MRC National Survey of Health and Development: an update Diana Kuh & LHA & data collection teams Director, MRC N

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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 19 follow ups 1948-1977 (2-31 years) MRC Unit for the Study of EnvironmentalFactors in Mental & PhysicaI Illness established 1962

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

8. 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

9. NSHD clinic data collection Clinical Research Facilities Cardiff

10. 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 (>60% in Manchester) (additional 20%)

11. 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 NSHD new clinic data collection: questionnaire-based data and performance tests

12. NSHD clinic data collection:cardiac & 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)

13. 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)

14. NSHD clinic data collection: bone measuresProfessor Judith Adams, Manchester University Bone measures include: • DXA hip • total, femoral neck, trochanter, Ward’s • Lumbar spine (L1-4) • Whole body & region BMD, fat & lean mass • vertebral fracture assessment • Aortic calcification score • pQCT radius • 4% • 50%

15. 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

16. 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

17. Flow Chart for processing of NSHD blood & urine samples (Dr Alison Lennox, MRC HNR)

18. 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 Expanding collaborations & capacity building

19. 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.

20. HALCyon cohorts

21. FALConFunction 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.

22. 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.

23. 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

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