MRC National Survey of Health and Development: an update

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MRC National Survey of Health and Development an
update Diana Kuh LHA data collection
teams Director, MRC National Survey of Health and
Development MRC Unit for Lifelong Health and
Ageing Longview, Oxford, October 2nd 2008
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MRC NSHD Review 2005-2008 NSHD has a research
and resource function

• Sept 2005 Review of NSHD
• 2005- 2006 Search for new Director.
• Sept 2006 DK appointed. MRC agrees to set up
  new Unit
• Jan 2007 Mike Wadsworth ? Diana Kuh
• May 2007 Submission of 5-year strategic
  scientific plans
• Nov 2007 HSPHRB Board approve funding of Unit
  clinic data collection
• Jan 2008 MRC Unit for Lifelong Health and
  Ageing

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MRC Unit for Lifelong Health Ageing

• Mission To develop the MRC National Survey of
  Health Development into a world class,
  interdisciplinary life course study of ageing

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Maximising the scientific potential of NSHD

• Scientific discovery of life course influences on
  normal and healthy ageing
• Physical and cognitive capability the capacity
  to undertake the physical and mental tasks of
  daily living
• Musculoskeletal and cardiovascular function on
  which capability depends
• New initiatives on which the scientific plans
  depend
• Enriching the NSHD clinic data collection
  2008-2010
• Expanding collaborations capacity building
• More inter-cohort research secured additional
  funding
• Facilitate genetic studies of lifelong health and
  ageing
• New DNA repository 2008 ?
• Develop e-science capability to facilitate data
  sharing
• Governance arrangements

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Seven interdisciplinary integrated NSHD
scientific programmes

• Physical capability musculoskeletal ageing
• Cognitive capability ageing
• Cardiovascular ageing
• Mental health wellbeing
• Growth, functional trajectories
• Lifetime lifestyles social environment
• Nutrition through the life course

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19 follow ups 1948-1977 (2-31 years)
MRC Unit for the Study of EnvironmentalFactors
in Mental PhysicaI Illness established 1962

• Heights weights at 2,4,6,7,11,15, 26y
• Cognitive development assessed at 8,11,15y
  educational achievement
• Diet Breastfeeding , weaning, 24 hr recall at 2y
• Developmental milestones, physical co-ordination
• Behaviour temperament
• Mortality, hospital admissions, reported health
• Marital, fertility histories work histories
• Social physical environment at all contacts
• Study of offspring children 4 8 y

• Dr James Douglas
• Key texts
• Children under five 1958
• The home and the school 1964
• All our future 1968

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NSHD follow ups since 1982focus on life course
social biological risks for adult health
function and age related change

• Blood pressure, lung function, body size, mental
  health at 36,43,53y
• Cognitive performance at 43 53 years
• Verbal memory, search speed concentration,
  general ability
• Physical performance at 53y
• Grip strength, balance, chair rises
• Age at menopause 47-53,57y
• Blood samples at 53 y for DNA cell lines,
  HbA1c, lipids
• Mortality cancer registrations, hospital
  admissions, health
• Diet, lifestyle, life circumstances

• Professor Mike Wadsworth

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Clinic data collection 60-64 yrsFeasibility
study 2006-2007Main study 2008-2010

• Repeat measures of function, body size, life
  circumstances
• Cardiac vascular structure function
• Musculoskeletal function
• Fasting blood overnight urine samples (energy
  metabolism, kidney function, Inflammation,
  oxidative stress, bone resorption formation,
  neuro-endocrine function)

Manchester clinical research facility
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NSHD clinic data collection Clinical Research
Facilities
Cardiff
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Summary of clinic data collection
Postal questionnaire (80 response to date)
Send out clinic invitation (CRF)
Pre-assessment questionnaire Pre-assessment
questionnaire Clinic visit Home
visit (gt60 in Manchester)
(additional 20)

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NSHD new clinic data collection
questionnaire-based data and performance tests

• Household size
• Housing tenure
• Own/partner SEP
• Work status retirement
• Household income sources
• Financial hardship
• Marital fertility histories
• Spare time activities
• Social networks life events
• Caring for others
• Smoking drinking habits
• Exercise assessment (EPAC2)
• Edinburgh wellbeing Q
• Neighbourhood satisfaction
• Life satisfaction

• SF36
• Self reported health problems CVD events, signs
  symptoms (incl. Rose angina)
• Bronchitis questionnaire
• Fracture history
• Medication
• Hospital admissions
• Close persons questionnaire
• GHQ28
• Anthropometry
• ADLs
• Grip strength, chair rises, balance stand, timed
  get up go
• Reaction time, word list memory, visual search
• Spirometry

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NSHD clinic data collectioncardiac vascular
measuresProfessor John Deanfield Dr Denis
Pellerin, UCL

• Cardiac measures include
• Global LV diastolic function
• Global systolic function
• LV Measurements
• Proximal aorta measurements
• Vascular measures include
• Carotid-femoral pulse wave velocity (arterial
  stiffness)
• Radial pulse wave analysis (indirect measure of
  arterial stiffness)
• Carotid distensibility (local measure of arterial
  compliance)
• Carotid Intima-Media Thickness (IMT) (local
  measures of vessel wall)

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NSHD clinic data collection other CVD measures

• ECG (Professor Peter MacFarlane, Glasgow
  University)
• Heart rate variability beat to beat alterations
  in heart rate - indicator of autonomic regulation
  of circulatory function (Professor Peter Friberg,
  Gothenburg University)
• Blood pressure 4th repeated measure since 36
  years
• Step test (sub-maximal) MRC Epidemiology Unit,
  Cambridge
• Free living activity (over 5 days)

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NSHD clinic data collection bone
measuresProfessor Judith Adams, Manchester
University

• Bone measures include
• DXA hip
• total, femoral neck, trochanter, Wards
• Lumbar spine (L1-4)
• Whole body region BMD, fat lean mass
• vertebral fracture assessment
• Aortic calcification score
• pQCT radius
• 4
• 50

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NSHD clinic data collection challenges

• Balance between number of sites and participant
  travel
• Complexity
• Integration of nurses, echotechnicians, bone
  technicians
• Clinically relevant results duty of care
• Increased regulatory environment
• Raised awareness of security issues by
  participants
• Secure transfer of clinical and other data
• Volume of data for checking, co-ordinating with
  core reading labs merging into NSHD data base
• Strategies for maximising the scientific
  investment

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Cardiology/ DXA/ hosp lab
ECG Glasgow
WTCRF
GP practice
Manchester CRF, Imaging Science
Clinic or home visit
MRC HNR MRC Epi
Participants
Postal
MRC NSHD
GOS
Heart hospital
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Flow Chart for processing of NSHD blood urine
samples (Dr Alison Lennox, MRC HNR)
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Expanding collaborations capacity building

• Key collaborators sharing responsibility for NSHD
  programmes data collection
• Externally funded initiatives with collaborators
• NSHD based
• Inter-cohort comparative research
• Genetic studies of lifelong health ageing
• Funding of 3 NIA life course fellowships
• Shared fellowships studentships

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HALCyon Healthy Ageing across the Life Course

• LHA is leading a collaborative programme
• 9 UK cohorts born 1921 to 1958
• 23 investigators, 19 collaborators
• 8 projects
• Aim is to improve the lives of older people by
  understanding how healthy ageing is influenced by
  factors operating across the whole of life.
• Indicators of healthy ageing being studied
  include
• the ability to undertake the physical and
  cognitive tasks of daily living
• social and psychological wellbeing
• genetic and other biological ageing processes.

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HALCyon cohorts
Cohort birth yr Birth Child Early A Mid A Late A
Lothian 1921
Herts 1920-30
Boyd Orr 1925-37
Aberdeen/Lothian 1936
Herts 1931-39
NSHD 1946
NCDS 1958
ELSA/Caerphilly
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FALCon Function Across the Life Course

• Funded by Population Health Sciences Research
  Network
• LHA are leading this project which uses data from
  cohorts based at MRC Units and Centres.
• The aims are

• to develop statistical methods to allow pooling
  of data from several cohorts
• to apply the methodology to model physical,
  cognitive and cardiovascular trajectories across
  the whole of life
• to recommend appropriate measures of function at
  different ages and their timing.

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NSHD E-science initiatives

• Manage and preserve the ever expanding data
  resource
• Existing NSHD data collected over 60 years
  (15,000 variables)
• New clinic and genetic data
• Data from other cohorts for comparative research.
• Facilitate data discovery and use
• Maintain data security and study reputation.
• The new LHA Web Data Access system will
• Integrate the various sources of data, metadata
  and semantic classifications
• Manage data requests and analysis
• Act as an exemplar for the MRC Data Preservation
  and Sharing Initiative.

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LHA/NSHD Organisational Structure
Governance structure
Operational structure
Director Steering Committee
Executive Team Risk
management Cardiac/Vascular
Bone/Muscle Sub-Committee
Project Management Groups UCL
Genetics Advisory Group Samples Access
Advisory Group



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Acknowledgements

• My predecessors
• LHA team
• LHA/NSHD Collaborators
• Lifelong study participants
• Thank you for listening!