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Objective: To provide a direct estimate of the risk of admission to permanent residential aged care among older women while accounting for death, according to housing type and other variables. Methods: A competing risk analysis from 8,867 Australian women born 1921–26, using linked data from the Australian Longitudinal Study on Women's Health (ALSWH), Residential Aged Care (RAC), and the Australian National Death Index. Results: After accounting for deaths, around 35% of women will be admitted to RAC between ages 73 and 90. The conditional cumulative incidence of admission to RAC was 26.9% if living in a house, compared to 36.0% from an apartment, 43.6% within a retirement village, and 37.1% if living in a mobile home. Each one‐year increase in age was associated with a relative 17% increased risk of RAC. Conclusions: Around one‐third of women will enter RAC between age 73 and 90. Living in a house had the lowest risk of entering residential aged care over time. Implications for public health: These findings have important implications for planning for aged care services, including the role of housing in delaying admission to residential aged care, and the need for residential care by a high proportion of women towards the end of life.

Background Falls in older people are a major public health concern. To target falls prevention interventions, screening tools need to be able to identify older people at greater risk of falling. This study aimed to investigate the screening capacity of the Home Falls and Accidents Screening Tool for health professionals (HOME FAST-HP), and to identify the best cut-off score to identify older people at higher risk of falls using the HOME FAST-HP. Methods The study used cross-sectional data from a random sample of 650 women from the 1921 to 1926 cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Selected women were sent a postal survey including the HOME FAST-HP, falls history, and other health factors. Scores on the home fast were calculated and the cut-point for optimal sensitivity and specificity of the HOME FAST-HP in relation to falls was assessed using a Receiver Operating Characteristic curve. Results A total of 567 older women participated (response rate 87%). The mean age of participants was 77.5 yrs (95% CI 77.31-77.70). A total of 153 participants (27%) reported a fall in the previous six months. The mean number of hazards using the HOME FAST-HP was 9.74 (95% CI 9.48-10.01), range 2-22. Non-fallers had a mean of 9.6 hazards (95% CI 9.32-9.91) and fallers had a mean of 10.63 hazards (95% CI 10.08-11.19) which was a significant difference (t = 3.41, P = 0.001). The area under the receiver operator curve (AUC) was 0.58 (95% CI 0.53-0.64). A HOME FAST-HP cut-off score of 9 was associated with the optimal sensitivity for falls (73.9%), with specificity (37.9%), and positive predictive value was 30.6% and negative predictive value was 79.7%. Conclusion The HOME FAST-HP can be used as a screening tool to identify fallers with a cut-off score of nine indicating a higher risk of falling.

This study investigates the long-term impact of English adult migration to Australia by comparing health and wellbeing outcomes in later life of English migrants to their counterparts who remained in England (non-migrants) and to native-born Australians. It traces the influence of selection, adaptation and advantage as three mechanisms that can influence migrant health in later life. The analysis utilises data for a cohort aged 60 to 64 years from the Australian Life Histories and Health (LHH) survey (n=1088), a sub-study of the Australian 45 and Up Study, in combination with a matched cohort from the English Longitudinal Study of Ageing (ELSA) (n=1139). Social rather than health characteristics were found to play a role in the selection of English migrants. English migrants reported higher subjective quality of life than English non-migrants, and better physical health than the Australian-born, but their mental health outcomes did not significantly differ from the other cohorts. The comparatively better later-life outcomes for the English migrants can partly be linked to advantage, as they hold higher prestige jobs than Australian-born at lower levels of education.

Almost one in ten Chinese adults has chronic kidney disease (CKD). However, the link between dietary patterns, dietary cadmium intake and CKD has not been studied in China.Adults (n = 8429) in the China Health and Nutrition Survey who had at least one 3-day 24 h food record in combination with household food inventory in 1991, 1993, 1997, 2000, 2004, 2006, and 2009 and estimated glomerular filtration rate (eGFR) measured in 2009. Dietary pattern was identified using factor analysis. CKD was defined as eGFR60 mL/min/1.73 mThere were 641 (7.6%) cases of CKD in the sample. After adjustment for demographic, lifestyle factors (i.e. smoking, alcohol drinking, physical activity) and chronic conditions, the odds ratio (OR) for CKD was 4.05 (95%CI 2.91-5.63, p for trend0.001) for extreme quartiles of estimated cumulative cadmium intake. A traditional southern dietary pattern (high intake of rice, pork, and vegetables, and low intake of wheat) was associated with more than four times increased prevalence of CKD (comparing extreme quartiles, OR 4.56, 95%CI 3.18-6.56). A modern dietary pattern (high intake of fruit, soy milk, egg, milk and deep fried products) was inversely associated with CKD (for extreme quartiles, OR 0.5, 95%CI 0.36-0.71). The association between dietary patterns and CKD were attenuated by cadmium intake.Traditional southern dietary pattern is positively associated, and modern dietary pattern is inversely associated, with CKD among Chinese adults. However, these associations can be partly attributed to cadmium contamination in parts of the food supply.

Aim: To determine differences in food and nutrient intakes between Australian- and Asian-born women living in Australia. Methods: Data were obtained from the Australian Longitudinal Study on Women's Health, including 6461 women born in Australia or Asia who completed food frequency questionnaires in 2001 and 2013. Diet was assessed using the Dietary Questionnaire for Epidemiological Studies version 2. Longitudinal generalised estimating-equation modelling was performed to determine the effect of country of birth and survey year on fruit and vegetable intake. Results: Asian-born women ate more cereals, soybeans and fish but less vegetables, legumes, dairy, meat and meat products than Australian-born women both in 2001 and in 2013. Asian-born women ate less cereals, rice and noodles, meat and its products (P

Background: Levels of internal migration vary significantly between countries. Australia and the United States consistently record among the highest levels of migration anywhere in the world. Very little is known, however, about the factors underlying mobility differentials. We argue that this is because existing evidence is almost exclusively based on period measures applied to cross-sectional data. Aims: We seek to advance understanding of cross-national variations in levels of residential mobility by drawing on a newly proposed suite of cohort migration measures, coupled with the recent release of internationally comparable retrospective residential history data. Data and methods: Focusing on the early cohort of baby boomers born between 1947 and 1951, the paper examines residential mobility levels and patterns in early and mid-adulthood in Australia and the United States and compares them with 14 European countries. Differences in completed levels of residential mobility are assessed in terms of four components: the proportion of a cohort who moved at least once; mean age at first move; mean age at last move; and average interval between moves. Results: While cohort analysis confirms high levels of mobility in Australia and the United States, it does not support the notion of a common ‘new world’ mobility regime distinct from other advanced economies. Conclusion: A cohort perspective offers refined insights into population mobility. The increasing availability of retrospective survey data means that researchers can now apply cohort measures to a wide range of countries.

This study aims to delineate the sociodemographic differences in disability prevalence across the population aged 60 years and over in Bangladesh, and to investigate the association of factors with reporting disability in later life. A microdata sample for those aged 60 years or over from the Census of Bangladesh 2011 was used where disability was assessed with a self-reported single response question. Logistic regression models were performed separately for men and women. Results reveal that the disability prevalence rate increased sharply with age, and it was higher among older women (5.2%) compared to men (4.8%). Physical and vision disabilities were the two categories with the highest prevalence of reported disabilities, with a higher prevalence of physical disability among men and vision disability among women. Being older, female, currently not in marital partnership, and having a lower educational attainment, not being employed, living alone, and residing in the rural areas were significantly associated with reporting disability in later life. The higher prevalence of disability among older women, those who are illiterate, and those residing in rural areas highlights the need for policies prioritising these groups. Special attention should also be given to those who are currently not in marital partnership, particularly women who are living alone.

Introduction The number of older drivers is quickly rising as the world's population is ageing. Driving was found to be essential in improving older people's quality of life. However, in assessing factors associated with driving in old age, previous studies have focused on medical conditions and sociodemographic factors, such as age and sex. Little is known about the effect of environment and social roles in determining driving in old age. Objective This study aimed to identify the predictors of driving among women as they age from 76 to 81 to 85–90 years based on the World Health Organization's (WHO) Healthy Ageing framework. Method The study analysed longitudinal data from the 1921–26 cohort of the Australian Longitudinal Study on Women's Health (ALSWH), nine years of follow up from survey waves three (aged 76–81 years) to six (aged 85–90 years). The study examined factors associated with driving based on the WHO's healthy ageing approach. Generalised estimating equation (GEE) models were used to identify predictors of driving over time. Result At baseline (ages 76–81 years), 55.7% of women were driving themselves, and this was their main means of transport. Over time, the odds of driving decreased as the women aged. In multivariable analyses, personal factors including education, providing care, grandparenting, and volunteering had positive associations with driving. In addition, the environmental factors of living in remote, outer regional and inner regional Australia, living in the states of Victoria and Western Australia, and living alone were also positively associated with driving. In contrast, medical conditions like diabetes, stroke, visual impairment, and need for assistance with daily tasks had negative associations with driving. Conclusion Age alone does not determine driving. Therefore, the context of personal, social, and environmental factors should also be considered and aligned with the healthy ageing goals when developing driving policy for older people.

Objectives The aims of this study were to (1) report the prevalence and explore the influence of spinal pain on quality of life and (2) assess the relationship between spinal pain and the type and number of comorbidities. Methods This cross-sectional study comprised 579 community-dwelling, older Australian women. Women had “spinal pain” if they marked “yes” to neck pain, upper back pain, mid-back pain, and/or lower back pain. Descriptive statistics and binary logistic regression were performed to report the prevalence and explore the relationship between spinal pain and the type and number of comorbidities. Results A majority of women (55.8%) who returned surveys had spinal pain. Women with spinal pain had significantly lower physical and mental quality of life scores than women without spinal pain (Medical Outcomes Study: 36 Item Short Form Survey [SF-36] physical component summary: 40.1 ± 11.1 vs 49.0 ± 9.0, and SF-36 mental component summary: 50.0 ± 10.5 vs 53.9 ± 8.2, respectively). Having spinal pain was significantly associated with overweight and obesity (odds ratio 1.98 [95% confidence interval 1.3-2.96] and 2.12 [1.37-3.28]), diabetes (1.93 [1.01-3.67]), pulmonary comorbidity (1.66 [1.04-2.65]), and cardiovascular comorbidity (1.57 [1.07-2.28]). More than half of the women with spinal pain reported 2 or more comorbidities, with comorbidities significantly more common among women with spinal pain than among women without spinal pain. The odds of having spinal pain increased with an increasing number of comorbidities (2 comorbidities: 2.44 [1.47-4.04], 3 comorbidities: 3.07 [1.66-5.67], 4 comorbidities: 5.05 [1.64-15.54]). Conclusions Spinal pain is common in community-dwelling, older Australian women and is associated with greater disability and poorer quality of life. Diabetes, cardiovascular disease, pulmonary disease, and obesity appear to have a relationship with spinal pain. There was an incremental increase in the risk of spinal pain associated with increasing comorbidity count.

Parental bonding is cited as a determinant of mental health outcomes in childhood, adolescence and early-mid adulthood. Examination of the long-term impact for older adults is limited. We therefore examine the long-term risk of perceived poor parental bonding on mental health across the lifespan and into early-old age.Participants (N = 1255) were aged 60-64 years of age and drawn from the Australian Life Histories and Health study. Quality of parental bonding was assessed with the Parental Bonding Instrument (PBI). Self-reported history of doctors' mental health diagnoses and current treatment for each participant was recorded. Current depression was assessed with the Centre for Epidemiologic Studies Depression-8 (CESD-8). Due to known gender differences in mental health rates across the lifespan, analyses were stratified by sex.A bi-factor analysis of the PBI in a structural equation framework indicated perceived Poor Parental Quality as a risk for both ever and current depression for both sexes. For males, Over-Protective Fathers were a risk for ever and current depression, whilst overall Poor Parental Quality was a risk for reporting current depression treatment. Whilst a number of the risks associated with current depression and treatment were attenuated when controlling for current mood, parental quality remained a significant risk for having reported a lifetime diagnosis for depression and anxiety for men.Our results extend the existing literature base and demonstrate that mental health risk attributed to poor perceived parental quality continues across the life-course and into early-old age.

Background: By 2050, adults aged 80 years and over will represent around 20% of the global population. Little is known about how adults surviving into very old age use hospital services over time.Objective: The objective of the study was to examine patterns of hospital usage over a 10-year period for women who were aged 84 to 89 in 2010 and examine factors associated with increased use.Methods: Survey data from 1936 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the state-based Admitted Patients Data Collection. Hospital use profiles were determined using repeated measures latent class analysis.Results: Four latent class trajectories were identified. One-quarter of the sample were at low risk of hospitalization, while 20.6% demonstrated increased risk of hospitalization and a further 38.1% had moderate hospitalization risk over time. Only 16.8% of the sample was classified as having high hospitalization risk. Correlates of hospital use for very old women differed according to hospital use class and were contingent on the timing of exposure (ie, short-term or long-term).Conclusions: Despite the perception that older adults place a significant burden on health care systems, the majority of women demonstrated relatively low hospital use over an extended period, even in the presence of chronic health conditions. High hospitalization risk was found to be concentrated among a small minority of these long-term survivors. The findings suggest the importance of service planning and treatment regimes that take account of the diverse trajectories of hospital use into and through advanced old age.

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007–2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

We examined women's access to health insurance in Indonesia. We analyzed IFLS-4 data of 1,400 adult women residing in four major cities. Among this population, the health insurance coverage was 24%. Women who were older, involved in paid work, and with higher education had greater access to health insurance (p

Comorbid conditions frequently coexist with asthma in older adults and can alter the natural history of asthma, complicating management and affecting overall prognosis and survival.This study investigates the impact of asthma on mortality among older women, with a specific interest in influence of comorbidities and social factors on survival of older women with asthma.Participants were from the Australian Longitudinal Study on Women's Health and were born between 1921 and 1926. Cox proportional hazards were used to evaluate mortality rates for women with and without asthma, after adjustment for comorbidities and other factors.Of 10,413 women aged 73-78, 829 (8%) reported having been diagnosed by a doctor for asthma. Women with asthma had a higher likelihood of heart disease, hypertension, thrombosis, bronchitis/emphysema, osteoporosis and major illnesses (p 0.0001). Asthma was associated with increased risk of death (HR = 1.31, 95%CI 1.18-1.45, p 0.0001). After adjusting for age, demographic factors, comorbidities, risk factors, residential area and social support, women with asthma retained a 17% increased risk of death compared to women without asthma (HR = 1.17, 95%CI 1.03-1.32, p = 0.016).Older women with asthma have a higher rate of mortality compared with other women of the same age. This increased risk of death remains after age, demographic factors, comorbidities, risk factors, residential area and social support have been taken into account.

Decline in physical function is common in older age, with important consequences for health-related quality of life, health care utilisation, and mortality. This study aimed to identify patterns of change in physical functioning (PF) for women in later life. PF was measured longitudinally using the ten-item subscale of the Medical Outcomes Study 36-item Short Form Health Survey, for 10 515 participants of the Australian Longitudinal Study on Women’s Health, who completed at least two surveys between 1999 (aged 73–78 years) and 2011 (aged 85–90 years). Conditional and unconditional latent profile analysis was conducted separately for deceased and surviving subgroups of women to uncover latent patterns of change in PF scores over time. Four patterns of change were identified for women who were still alive in 2011 (N = 5928), and four similar classes for deceased women (N = 4587): (1) ‘poor PF’ representing women with low PF scores, (2) ‘moderate PF’, (3) ‘high PF’, and (4) ‘very high PF’, where scores remained very high. All patterns exhibited a decrease in PF over time. Factors which predict low PF included sedentary levels of exercise, obese and overweight BMI, difficulty managing on income, and lower education. The results provided evidence for a gradual decrease in PF for all women with age; however, there was no evidence for an increased rate of decline prior to death.

Objectives To estimate the incidence of unplanned and planned hospitalization and identify associated factors among older women aged 75 years and over. Methods This study is a prospective longitudinal cohort study (over the period 2001-2016). Women born between 1921 and 1926 were included from the Australian Longitudinal Study on Women's Health (ALSWH). ALSWH self-reported data were linked with New South Wales's state Admitted Patient Data Collection. A competing risk analysis was performed using SAS v 9.4. Results Overall, during the 15-year observation period, 86.7% of women experienced at least one unplanned admission and 60.3% experienced at least one planned admission. The complement of Kaplan-Meier survival function overestimates hospitalization incidence compared to cumulative incidence function in the presence of a competing risk, that is, "death." Predisposing factors (older age and not partnered) and need factors (hospital doctor visit, GP or family doctor visit, poor perceived general health, and having at least one chronic disease) were associated with increased unplanned admission. First language other than English and not having private health insurance showed a negative association with planned admission; specialist doctor visits had a positive association. Conclusions Hospital admission was influenced by predisposing and enabling factors, as well as need. Intervention aiming to support older people who do not have private health insurance may be required to improve the goal of equal access to healthcare through planned admissions people with equal need.

Objective Prospective studies on obesity incidence specifically among young adults have not been reported. This study examined risks of obesity incidence over 19 years among young women without obesity at baseline. Methods Women aged 18 to 23 years at baseline (N = 8,177) were followed up every 2 to 3 years to ages 37 to 42 using the Australian Longitudinal Study on Women's Health. A latent class analysis identified obesity-risk classes based on time-dependent measures of income, education, physical activity, sleep quality, dietary behavior, depression, stressful events, and social functioning. Cox proportional hazards regression models examined associations between incident obesity and latent classes, controlling for covariates. Results Four latent classes were identified, including a lower-risk referent class and classes characterized by poor exercise and diet, stress and low income, and multiple intermediate-level risks. Compared with the referent, all three risk classes had significantly higher obesity risk, with the highest risk in the stress and low-income group (hazard ratio = 2.22; 95% CI: 1.92-2.56). Individual risks associated with obesity included lower education, stressful life events, and lower vigorous physical activity. Conclusions Young women without baseline obesity were at risk of developing obesity when they experienced co-occurring behavioral, socioeconomic, and psychosocial risks. Both latent classes and individual risk indicators offer insights into prevention strategies.

Introduction: In Australia, over a third of encounters with health care providers for diabetic patients fail to provide clinical guideline appropriate care. The Diabetes Alliance, integrated care model implemented across a large healthcare district with a view to enhance diabetes care capacity at primary care through intensive case-conferencing with primary care team, patients and visiting specialist team; whole practice performance feedback, and; regular diabetes masterclasses. Here, we aimed to provide in-depth insight into the case-conferencing process and impact of the model of care for patients with diabetes. Methods: Patients from 5 practices (including 2 with high and 3 with low proportions of patients with a recent HbA1c) provided the sampling frame. Patients were selected according to Patient Activation Measure scores to achieve maximum variation with 1 or 2 patients with high scores and 2 or 3 patients with low scores were selected from each practice. Participants were sampled until saturation was achieved. Thematic content analysis was applied to the 19 interviews. Results: Patients largely found the model of care a positive experience, reporting a boost in confidence in diabetes self-management (particularly around nutrition), with the program providing an opportunity to refocus when “life gets in the way.” Other key aspects of the program that were viewed positively included the holistic approach to healthcare, reduced travel time and congestion, familiarity in environment and clinical care, top-down knowledge transfer as well as mutual learning by the patient and their primary care team. Patients however also described difficulties in coping with diabetes as a chronic illness and adherence to treatment recommendations. Conclusion: Providing timely integrated specialist care within the primary care setting is an efficient means of enhancing the engagement of diabetic patients with their diabetes care and therefore their outcomes. Disclosure D.O. Kuzulugil: None. M.L. Harris: None. J.E. Byles: None. M.E. Parsons: None. A.N. Philcox: None. S.H. Acharya: None.

Substantial changes in the prevalence of the principal kidney and bladder cancer risk factors, smoking (both cancers) and body fatness (kidney cancer), have occurred but the contemporary cancer burden attributable to these factors has not been evaluated. We quantified the kidney and bladder cancer burden attributable to individual and joint exposures and assessed whether these burdens differ between population subgroups. We linked pooled data from seven Australian cohorts (N = 367,058) to national cancer and death registries and estimated the strength of the associations between exposures and cancer using adjusted proportional hazards models. We estimated exposure prevalence from representative contemporaneous health surveys. We combined these estimates to calculate population attributable fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. During the first 10‐year follow‐up, 550 kidney and 530 bladder cancers were diagnosed and over 21,000 people died from any cause. Current levels of overweight and obesity explain 28.8% (CI = 17.3–38.7%), current or past smoking 15.5% (CI = 6.0–24.1%) and these exposures jointly 39.6% (CI = 27.5–49.7%) of the kidney cancer burden. Current or past smoking explains 44.4% (CI = 35.4–52.1%) of the bladder cancer burden, with 24.4% attributable to current smoking. Ever smoking explains more than half (53.4%) of the bladder cancer burden in men, and the burden potentially preventable by quitting smoking is highest in men (30.4%), those aged 2 standard alcoholic drinks/day (41.2%). In conclusion, large fractions of kidney and bladder cancers in Australia are preventable by behavior change. Cancer Institute New South Wales, NHMRC, Ageing and Alzheimer's Institute, Cancer Council Victoria, VicHealth

Objectives We examined the development of disease and disability in a large cohort of older women, the extent to which these conditions exempt them from being classified as successful agers and different trajectories of disease, disability and longevity across women’s later life. Methods We used survey data from 12,432 participants of the 1921–26 birth cohort of the Australian Longitudinal Study of Women’s Health from 1996 (age 70–75) to 2016 (age 90–95). Repeated measures latent class analysis (RMLCA) identified trajectories of the development of disease with or without disability and according to longevity. Bivariate analyses and multivariable multinomial logistic regression models were used to examine the association between participants’ baseline characteristics and membership of the latent classes. Results Over one-third of women could be considered to be successful agers when in their early 70s, few women could still be classified in this category throughout their later life or by the end of the study when they were in their 90s (~1%). RMLCA identified six trajectory groups including managed agers long survivors (9.0%) with disease but little disability, usual agers long survivors (14.9%) with disease and disability, usual agers (26.6%) and early mortality (25.7%). A small group of women having no major disease or disability well into their 80s were identified as successful agers (5.5%). A final group, missing surveys (18.3%), had a high rate of non-death attrition. Groups were differentiated by a number of social and health factors including marital status, education, smoking, body mass index, exercise and social support. Conclusions The study shows different trajectories of disease and disability in a cohort of ageing women, over time and through to very old ages. While some women continue into very old age with no disease or disability, many more women live long with disease but little disability, remaining independent beyond their capacity to be classified as successful agers.

Objective To assess which older Australian women had Medicare subsidized health assessments between 1999 and 2013. Methods This study used prospective, longitudinal survey data from the 1921 to 1926 birth cohort of Australian Longitudinal Study on Women’s Health (ALSWH) linked with Medicare Australia data on health services use. Over 11,000 Australian women were included in the study. Latent class analysis was used to identify assessment patterns over time, accounting for death, and based on three categories (‘no assessment’; ‘assessment; ‘deceased’) for each year between 1999 and 2013. Further analysis explored the impact of health and sociodemographic characteristics on class membership. Results Of the women included in the latent class analysis, 37% never had any assessment and the remainder had had at least one assessment. After a steady uptake from 1999 to 2003, there was decline in uptake from 2003 onwards. A six-class model with sufficient homogeneity and reliable estimation was selected to represent assessment patterns and mortality risk, labelled as: ‘high mortality’ rate with little chance for assessment (12.4%), ‘intermediate mortality, low assessment’ (14.1%), ‘later mortality/low assessment’ (13.1%), ‘later mortality, high assessment’ (7.0%), ‘low mortality, low assessment’ (31.8%), ‘low mortality, high assessment’ (21.6%). Older women with certain conditions (such as diabetes, depression, heart disease) were more likely to be in the low assessment groups, and women with difficulty managing on income were more likely to be in low assessment groups. Conclusion Distinct assessment and mortality patterns were seen, with many women not having assessment, in particular those who had certain health conditions, were taking 3+ medications, had difficulty in managing on income, needed help or were in respite care, and had caring responsibilities. The findings point to a need to promote these assessments among older women, and to reduce financial barriers, even within the context of a heavily subsidized health care system.

Background: Musculoskeletal pain frequently occurs in more than one body region, with up to 80% of adults reporting more than one joint pain site in the last 12 months. Older people and females are known to be more susceptible to multiple joint pain sites, however the association of multisite joint pain with physical and psychosocial functions in this population are unknown.Methods: Cross-sectional data from 579 women were analyzed. Women were asked "Which of your joints have been troublesome on most days of the past month?" Pain qualities were measured using the McGill Pain Questionnaire (Short Form) and PainDETECT, and health was assessed using the SF-36 and sociodemographic variables. Statistical analysis using generalized ordinal logistic regression included comparison of three joint pain groups: no joint pain, 1-4 sites of joint pain and ≥ 5 sites of joint pain.Results: Two thirds of respondents had multisite pain (>1 site), and one third had ≥5 joint pain sites. Compared to women with fewer joint pain sites, women with >5 joint pain sites (multisite joint pain) had significantly poorer physical and emotional health-related quality of life, more severe pain, a higher probability of neuropathic pain, and a longer duration of pain. More than half of women in the multisite joint pain group were still employed, statistically significantly more than women with no joint pain. In the final model, pain duration, the number of medications, pain intensity (discomforting and distressing) and the physical component of health-related quality of life were significantly associated with increased number of joint pain sites.Conclusions: Over one-third of older women in our sample had >5 painful joints in the last month. These women demonstrated significantly poorer psychosocial health, and increased medication use, than women with no or fewer sites of joint pain. Many women with multisite joint pain were still in the workforce, even when nearing retirement age. This study has important implications for future research into musculoskeletal pain, particularly in regards to womens health and wellbeing, and for clinical practice where there should be increased awareness of the implications of concurrent, multisite joint pain.

Objective Evidence on the endometrial and ovarian cancer burden preventable through modifications to current causal behavioural and hormonal exposures is limited. Whether the burden differs by population subgroup is unknown. Methods We linked pooled data from six Australian cohort studies to national cancer and death registries, and quantified exposure-cancer associations using adjusted proportional hazards models. We estimated exposure prevalence from representative health surveys. We then calculated Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. Results During a median 4.9 years follow-up, 510 incident endometrial and 303 ovarian cancers were diagnosed. Overweight and obesity explained 41.9% (95% CI 32.3–50.1) of the endometrial cancer burden and obesity alone 34.5% (95% CI 27.5–40.9). This translates to 12,800 and 10,500 endometrial cancers in Australia in the next 10 years, respectively. The body fatness-related endometrial cancer burden was highest (49–87%) among women with diabetes, living remotely, of older age, lower socio-economic status or educational attainment and born in Australia. Never use of oral contraceptives (OCs) explained 8.1% (95% CI 1.8–14.1) or 2500 endometrial cancers. A higher BMI and current long-term MHT use increased, and long-term OC use decreased, the risk of ovarian cancer, but the burden attributable to overweight, obesity or exogenous hormonal factors was not statistically significant. Conclusions Excess body fatness, a trait that is of high and increasing prevalence globally, is responsible for a large proportion of the endometrial cancer burden, indicating the need for effective strategies to reduce adiposity.

Nitric oxide (NO) facilitates anti-atherosclerotic effects. Vegetables are a major source of dietary nitrate. Experimental data indicates that dietary nitrate can significantly reduce major risk factors for atherosclerosis and subsequent cardiovascular disease (CVD), as nitrate can be metabolized to produce NO via the nitrate-nitrite-NO pathway. The purpose of this study was to prospectively investigate the association between habitual dietary nitrate intakes and the incidence of self-reported CVD-related complications within a representative sample of middle-aged Australian women (1946–1951 cohort of the Australian Longitudinal Study on Women’s Health). Women free from disease at baseline who had completed the food frequency questionnaire data were included. Generalized estimating equations were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) across quartiles for nitrate intakes. Of the 5324 women included for analysis, there were 1951 new cases of CVD-related complications over 15-years of follow-up. Women reporting higher total dietary nitrate intakes (Q4 &gt, 78.2 mg/day) and vegetable nitrate intakes (Q4 &gt, 64.4 mg/day) were 25% and 27% reduced risk of developing CVD-related complications respectively, compared with women reporting low total (Q1 &lt, 45.5 mg/day) and vegetable nitrate intakes (Q1 &lt, 34.8 mg/day). Our findings were consistent with other observational data indicating that dietary nitrate may explain some of the cardiovascular benefits of vegetable consumption.

Aims To assess the impact of diabetes on the survival of older women, adjusted for other all-cause mortality predictors. Methods Data were used from the 1921–26 cohort of the Australian Longitudinal Study on Women’s Health, when the women were aged 76–81 years at baseline, with linkage to the National Death Index. Survival curves were plotted to compare the survival of women with no diabetes, incident diabetes and prevalent diabetes over 15 years. Cox proportional hazards models were used to examine the association between diabetes and all-cause mortality risks. Results A total of 972 (11.7%) of 8296 eligible women reported either incident, 522 (6.3%) or prevalent, 450 (5.4%) diabetes. The median survival times were 10.1, 11.4 and 12.7 years among women with prevalent, incident and no diabetes, respectively. The risks of death were 30% [HR: 1.30 (95% CI: 1.16–1.45)] and 73% [HR: 1.73 (CI: 1.57–1.92)] higher for women with incident and prevalent diabetes compared to women without diabetes. These associations were sustained after controlling for demographics, body mass index, smoking status, comorbidities and health care use. Conclusions This study revealed that diabetes is associated with reduced survival probabilities for older women with minimal moderation after adjustment for other predictors. Our findings suggest that diabetes management guidelines for older women need to integrate factors such as comorbidities, smoking and being underweight to reduce the risk of mortality.

Background Frailty is among the most serious global public health challenges due to the rapid increase in the ageing population and age-associated declines in health. We aimed to validate hospital frailty risk score (HFRS) for its ability to predict prolonged hospital length of stay, 28-day unplanned readmission, repeated admission, and mortality in older people over a 15-year follow-up period. Methods We linked data from the Australian Longitudinal Study on Women’s Health (ALSWH) with hospital admission and National Death Index datasets to identify admitted patients and death dates. This study included patients with an index unplanned admission resulting in an overnight hospital stay in 2001–2016 and aged 75–95 years at the time of admission. HFRS and Charlson comorbidity index (CCI) were calculated from the hospital data using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes. Results Of 2740 older women aged 75 years and over with unplanned admission, the proportions of patients with low, intermediate, and high frailty risks were 77.15 % (n = 2114), 20.95 % (n = 574), and 1.90 % (n = 52), respectively. The 15-year follow-up revealed that high frailty risk patients increased 5-fold in 2015 (15.67 % patients, mean age = 92.26 years) compared to 2001 (2.56 % patients, mean age = 77.96 years). Prolonged hospital length of stay was higher in the intermediate (AOR = 2.86, 95 %CI: 2.26, 3.62) and high frailty risk group (AOR = 4.26, 95 %CI: 2.32, 7.63) compared to the low frailty risk group. Frailty risk was not associated with unplanned or repeated hospital admission. However, the intermediate frailty risk group (AHR = 1.78, 95 %CI: 1.47, 2.17) and the high frailty risk group (AHR = 4.17, 95 %CI: 2.00, 8.66) had a significant risk of mortality compared to the low frailty risk group. Conclusions This study confirms the ability of HFRS to identify older, frail people at higher risk of prolonged hospital length of stay and increased mortality risk. However, we did not observe a significant association between HFRS and 28-day unplanned readmission or repeated hospital admission.

Objectives To assess the impact of dementia on the use of health and community services in the last 2 years of life by women who also had other major chronic conditions. Design Matched groups of women with a chronic condition who did or did not also have dementia, and who died or did not die for at least another 2 years. Setting and Participants Participants in the Australian Longitudinal Study on Women's Health who were born from 1921-1926. These women were from a random, nationally representative sample of 12,432 recruited in 1996 with follow-up until 2014. Methods Repeated survey data and linked administrative records were used to identify women with heart disease, chronic lower respiratory tract disease, and dementia. Use of aged care services, medical visits, and hospital admissions were compared among the matched groups. Results Women with dementia were more likely to move into residential aged care, especially in the months and years before death. Consequently, they made less use of community-based services. Numbers of general practitioner visits were similar for women with or without dementia, increasing substantially in the last 4 months of life. In contrast, women with dementia were less likely to see medical specialists and slightly less likely to be admitted to hospital, even in the last 4-6 months of life when hospitalization was more common. The findings were similar whether the comorbid condition was heart disease or chronic lower respiratory tract disease. Conclusions and Implications Use of other services is affected by use of residential aged care, so the comprehensive care of people with dementia requires understanding connections between sectors.

Objectives There is limited research on hot flushes and night sweats in women with a hysterectomy with ovarian conservation. We aimed to describe the patterns of these symptoms in a cohort of Australian women and to investigate the relationship between distinct symptom patterns and hysterectomy status. Study design and outcome measures Repeated-measures latent class analysis (LCA) was used to identify hot flushes and night sweats symptom patterns across seven surveys (over 17 years) in the mid-cohort of the Australian Longitudinal Study on Women⿿s Health. Multinomial logistic regression was used to assess the associations of the symptom patterns in women with a hysterectomy with ovarian conservation (n = 1129) versus women without a hysterectomy (n = 4977). Results A higher proportion of women with a hysterectomy than of those without experienced a constant pattern of hot flushes (15% versus 30%) and night sweats (9% versus 19%). Women with a hysterectomy had higher odds of constant hot flushes versus minimal hot flushes (OR = 1.97, 95% CI: 1.64, 2.35) and constant versus minimal night sweats (OR = 2.09, 95% CI: 1.70, 2.55). Smoking, a ⿿lower level of education to non-professional occupation⿿ pathway and body mass index (BMI) patterns of ⿿always obese⿿ and ⿿increasingly obese⿿ were also associated with a higher risk of constant symptoms. Conclusions Women who have a hysterectomy (with ovarian conservation) have a higher risk of hot flushes and night sweats that persist over an extended period.

Background Screening reduces cervical cancer incidence and mortality. Objective To describe cervical cancer epidemiology and screening guidelines in six low- and middle-income countries (LMICs) participating in the Study on global AGEing and adult health (SAGE). Search strategy Incidence, mortality, and screening-rate data were obtained for six LMICs and three higher-income comparator countries (Australia, USA, and UK). SCOPUS and PubMed were used to identify literature published after 2000 in English, using several screening-linked terms. Selection Criteria Literature describing the use of cervical cancer screening guidelines in China, Ghana, India, Mexico, Russia, and South Africa were included. Data collection and analysis Incidence, mortality trends, and screening rates were graphed and screening recommendations were summarized. Main Results Higher rates of cervical cancer incidence, mortality, and 5-year prevalence were found in LMICs compared with the comparator countries. LMICs with absent or newly implemented screening guidelines had the lowest rates of crude and effective cervical cancer screening, with high cancer incidence and mortality. Countries with established guidelines had higher screening rates and lower disease burden. Cost, inadequate knowledge, geographical location, and cultural views were common barriers to effective screening coverage. Conclusion Work must continue to improve the implementation of affordable, relevant, and achievable methods to improve screening coverage in LMICs.

Scant research exists on the patterns of changes in older women’s housing, and whether and when women transition into residential aged care (RAC). This study aimed to identify groups of women with different housing patterns (latent classes) over time, with a secondary aim to describe socio-demographic and health characteristics of women in each class. We analysed linked data for 9575 women born 1921–1926 from the Australian Longitudinal Study of Women’s Health (ALSWH), Australian National Death Index, and Residential Aged Care (RAC) administrative records for the years 1999 through to 2011. Seven distinct housing patterns (classes) were identified over time. Four classes showed a stable pattern: living in a house for most surveys (47.0%), living in a house but with earlier death (13.7%), living in an apartment (12.8%), living in a retirement village (5.8%). One class showed a pattern of downsizing: moving from a house to retirement village (6.6%). Two patterns showed transition: from an apartment or retirement village, to RAC and death (7.8%), and from house to RAC (6.4%). This study provides new evidence about socio-demographic and health influences on housing patterns and entry into residential care in later life. These findings can inform policy and aged care planning for women in later life, by identifying patterns of transition into residential aged care, or alternatively, remaining in the community.

Aim China faces a “time-bomb” of the aging population. Successful aging has long been a goal in the field of gerontology. The present study aimed to evaluate successful aging among Chinese older adults. Methods Data on a total of 7102 people in the China Health and Retirement Study aged ≥60 years were analyzed in the present study. Successful aging is defined by the model of Rowe and Kahn including the following five indicators: “no major diseases,” “no disability,” “high cognitive functioning,” “high physical functioning” and “active engagement with life.” Using logistic regression analysis, crude and adjusted odds ratios with 95% confidence intervals were calculated to evaluate the relationship between sociodemographic parameters and successful aging. Results The prevalence of successful aging was 13.2% among Chinese older people. The percentage of older people with the five indicators, “no major diseases,” “no disability,” “high cognitive functioning,” “high physical functioning,” and “active engagement with life” was 41.7%, 92.1%, 54.2%, 70.2% and 46.0%, respectively. Multiple logistic regression showed people who had received education of high/vocational school or above had significantly greater odds of successful aging compared with those with less than primary school education (P

Introduction Population aging is associated with a rising burden of non-communicable disease, profoundly impacting health policy and practice. Adopting and adhering to healthy lifestyles in middle or older age can protect against morbidity and mortality. Retirement brings opportunities to reconfigure habitual lifestyles and establish new routines. This study examines the longitudinal association between retirement and a range of lifestyle risk behaviors among a large population-based sample of Australian adults. Methods Study sample included working adults aged ≥45 years at baseline (2006–2009, N=23,478–26,895). Lifestyle behaviors, including smoking, alcohol use, physical activity, diet, sedentary behavior, and sleep, were measured at both baseline and follow-up (2010). Logistic regression models estimated the odds of having each risk factor at follow-up and multiple linear regression models calculated the change in the total number of risk factors, adjusted for baseline risk and other covariates. Sociodemographic characteristics and reasons for retirement were tested as potential effect modifiers. Results During the 3.3-year follow-up, about 11% of respondents retired. Retirement was associated significantly with reduced odds of smoking (AOR=0.74); physical inactivity (AOR=0.73); excessive sitting (AOR=0.34); and at-risk sleep patterns (AOR=0.82). There was no significant association between retirement and alcohol use or fruit and vegetable consumption. Change in the total number of lifestyle risk factors differed significantly by reason for retirement. Conclusions In a large population-based Australian cohort, retirement was associated with positive lifestyle changes. Health professionals and policymakers should consider developing special programs for retirees to capitalize on the healthy transitions through retirement.

Objectives The aim of this study was to analyze the prevalence and determinants of time pressure among younger Australian women born between 1973 and 1978 over a 17-year period. Methods Using six surveys (N=14 247 at baseline in 1996) from the Australian Longitudinal Study on Women`s Health (ALSWH), we estimated fixed-effects ordered logistic regression models. Results More than two thirds of women felt rushed, pressured, too busy every day or a few times a week, and time pressure substantially increased over the observed 17-year period. Baseline estimates show that time pressure is significantly (P

Aim To explore the implementation of poslansia, a community-based integrated health service implemented across Indonesia to improve the health status of older people through health promotion and disease prevention. Methods Data analysis of 307 poslansia surveyed in the 4th wave of Indonesia Family Life Survey (IFLS-4). We examined the services provided in the programme, resources and perceived problems. Results The services provided by poslansia focused mostly on risk factor screening and treatment for minor illness, and less on health promotion activities. Lack of support from community health centres, no permanent place for holding poslansia and lack of participant interest in joining the programme were associated with fewer services provided in the programme (P < 0.05). Conclusion The findings indicate existing support from the community, community health centres and related institutions for poslansia is not adequate for optimal service function. Health awareness among the older population should also be increased for programme sustainability.

We examined retirement transitions by gender, and different associations between retirement, physical function and mental health.Data for 21,608 participants aged 55-69 from the 45 and Up Study were used. Generalised estimating equations were used to investigate longitudinal associations between retirement with psychological distress (Kessler score, K10) and physical dysfunction across two time points, by gender separately.Retirement in men was associated with a 25% relative increase in mean physical dysfunction score (p0.001) and a 2% relative increase in mean K10 score (p=0.004), although men with high physical dysfunction score had a 6% increase in mean K10 score (p=0.005) if retired. For women, retirement was associated with a 17% increase in mean physical dysfunction score (p0.001), with no association observed with the K10 score. Results were adjusted for demographic and health covariates.Retirement is associated with physical dysfunction over time. Retirement is not associated with psychological distress among women, but retirement is associated with psychological distress among men who have a high level of physical dysfunction. The findings point to the importance of attending to the physical and mental health needs, around the retirement period, particularly for men with poor physical health.

Objective. To estimate the prevalence and examine the associations of neuropathic-like pain in a community-based sample of older Australian women with arthritis. Design. Population based cross-sectional survey. Setting. Participants were recruited from the 1946-1951 cohort of the Australian Longitudinal Study of Women’s Health. Subjects . Women with self-reported arthritis (n = 147). Methods . Primary outcome measure was self-reported neuropathic-like pain, defined as scores ≥12 via the painDETECT screening tool. Descriptive statistics summarized health and socio-demographic characteristics, and comparisons made using student’s t -test or Wilcoxon Rank Sum test, and Chi-square tests. Independent health and demographic variables were examined by univariable logistic regression, and significant variables included in multiple variable logistic regression modelling. Results. Thirty-nine women (26.5%) were screened as having neuropathic-like pain. Women with neuropathic-like pain were more likely to have poorer health, worse pain, higher pain catastrophizing, more fatigue, and more depression than women with nociceptive pain. Neuropathic-like pain was significantly associated with higher scores on the SF-MPQ sensory scale and pain catastrophizing scale, and with more medication use. Conclusions . Neuropathic-like pain in women with arthritis was common and is associated with greater disability and poorer quality of life.

Aim To describe and compare the mental health and physical functioning of community-dwelling men aged 70 years and over who live alone, and those who live with their partner/spouse. Method Data were obtained from the baseline survey of the New South Wales 45 and Up Study. Mental health was measured using the Kessler Psychological Distress Scale and physical health was measured using the Medical Outcome Short Form 36 physical functioning scale. Results 37 690 community-dwelling men aged 70 years or over were included in the analyses. Men living alone were more likely to have high psychological distress scores and lower physical functioning scores compared to men living with a spouse/partner within each age group, except those 85 and over. Conclusions Specific health and welfare programs targeted to the increasing number of older men living alone may be needed to address their higher levels of psychological distress and lower levels of physical functioning.

This paper will highlight current evidence about health and well-being that could encourage investment in health for older populations. The paper uses the example of hypertension throughout to illustrate how data collection efforts are translating research to policy. Hypertension, is a global scourge for poor and wealthy, younger and older adults, increasing the risk of stroke and cardiovascular disease. Although it is easily diagnosed and can be effectively treated the burden of hypertension continues to grow as awareness, prevention and treatment lags, particularly for the poor and old. The focus is brought back to how current research can inform policy for ageing populations in the final section, using Ireland’s experience to demonstrate how to legislate the good life for older adults.

Objective Older women are more likely than men to enter residential aged care (RAC) and generally stay longer. We aimed to identify and examine their trajectories of care needs over time in RAC across 3 fundamental care needs domains, including activities of daily living (ADL), behavior, and complex health care. Design Population-based longitudinal cohort study. Setting RAC facilities in Australia. Participants A total of 3519 participants from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), who used permanent RAC between 2008 and 2014. Methods We used data from the Aged Care Funding Instrument, National Death Index, and linked ALSWH survey. Participants’ care needs in the 3 domains were followed every 6 months up to 60 months from the date of admission to RAC. Trajectories of care needs over time were identified using group-based multitrajectory modeling. Results Five distinct trajectory groups were identified, with large variation in the combinations of levels of care needs over time. Approximately 28% of residents belonged to the “high dependent–behavioral and complex need” group, which had high care needs in all 3 domains over time, whereas around one-third of residents (31%) were included in 2 trajectory groups (“less dependent–low need” and “less dependent–increasing need”), which had low or low to medium care needs over time. More than two-fifths of residents (41%) comprised 2 trajectory groups (“high dependent–complex need” and “high dependent–behavioral need”), which had medium to high care needs in 2 domains. Higher age at admission to RAC and multiple morbidities were associated with increased odds of being a member of the high dependent–complex need group than the less dependent–increasing need group. Conclusions and Implications Identification of the differential trajectories of care needs among older women in RAC will help to better understand the circumstances of their changing care needs over time. This will facilitate appropriate care planning and service delivery for RAC residents, who are mostly older women.

Purpose To determine the prevalence and incidence of atrial fibrillation (AF) among older Australian women from 2000 to 2015, determine factors associated with AF, and to calculate risk of stroke at the time of AF diagnosis. Methods This is a retrospective analysis of 6671 women of the 1921–1926 birth cohort of the Australian Longitudinal Study on Women's Health, linked to data from hospital admissions to identify AF and National Death Index to determine date of death. Yearly prevalence and incidence proportions of AF, and stroke risk using CHA2DS2-VA scheme, were calculated. Factors associated with AF were assessed using logistic regression. Results From 2000 to 2015, a total of 1827 women with AF were identified. AF prevalence increased every year as women aged from 2.71% (95% CI 1.62%–3.80%) in 2000 among women aged 74–79 years to 24.83% (95% CI = 23.23%–26.44%) in 2015 among women aged 89–94 years. The incidence proportion remained constant (between 3% and 5%) throughout the study period. Sedentary lifestyle (OR = 1.24, 95% CI = 1.04–1.49), hypertension (OR = 1.24, 95% CI = 1.09–1.42), arthritis (OR = 1.24, 95% CI = 1.09–1.41), heart attack (OR = 1.62, 95% CI = 1.18–2.24), and angina (OR = 1.39, 95% CI = 1.14–1.70) were independently associated with AF. Mean CHA2DS2-VA score for women with AF was 3.43 (SD ± 1.23). Conclusions The prevalence of AF reported in Australian women is among the highest compared to previous estimations from other countries and regions. According to the findings, about one in four women over the age of 90 years had AF. These women were also at high risk of stroke. This has significant public health implications especially with changing demographics of increase in the aging population. Further research is required on understanding how women with AF are treated in Australia and their health outcomes.

Objectives To identify patterns of health, socioeconomic, behavioral, and psychosocial indicators that may be associated with low birth weight delivery or preterm birth. Study design Data were analyzed from the Australian Longitudinal Study on Women's Health. A total of 9075 live singleton births among 3801 women were linked to state perinatal records with birth outcome data. Survey data were used to identify 11 indicators for latent class analysis. Latent classes were tested for association to birth outcomes. These indicators also were used along with covariates in main effect multiple logistic regression analyses of birth outcomes. Results Latent class analysis revealed 5 classes, including those characterized by low education, recent drug use, stress/anxiety/depression, smoking/drinking/low education/multi-risk, and a low risk referent group. The stress/anxiety/depression class was associated with preterm delivery (OR 1.87, 95% CI 1.20-2.92), and the smoking/drinking/low education/multirisk class was associated with low birth weight (OR 1.54, 95% CI 1.02-2.30). Traditional logistic regression analyses for main effects identified some measures not captured by the latent classes, and the latent classes identified variable combinations not captured by the main effect analysis. Conclusions Unique latent classes were associated with preterm delivery vs low birth weight. Both latent class analysis and main effects analyses may be combined to improve understanding of birth outcome risks. Clinical and programmatic interventions to reduce risks of low birth weight and preterm delivery may benefit from risk profiles that women experience.

We would like to thank Dr Kawada for the interest in our study. Dr Kawada raised a critical point regarding the provisional tolerable monthly intake (PTMI) for cadmium (25 μg/kg body weight/month) proposed by WHO in 2013 [1]. We agree that the mean dietary cadmium intake in our sample is well below this PTMI. Several other studies in China also found that the mean dietary cadmium was below the PTMI, including Song et al's which found the mean cadmium intake to be 15.3 g/kg BW (compared to 13.6 g/kg BW in our study), and concluded that the health risk from dietary cadmium exposure of the general Chinese people was low [2], [3]. Such a conclusion may be risky from a public health perspective, as it suggests that there is no urgent need to intervene. However, the European Food Safety Authority (EFSA) set a more conservative provisional tolerable weekly intake for cadmium at 2.5 μg/kg BW/week [4]. We found that 65.4% of our participants had an estimated usual cadmium intake above the EFSA TWI, while 2.9% were above the WHO PTMI. The strong association between dietary cadmium intake and chronic kidney disease (CKD) in our study should serve as an alarming signal for public health intervention and further investigation to determine which tolerable limit is more clinically relevant. Our findings provide support for the use of the more conservative EFSA TWI, rather than the PTMI set by WHO, while acknowledging that both figures are provisional. Our findings add additional observational evidence to the previous research summarized by Byber et al[5]. Although we did not have information on the biomarkers of renal tubular damage, several recent studies in China confirmed that cadmium exposure was adversely associated with renal biomarkers, such as N-acetyl-beta-d-glucosamidase [6], [7]. Further longitudinal studies on cadmium exposure and kidney function decline or the development of CKD are needed. The 2015 China Health and Nutrition Survey may provide further opportunity as it will collect follow-up data on kidney function.

Background Exposure to environmental air pollutants exacerbates respiratory illness, but prospective studies of disease incidence are uncommon. Further, attempts to estimate effects from multiple point sources have rarely been undertaken. The current study examined risk of incident chronic obstructive pulmonary disease (COPD) and asthma in association with emissions of multiple air pollutants from point pollution sources in Australia. Methods We analyzed prospective cohort data from the Australian Longitudinal Study on Women's Health. Women from three age-cohorts (N = 35,755) were followed for up to 21 years for incident COPD and asthma. Exposures were measured from the National Pollutant Inventory and included carbon monoxide, nitrogen oxides, sulfur dioxide, and particulate matter (PM2.5 and PM10). We identified inverse-distance weighted emissions in kilograms that women experienced over time from point sources within 10 km of their residences. Cox proportional hazards regression models examined risk of self-reported doctor-diagnosed COPD and asthma in association with pollutant exposures and covariates. Results New COPD cases numbered 3616 (11.5%) and new asthma cases numbered 2725 (9.4%). Participants were exposed to an average of 47–59 sites with air pollution emissions within 10 km of their residences. Fossil fuel electricity generation and mining made the largest contributions to air pollution but hundreds of other types of emissions also occurred. Controlling for covariates, all five air pollutants modeled individually were significantly associated with risk of COPD. Modeled jointly, only sulfur dioxide (SO2) remained significantly associated with COPD (HR = 1.038, 95% CI = 1.010–1.067), although the five pollutants were highly correlated (r = 0.89). None of the pollutants were significantly associated with adult onset asthma. Cohort-specific analyses indicated that COPD risk was significantly associated with SO2 exposure for younger (HR = 1.021, CI = 1.001–1.047), middle-age (HR = 1.019, CI = 1.004–1.034) and older cohorts (HR = 1.025, CI = 1.004–1.047). Conclusions Multiple exposure sources and pollutants contributed to COPD risk, including electricity generation and mining but extending to many industrial processes. The results highlight the importance of policy efforts and technological improvements to reduce harmful air pollution emissions across the industrial landscape.

IntroductionThe cancer burden preventable through modifications to risk factors can be quantified by calculating their population attributable fractions (PAFs). PAF estimates require large, prospective data to inform risk estimates and contemporary population-based prevalence data to inform the current exposure distributions, including among population subgroups. Objectives and ApproachWe provide estimates of the preventable future cancer burden in Australia using large linked datasets. We pooled data from seven Australian cohort studies (N=367,058) and linked them to national registries to identify cancers and deaths. We estimated the strength of the associations between behaviours and cancer risk using a proportional hazards model, adjusting for age, sex, study and other behaviours. Exposure prevalence was estimated from contemporary National Health Surveys. We harmonised risk factor data across the data sources, and calculated PAFs and their 95% confidence intervals using a novel method accounting for competing risk of death and risk factor interdependence. ResultsDuring the first 10-years follow-up, there were 3,471 incident colorectal cancers, 640 premenopausal and 2,632 postmenopausal breast cancers, 2,025 lung cancers and 22,078 deaths. The leading preventable causes were current smoking (53.7% of lung cancers), body fatness or BMI ≥ 25kg/m2 (11.1% of colorectal cancers, 10.9% of postmenopausal breast cancers), and regular alcohol consumption (12.2% of premenopausal breast cancers). Three in five lung cancers, but only one in four colorectal cancers and one in five breast cancers, were attributable to modifiable factors, when we also considered physical inactivity, dietary and hormonal factors. The burden attributable to modifiable factors was markedly higher in certain population subgroups, including men (colorectal, lung), people with risk factor clustering (colorectal, breast, lung), and individuals with low educational attainment (breast, lung). Conclusion/ImplicationsEstimating PAFs for modifiable risk factors across cancers using contemporary exposure prevalence data can inform timely public health action to improve health and health equity. Testing PAF effect modification may identify population subgroups with the most to gain from programs that support behaviour change and early detection.

The aim of the study was to analyze the prevalence of activities of daily living (ADL) difficulties among older Ghanaians and specifically how one ADL, toileting difficulty, predicts care and supports needs using the World Health Organization International Classification of Disability and Health framework (WHO-ICF). Toileting difficulty requiring upper extremity strength is among ADLs that can lead to functional loss of independence among older people globally. A sample of n=5,096 adults aged 50 years and older from the WHO Study on global AGEing and adult health (SAGE) Ghana Wave 1 was used to analyze difficulties with ADLs and toileting. Level of difficulty was assessed against 22 other functioning items from the interview. Out of the 22 functioning items, climbing one flight of stairs without resting was the most difficult activity to be completed by older Ghanaians, and difficulty eating being the least endorsed item. Toileting was ranked the 16th in terms of reported difficulty and was related to other ADLs. Logistics multivariate regression was used to analyze data. Including significant variables from the univariate analysis in parsimonious model based on WHO-ICF framework, age, self-report health, memory, bodily pain, short distance vision, stroke, neighborhood trust, toilet facility type, and religious meeting attendance, were significantly independently associated with toileting difficulty. Gender was significant at the univariate level but became insignificant after adjusting for body function and structural variables. Toileting difficulty was associated with factors across different components in the WHO-ICF making the WHO-ICF an appropriate tool for understanding health and disability.

Background Knowledge of preventable disease and differences in disease burden can inform public health action to improve health and health equity. We quantified the future lung cancer burden preventable by behavioural modifications across Australia. Methods We pooled seven Australian cohort studies (n = 367 058) and linked them to national registries to identify lung cancers and deaths. We estimated population attributable fractions and their 95% confidence intervals (CIs) for modifiable risk factors, using risk estimates from the cohort data and risk factor exposure distribution from contemporary national health surveys. Results During the first 10-year follow-up, there were 2025 incident lung cancers and 20 349 deaths. Stopping current smoking could prevent 53.7% (95% CI, 50.0–57.2%) of lung cancers over 40 years and 18.3% (11.0–25.1%) in 10 years. The smoking-attributable burden is highest in males, those who smoke

Background Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint effects, competing risk, or population subgroup differences. Methods We pooled data from seven prospective Australian cohort studies (n = 367 058) and linked them to national registries to identify CRCs and deaths. We estimated the strength of the associations between behaviors and CRC risk using a parametric piecewise constant hazards model, adjusting for age, sex, study, and other behaviors. Exposure prevalence was estimated from contemporary National Health Surveys. We calculated population attributable fractions for CRC preventable by changes to current behaviors, accounting for competing risk of death and risk factor interdependence. Statistical tests were two-sided. Results During the first 10 years of follow-up, there were 3471 incident CRCs. Overweight or obesity explained 11.1%, ever smoking explained 10.7% (current smoking 3.9%), and drinking more than two compared with two or fewer alcoholic drinks per day explained 5.8% of the CRC burden. Jointly, these factors were responsible for 24.9% (95% confidence interval [CI] = 19.7% to 29.9%) of the burden, higher for men (36.7%) than women (13.2%, Pdifference < .001). The burden attributed to these factors was also higher for those born in Australia (28.7%) than elsewhere (16.8%, Pdifference = .047). We observed modification of the smoking-attributable burden by alcohol consumption and educational attainment, and modification of the obesity-attributable burden by age group and birthplace. Conclusions We produced up-to-date estimates of the future CRC burden attributed to modifiable behaviors. We revealed novel differences between men and women, and other high–CRC burden subgroups that could potentially benefit most from programs that support behavioral change and early detection.