4.40, n  = 18), Black African (OR = 3.11, 95% CI = 2.40 to 4.02, n  = 6), and South Asian patients (OR = 1.50, 95% CI 1.07 to 2.12, n  = 10). Analyses of each Mental Health Act section revealed significantly higher rates for Black people under (civil) Section 2 (OR = 1.53, 95% CI = 1.11 to 2.11, n  = 3). Rates in repeat admissions were significantly higher than in first admission for South Asian patients (between-group difference p  < 0.01). Some ethnic groups had more police contact (Black African OR = 3.60, 95% CI = 2.15 to 6.05, n  = 2; Black Caribbean OR = 2.64, 95% CI = 1.88 to 3.72, n  = 8) and criminal justice system involvement (Black Caribbean OR = 2.76, 95% CI = 2.02 to 3.78, n  = 5; Black African OR = 1.92, 95% CI = 1.32 to 2.78, n  = 3). The White Other patients also showed greater police and criminal justice system involvement than White British patients (OR = 1.49, 95% CI = 1.03 to 2.15, n  = 4). General practitioner involvement was less likely for Black than the White reference group. No significant variations over time were found across all the main outcomes. Conclusions Our updated meta-analyses reveal persisting but not significantly worsening patterns of ethnic inequalities in pathways to psychiatric care, particularly affecting Black groups. This provides a comprehensive evidence base from which to inform policy and practice amidst a prospective Mental Health Act reform. Trial registration CRD42017071663

Although migration is almost always a family decision, the couple's perspective is overlooked in the study of migration and health. In China, family migration patterns have diversified and become more complex, making it vital to understand the consequences of this trend on well-being. This study aims to investigate: (1) the common migration patterns among Chinese couples; (2) the association between couple migration patterns and the mental health of men and women in later life. Using unique couple-level life history data, this study employs multichannel sequence analysis to identify typical couple migration patterns, and seemingly unrelated regressions to examine the couple migration-mental health nexus. The results show that wives who reunite with their migrant husbands at the destinations have fewer depressive symptoms in later life than left-behind wives whose husbands migrate alone for a short term or a long term. However, no substantial group differences in depressive symptoms were found between migration groups among men. Wives possessing an independent bank account can partly explain the gender differences in later-life depression. The findings imply that a family-oriented migration policy is vital to improve the well-being of both migrants and their family members who are left behind.

Purpose To explore country-specific influences on the determinants of two forms of subjective well-being (life satisfaction and quality of life) among older adults in England and the USA. Methods Harmonised data from two nationally representative panel studies of individuals aged 50 and over, the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), are used. Linear regression models are fitted separately for life satisfaction and quality of life scales using cross-sectional samples in 2004. The ELSA sample was 6,733, and the HRS sample was 2,300. Standardised coefficients are reported to determine the country-specific importance of explanatory variables, and predicted values are shown to highlight the relative importance of statistically significant country-level interaction effects. Results Having a disability, been diagnosed with a chronic conditions or having low household wealth are strongly associated with poorer life satisfaction and quality of life. These statistical effects are consistent in England and the USA. The association of years spent in education, however, varied between the two countries: educational inequalities have a greater adverse effect on subjective well-being in the USA compared with England. Conclusion Interventions are required to counterbalance health and socioeconomic inequalities that restrict sections of the population from enjoying satisfying and meaningful lives in older age. The differential association between education and well-being in England and the USA suggests that the provision of welfare benefits and state-funded public services in England may go some way to protect against the subsequent adverse effect of lower socioeconomic status on subjective well-being.

This study uses data from consecutive England and Wales censuses to examine the intragenerational economic mobility of individuals with different ethnicities, religions and genders between 1971 and 2011, over time and across cohorts. The findings suggest more downward and less upward mobility among Black Caribbean, Indian Sikh and Muslim people with Bangladeshi, Indian and Pakistani ethnicities, relative to white British groups, and more positive relative progress among Indian Hindu people, but also some variation in the experiences of social mobility between individuals even in the same ethnic groups. For some groups, those becoming adults or migrating to the UK since 1971 occupy an improved position compared with older or longer resident people, but this is not universal. Findings suggest that these persistent inequalities will only be effectively addressed with attention to the structural factors which disadvantage particular ethnic and religious groups, and the specific ways in which these affect women.

The concept of frailty has been used in the clinical and research field for more than two decades. It is usually described as a clinical state of heightened vulnerability to poor resolution of homeostasis after a stressor event, which thereby increases the risk of adverse outcomes, including falls, delirium, disability and mortality. Here we report the results of the first genome-wide association scan and comparative gene ontology analyses where we aimed to identify genes and pathways associated with the deficit model of frailty. We used a discovery-replication design with two independent, nationally representative samples of older adults. The square-root transformed Frailty Index (FI) was the outcome variable, and age and sex were included as covariates. We report one hit exceeding genome-wide significance: the rs6765037 A allele was significantly associated with a decrease in the square-root transformed FI score in the Discovery sample (beta = -0.01958, p = 2.14E-08), without confirmation in the Replication sample. We also report a nominal replication: the rs7134291 A allele was significantly associated with a decrease in the square-root transformed FI score (Discovery sample: beta = -0.01021, p = 1.85E-06, Replication sample: beta = -0.005013, p = 0.03433). These hits represent the KBTBD12 and the GRIN2B genes, respectively. Comparative gene ontology analysis identified the pathways 'Neuropathic pain signalling in dorsal horn neurons' and the 'GPCR-Mediated Nutrient Sensing in Enteroendocrine Cells', exceeding the p = 0.01 significance in both samples, although this result does not survive correction for multiple testing. Considering the crucial role of GRIN2B in brain development, synaptic plasticity and cognition, this gene appears to be a potential candidate to play a role in frailty. In conclusion, we conducted genome-wide association scan and pathway analyses and have identified genes and pathways with potential roles in frailty. However, frailty is a complex condition. Therefore, further research is required to confirm our results and more thoroughly identify relevant biological mechanisms.