Press releases Monday 9 November to Friday 13 November 2009

Please remember to credit the BMJas source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

(1) Income inequality could cause 1.5 million deaths in developed countries
(2) Slow walkers at increased risk of cardiovascular death
(3) Government's NHS Plan linked to striking improvements in critical care
(4) Quarter of a million children in England at risk of skin cancer from sunbeds
(5) Enjoying school key to tackling teenage pregnancy

(1) Income inequality could cause 1.5 million deaths in developed countries
(Research: Income inequality, mortality and self-rated health: meta-analysis of multilevel studies)
http://www.bmj.com/cgi/doi/10.1136/bmj.b4260
(Editorial: Greater equality and better health)
http://www.bmj.com/cgi/doi/10.1136/bmj.b4488

If the gap between the richest and poorest people in developed countries was reduced, 1.5 million deaths could be prevented, say researchers in a study published on bmj.com today.

While numerous studies have already investigated the link between income inequality, health and premature death, they have reached different conclusions, say the researchers from the University of Yamanashi in Japan and Harvard School of Public Health in the USA.

They explain that even a modest association between economic inequality and health "can amount to a considerable population burden." They add that more than three quarters of countries belonging to the Organisation for Economic Co-operation and Development (OECD) have experienced an increasing gap between the rich and poor in the last two decades.

The authors analysed almost 60 million subjects who took part in previous studies. The findings demonstrate that people living in regions with high income inequality are more likely to die younger, regardless of their income, socio-economic status, age and gender. They argue that while "the results suggest a modest adverse effect of income inequality on health, this impact might be larger if the association is truly causal."

They conclude that the results have important policy implications because "income inequality is an exposure that applies to society as a whole." And add that around 1.5 million deaths could be averted in 30 OECD countries by reducing the gap between rich and poor.

In the accompanying editorial, Professors Kate Pickett and Richard Wilkinson, from the Universities of York and Nottingham, agree that the issue had remained controversial despite 200 peer-reviewed studies examining links between income inequality and health. They argue that perhaps this is because of the "deep political implications of a causal relation between better health of the population and narrower differences between incomes."

Pickett and Wilkinson call on governments to stop paying lip service to creating a "classless society" and focus on "undoing the widening of inequalities that has taken place since the 1970s." They conclude that "the benefits of greater equality tend to be largest among the poor but seem to extend to almost everyone" and that "a more equal society might improve most people's quality of life."

Contacts:

Research: Naoki Kondo, Assistant Professor, Department of Health Sciences, University of Yamanashi, Japan Tel: +81 55 273 9569 (direct) or +81 55 273 9566 (department office)
Email: nkondo@yamanashi.ac.jp
or
Ichiro Kawachi and Professor S V Subramanian, Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, USA
Email: ikawachi@hsph.harvard.edu

Editorial: Professor Kate Pickett, Professor of Epidemiology, Department of Health Sciences, University of York, UK
Email: kp6@york.ac.uk

Older people who walk slowly are three times more likely to die from cardiovascular disease than those who walk faster, finds new research published on bmj.com today.

These findings highlight the vital role of fitness in preserving life and function in older age, say the authors.

Previous studies have shown that low walking speed can predict adverse health related events, including death. However, it is not known whether specific causes of death account for this increased mortality.

So a team of researchers from France investigated the relationship between low walking speed and the risk of death in older people, both overall and with regard to the main underlying causes of death (defined as cancer, cardiovascular, and other causes such as infectious diseases or respiratory failure).

Their findings are based on the five year monitoring of 3,208 men and women living in the community, aged 65 to 85 years, as part of the Three City Study in France.

At the start of the study, demographic and medical information was obtained and participants were asked to perform a walking test over six metres. A speed camera was used to take an automated measure of walking speed.

Follow-up examinations were performed at regular intervals over five years and risk of death was calculated according to thirds of walking speed - lowest, middle, and highest.

After adjusting for several baseline characteristics, individuals in the lowest third of walking speed at the start of the study had a 44% increased risk of death compared to those in the upper thirds.

Similarly, participants in the lowest third of walking speed had a three times increased risk of cardiovascular death than those who walked faster. This increased risk of cardiovascular death was seen in both men and women, in younger as well as in older individuals, and in participants with low or usual physical activity.

Interestingly, no relationship between walking speed and death from cancer was found.

The authors conclude: "These findings show that assessment of motor performances in older people using simple measures such as walking speed can be performed easily and that the role of fitness in preserving life and function in older age is important."

An accompanying editorial supports these findings and suggests that walking speed may also help predict future frailty in older people.

Contacts:

Research: Alexis Elbaz, Epidemiologist, Inserm, Unit 708, and UPMC University, Paris, France.
Email: alexis.elbaz@upmc.fr

Editorial: Rowan Harwood, professor of Geriatric Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
Email: Rowan.harwood@nuh.nhs.uk

Survival among patients in intensive care units in England has improved significantly since the implementation of the NHS Plan in 2000, finds new research published on bmj.com today.

Changes under the NHS Plan included increased funding for additional beds, the introduction of critical care outreach services in hospitals, the adoption of clinical guidelines, and the establishment of regional networks of hospitals to enhance cooperation.

Yet there have been conflicting claims as to the impact of these developments on the outcome and the processes of care. So researchers at the London School of Hygiene & Tropical Medicine and the Intensive Care National Audit & Research Centre set out to evaluate the impact and cost effectiveness of these interventions on a national scale.

They compared data for 1998-2000 with 2000-2006, before and after the changes began, covering nearly 350,000 admissions to 96 critical care units across England.

They found that the annual expenditure on critical care increased in real terms from £700m (1999-2000) to £1bn (2005-6). This was associated with major improvements in care between 2000 and 2006 including a 13.4% decline in hospital mortality, 11% fewer patients needing to be transferred between intensive care units each year, and a significant reduction in the number of patients having to be discharged from units at night to make way for other patients.

The cost effectiveness of critical care also increased after 2000, partly as a result of the improvements in outcome and partly because of smaller increases in the mean length of stay, say the authors.

Collectively these changes represent a highly cost effective use of NHS resources, they conclude.

While it is unclear how much each innovation contributed to the dramatic improvements in outcomes, the authors believe that the government's considerable additional expenditure on critical care since 2000, combined with the modernisation of NHS services led by clinicians and managers, has greatly improved the survival chances of patients.

This study also demonstrates the need for taking improvements in patients' outcomes into account when judging the impact of additional NHS funds, they add. If assessment of efficiency or productivity relies entirely on the number of patients treated and fails to take into account improvements in outcome, then the true gains in productivity will be seriously underestimated.

Contacts:

Andrew Hutchings, Lecturer, Health Services Research Unit, London School of Hygiene & Tropical Medicine, London, UK
Email: andrew.hutchings@lshtm.ac.uk
Nick Black, Professor, Health Services Research Unit, London School of Hygiene & Tropical Medicine, London, UK
Email: nick.black@lshtm.ac.uk

An estimated quarter of a million 11-17 year olds in England are being put at increased risk of developing malignant melanoma by using sunbeds, warn researchers in a letter to this week's BMJ.

Catherine Thomson from Cancer Research UK and Professor Chris Twelves from Leeds Institute of Molecular Medicine & St James's University Hospital in Leeds, say that sunbeds raise serious issues, and they call for urgent legislation to stop children in England using sunbeds, as is already in place in Scotland and proposed for Wales.

They point to two studies, recently carried out by Cancer Research UK involving over 9000 children aged 11-17 in England.

The first, a national prevalence study of 3101 children, established that 6% of 11-17 year olds had used a sunbed, the average age of first use being just 14. Sunbed use was more common in older children and girls, in the north (11%) compared with the rest of England (4%) and among deprived communities. More than a quarter (26.5%) said that they used a sunbed at least once a month.

In the second study of 6209 children in six cities, sunbed use was highest in Liverpool and Sunderland, reaching 51% and 48% respectively among 15-17 year old girls, with over 40% using them weekly.

Supervision of sunbed use was poor. Nationally, of those children who used sunbeds, 23.2% did so at home. The remaining three quarters had used tanning/beauty salons or gym/leisure centres, where more than one in five (21.8%) had been unsupervised. Only 11.4% of children who were supervised were warned of possible harms.

This rate of sunbed use would lead to more than an estimated quarter of a million 11-17 year olds being put at increased risk of developing malignant melanoma, say the authors.

National legislation to limit access to sunbed salons to those over 18, and close down unsupervised or coin operated salons, is required to stop more children being put at unnecessary risk of developing skin cancer, they conclude.

Contacts:

Sally Staples, Press Office, Cancer Research UK, London, UK
Email: Sally.Staples@cancer.org.uk

An estimated quarter of a million 11-17 year olds in England are being put at increased risk of developing malignant melanoma by using sunbeds, warn researchers in a letter to this week's BMJ.

Catherine Thomson from Cancer Research UK and Professor Chris Twelves from Leeds Institute of Molecular Medicine & St James's University Hospital in Leeds, say that sunbeds raise serious issues, and they call for urgent legislation to stop children in England using sunbeds, as is already in place in Scotland and proposed for Wales.

They point to two studies, recently carried out by Cancer Research UK involving over 9000 children aged 11-17 in England.

The first, a national prevalence study of 3101 children, established that 6% of 11-17 year olds had used a sunbed, the average age of first use being just 14. Sunbed use was more common in older children and girls, in the north (11%) compared with the rest of England (4%) and among deprived communities. More than a quarter (26.5%) said that they used a sunbed at least once a month.

In the second study of 6209 children in six cities, sunbed use was highest in Liverpool and Sunderland, reaching 51% and 48% respectively among 15-17 year old girls, with over 40% using them weekly.

Supervision of sunbed use was poor. Nationally, of those children who used sunbeds, 23.2% did so at home. The remaining three quarters had used tanning/beauty salons or gym/leisure centres, where more than one in five (21.8%) had been unsupervised. Only 11.4% of children who were supervised were warned of possible harms.

This rate of sunbed use would lead to more than an estimated quarter of a million 11-17 year olds being put at increased risk of developing malignant melanoma, say the authors.

National legislation to limit access to sunbed salons to those over 18, and close down unsupervised or coin operated salons, is required to stop more children being put at unnecessary risk of developing skin cancer, they conclude.

Contacts:

Sally Staples, Press Office, Cancer Research UK, London, UK
Email: Sally.Staples@cancer.org.uk

Youth development programmes that tackle deprivation and help children and young people enjoy school are successful in reducing teenage pregnancy rates, say researchers on bmj.com today.

UK teenage pregnancy rates are the highest in Western Europe and there is widespread concern that policies to reduce teenage pregnancies are not working, say the authors.

A recent evaluation of the Young People's Development Programme (YPDP) concluded that it had failed to reduce teenage pregnancies, indeed more women in the YPDP got pregnant than in other programmes.

But lead author, Professor Angela Harden from the University of East London, argues that perhaps the YPDP failed because it targeted and therefore stigmatised ‘high risk' young people and ultimately brought them together.

The YPDP kept young people out of mainstream schools and worked with them in alternative educational settings, but the programmes reviewed by Professor Harden and colleagues focused on after school and community projects.

Their research shows that projects that tackle social disadvantage and aim to improve school experiences and raise expectations for young people, are successful.

The authors evaluated ten trials and five qualitative studies that focused on early childhood interventions or youth development programmes. Teenage pregnancy rates were almost 40% lower in groups that participated in youth programmes compared to those who did not.

The main themes that emerged from the qualitative studies were that dislike of school, poverty, unhappy childhoods and low expectations for the future were all linked to early pregnancy.

The authors conclude that "young people who have grown up unhappy, in poor material circumstances, do not enjoy school, and are despondent about their future may be more likely to take risks when having sex or to choose to have a baby."

They argue that policies aimed at tackling these issues, combined with high quality sex education and contraceptive services, are successful in lowering teenage pregnancy rates.

They say the results "provide a small, but reliable, evidence base that early childhood and youth development programmes are effective and appropriate strategies for reducing unintended teenage pregnancy rates. Our findings on the effects of early childhood interventions highlight the importance of investing in early care and support in order to reduce the socioeconomic disadvantage associated with teenage pregnancy later in life."

Contacts:

Professor Angela Harden, Professor of Community and Family Health, Institute of Health and Human Development, University of East London, UK
Email: a.harden@uel.ac.uk

FOR ACCREDITED JOURNALISTS

For more information please contact:

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

Press Office telephone : 020 7383 6254 (Weekdays : 0900hrs - 1800hrs)
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