Excess Mortality

Question 1

What is the Glasgow effect?

Answer 1

Life expectancy is generally improving but is consistently worse in Glasgow compared to other European cities. This rate is still higher when controlled for deprivation.

Question 2

What are Glasgow’s biggest killers?

Answer 2

Cardiovascular disease/stroke, cancer,
type two diabetes, alcohol/drugs, suicide. Many of these are related to poverty and social deprivation.

Question 3

What are the determinants of health?

Answer 3

The personal, social, economic and environmental factors which effect health. Genetics and lifestyle factors play the biggest role but a individuals social and community networks, and the environment they live in or grew up in play a role.

Question 4

Why is social deprivation thought to be driving its low life expectancy in Scotland?

Answer 4

Scotland has higher social deprivation than England and Wales.

Question 5

What conclusions can we draw from a variable associated with a disease?

Answer 5

Each may cause the other or a third independent factor could be influencing both.

Question 6

What is a risk factor, and what is the difference between a modifiable and non modifiable risk factors?

Answer 6

A risk factor is something that increases the chance of developing a health condition, can be modifiable meaning it can be changed: smoking, weight, or non-modifiable meaning it cant be changed: age, family history.

Question 7

What is meant by the term health?

Answer 7

Health is defined as a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity. (WHO)

Question 8

Why does the WHO’s definition of health face criticism?

Answer 8

It is impossible to retain this over the course of your whole life, nobody is healthy all the time. Implies people are unhealthy most of the time.

Question 9

How does WHO’s definition of health allow pharmaceutical companies to benefit?

Answer 9

Seeing as the requirement for health leaves most people unhealthy all the time, this allows pharmaceutical. It allows drugs to be created for conditions not previously defined as health problems and leads to the medicalization of society.

Question 10

Why may WHO’s definition be outdated with current developments in health?

Answer 10

The nature of disease in more developed countries has changed in the last 50 years. When the definition was created infectious diseases were the primary cause of mortality, but now lifestyle related chronic conditions have the highest mortality rates. Many people with chronic illnesses can function normally, but WHO labels them as always ill.

Question 11

Why is it hard to measure health with WHO’s definition?

Answer 11

A complete state of health is not measurable, this is the reference state so it is hard to classify who exactly is healthy and who isn’t.

Question 12

What is an alternative, more relevant definition of health?

Answer 12

The ability to adapt and to self manage. This relates to resilience or capacity to cope with challenges, including illness.

Question 13

What are the three domains of health?

Answer 13

1. Physical health
2. Mental health
3. Social health

Question 14

What is meant by physical health?

Answer 14

An individuals ability to cope with physiological stress using protective responses. The ability to maintain homeostasis is the body. A healthy individual should be able to mount a protective response against a physiological stressor and avoid or reduce illness.

Question 15

What is meant by mental health?

Answer 15

The ability to cope and recover from psychological stress. The ability to manage difficult situations and maintain a state of coherence. A healthy individual should have control over cognitive-emotional functioning in demanding situations.

Question 16

What is meant by social health?

Answer 16

Peoples capacity to fulfil their potential and obligations. The standard level interpersonal functioning. A healthy individual should be able to work, and manage their life with some degree of independence.

Question 17

What is the number one killer?

Answer 17

Ischemic heart disease is the number one killer in the world and in the UK,

Question 18

Why is life expectancy much lower in deprived areas in cities?

Answer 18

Higher levels of pollution, higher drug and alcohol use.

Question 19

What types of research evidence allows us to evaluate exposures on health?

Answer 19

1. Observational- measuring people within a population without changing any variables. This can establish associations between exposures and diseases.
2. Experimental- changing a variable and measuring the effect on individuals. This data can be used to establish causality.

Question 20

What is epidemiology?

Answer 20

The study of the distribution and determents of health and disease in a specified population, and how this can be applied to control health problems.

Question 21

What do ecological (correlational) studies show?

Answer 21

These study the association between two variables within populations. This type of research focuses on populations, not people e.g. air pollution and respiratory diseases across cities.

Question 22

What are cross-sectional surveys?

Answer 22

Cross sectional studies split a group of people into different levels of the exposure variable (physical activity) and measure an outcome (BMI). The exposure and outcome variables are measured simultaneously. This means you cannot determine causality from these studies as each variable could cause the other.

Question 23

What is a case-control study?

Answer 23

Comparing a group of people with a health condition to a group of healthy controls. These are useful for understanding rare health conditions and identifying risk factors associated with the disease. Multiple control groups can be used to eliminate confounding variables such as age or sex.

Question 24

What is a prospective cohort study?

Answer 24

Similar to a cross sectional study but follows different cohorts over a period of time to determine associations. This can help establish causality as exposure is measured before the outcome so outcome cant influence the exposure. A set period of time should be left between exposure measurement and observed measurement incase the outcome was already present.

Question 25

What are confounding variables?

Answer 25

A variable that we are not measuring which effects the result. A confounding variable effects both the exposure and observed variable. You can statistically adjust for confounding variables during analysis.

Question 26

What is reverse causality?

Answer 26

Reverse causality is when you expect one variable to cause the other but it is actually the opposite. This may occur when exposure and outcome variables are measured around the same time. Landmark analysis excludes a period of time after the initial measurement to minimize this.

Question 27

What is a randomized control trial?

Answer 27

A randomized control trial is when you randomize the exposures across a sample of people. This gets rid of sources of bias as confounders are equally distributed amongst the groups.

Question 28

What are the advantages and disadvantages of randomized control trials?

Answer 28

Randomized control trials get rid of confounders, can establish causality, is the gold standard. But is very expensive and time consuming to follow up individuals after a period of time, is not appropriate for all exposure variables (immoral to refuse treatment).

Question 29

How can inferred links help lower the time needed for a randomized control trial?

Answer 29

A related factor can be used to infer a link and lower the overall time and cost of the experiment. For examples if lower blood pressure is known to reduce risk of CVD, and you establish a causal link between increased physical activity and lower blood pressure, you can conclude that increasing physical activity decreases CVD risk. This is quicker and easier to measure.

Question 30

Why are associated risk factors dangerous?

Answer 30

Associated risk factors, such as smoking and BMI, are dangerous as combining risk factors accumulates total risk of diseases.

Question 31

What are examples of non-modifiable risk factors and how can these be controlled?

Answer 31

Genetics, sex, ethnicity, age, family history. Non-modifiable risk factors cant be changed but they can have their effect reduced by making lifestyle changes.

Question 32

What genes are typically related to genetic diseases?

Answer 32

Genes that are related to lifespan are typically also related to genetic diseases.

Question 33

What is the FTO gene?

Answer 33

The FTO gene is a genotype related with a higher body weight as it is responsible for secreting the hunger hormone. People with these allele produce more hunger hormone, so typically eat more calories a day. This is an example of a gene which has an effect on another risk factor.

Question 34

What is the biggest non-modifiable risk factor of disease?

Answer 34

Aging is the biggest non-modifiable risk factor- 85% of deaths are attributed to this. People age at different rates so not completely related to years old.

Question 35

What is meant by aging popuation?

Answer 35

Healthcare is improving and elderly people are living longer. There is a decline in young people being born meaning there are more people unable to work and more elderly people to look after. The focus has shifted towards increasing healthy life expectancy.

Question 36

What are blue zones?

Answer 36

Blue zones are areas where life expectancy is abnormally high. People who are born there and live there tend to live longer. This is mainly in areas with a plant based diet and low meat intake.

Question 37

What type of diseases are strongly related with aging?

Answer 37

Non-communicable diseases that cannot be spread e.g. dementia.

Question 38

Why do woman tend to live longer than men?

Answer 38

Men have a higher risk than woman for many mortality related conditions e.g. CVD. Men store fat in the center of the body close to all the organs where as woman store fat in the hips so have less chance of damaging organs.

Question 39

How can family history impact disease risk?

Answer 39

For some diseases, you are at more risk of developing the disease is a close relative has been diagnosed with this young e.g. 7% increased CVD risk by 85 with family history.

Question 40

How can ethnicity impact disease risk?

Answer 40

Some ethnicities are at higher risk of certain diseases such as diabetes than others. This can be partially related to where fat is stored in the body depending on race. This risk can be negated by living a healthy lifestyle.

Question 41

How is socioeconomic status a risk factor of health and disease?

Answer 41

Socioeconomic status is linked to many other risk factors such as tobacco and alcohol consumption, physical inactivity, poor sanitation, bad environment.

Question 42

How can socioeconomic status be measured?

Answer 42

The Carstairs index is tool which looks at 4 indicators of deprivation: male unemployment, lack of car ownership, overcrowding in households and low occupational social class.

Question 43

What are the advantages of the Carstairs index?

Answer 43

This tool is simple and doesn't include health so can be used to measure health data, but is slightly outdated as people may chose to not own a car and many females are employed as the primary contributor.

Question 44

Why may it be difficult to compare the socioeconomic status of different places in the uk?

Answer 44

Each different nation has different indices for socioeconomic deprevation.

Question 45

What is socioeconomic status the biggest risk factor for?

Answer 45

Socioeconomic status has a positive correlation with ischemic heart disease. This may be due to an increased smoking and alcohol consumption.

Question 45

Which areas have the highest prevalence of smoking in?

Answer 45

The most deprived areas have the highest smoking prevalence- Scotland has the most lung cancer deaths in Europe which are still increasing, possibly due to a lag effect.

Question 46

How can quitting smoking decrease risk of disease?

Answer 46

Risk of developing many diseases reduces back to almost baseline over 15 years.

Question 47

How is tobacco use being discouraged?

Answer 47

No smoking indoors, increasing the price of tobacco, age limit on purchase, advertisement and marketing restrictions.

Question 48

How does alcohol use compare between the most and least deprived areas?

Answer 48

Overall, alcohol consumption in the uk is decreasing. The least deprived areas have the higher amount of people exceeding the alcohol guidelines but by a much lower amount than in less deprived areas.

Question 49

What is being done to limit the consumption of alcohol?

Answer 49

Minimum unit pricing, age limit on sales, information of healthy alcohol consumption- no more than 14 units a week spread across three days.

Question 50

What is the main disease caused by alcohol?

Answer 50

Liver disease is the main disease associated with alcohol use. The liver is damaged from excessive alcohol consumption. Alcohol consumption is also linked to a higher rate of CVD, even at very low levels consumption.

Question 51

What are examples of behavioral risk factors of disease?

Answer 51

Physical inactivity, diet, smoking, alcohol consumption, sleep.

Question 52

What is the definition of exercise and how does this relate to mortality rate?

Answer 52

Exercise is a subcomponent of physical activity, it is planned structured and repetitive bodily movements done to improve or maintain components of physical fitness. The more exercise you do, the lower your mortality rate is.

Question 53

What is physical activity and how does this relate to mortality rate?

Answer 53

Physical activity is any bodily movement produced by skeletal muscles that results in energy expenditure. Physical inactivity causes more deaths than smoking. Physical activity is often described as a miracle treatment, as important as medicines, due to the amount of stuff it treats.

Question 54

What are the current physical activity guidelines?

Answer 54

At least: 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity a week. 2 sessions of muscle strengthening a week Minimize sedentary time Activities to improve balance

Question 55

What is the difference between moderate and vigorous physical activity?

Answer 55

One MET is the energy expenditure at rest. 3-6 METs is moderate physical activity- walking 6+ METs is vigorous physical activity- running

Question 56

Why is the guidelines only 150 minutes a week?

Answer 56

The biggest benefit of physical activity comes from doing nothing to doing something- risk of mortality reduces at a lower rate as physical activity increases. A 30% reduced risk is associated with 150 minutes which only increases to 40% at 500 minutes a week.

Question 57

How can physical activity be measured?

Answer 57

Physical activity can be measured by using self-reported surveys or through accelerometers.

Question 58

Why are accelerometers a better measure of physical activity?

Answer 58

50% of the population met the guidelines when asked in a questionnaire, but when measured using an accelerometer, less than 10% met guidelines. Questionnaires may be inaccurate due to poor reporting.

Question 59

How do questionnaires negatively effect physical activity guidelines?

Answer 59

The actual physical activity to reduce mortality by a given percentage may be lower than in the guidelines due to inaccurate reporting of physical activity.

Question 60

What was the euro fit program?

Answer 60

The euro fit program was an effort to increase physical activity in middle aged men. This demographic was the most vulnerable to physical inactivity but is also difficult to reach. The program aimed to increase physical activity in this group through football- a working class sport which was an interest of many. This program didn't change physical activity drastically but still enough to cause changes.

Question 61

Why are strengthening exercises important and part of the guidelines?

Answer 61

Eventually humans reach a level of bone and muscle mass which is too low to perform daily tasks. The onset of this can be delayed by muscle strengthening exercises. The benefits are seen the most when done in unison with aerobic activity. Not many people know about this aspect of the guidelines, or complete it.

Question 62

Why is grip strength used to measure muscle mass?

Answer 62

Grip strength is a good measure of overall muscular strength and is easy to measure using a small device. Low grip strength can indicate risk as great as other measures such as smoking and age.

Question 63

How are physical activity and strength related?

Answer 63

The lowered risk of mortality works best when these are done in unison, but it is more important for inactive people who are weak to get active than those that are strong. People with high strength and fitness appear to be protected when they are inactive.

Question 64

What is cardiorespiratory fitness?

Answer 64

The ability of the circulation and respiratory systems to supply oxygen to the skeletal muscles during sustained physical activity. This is a key component of overall fitness and gives indication of the condition of the heart.

Question 65

How does low cardiorespiratory fitness impact rats?

Answer 65

Rats bred for low cardiovascular fitness has increased insulin resistance and reduced lifespan. This is applicable to humans, as seen in a prospective cohort study, which found higher fitness had a 4.9% longer lifespan.

Question 66

Why is diet hard to measure?

Answer 66

Measuring someone's diet tends to change it. The guideline acts as an example to follow as a passive measure.

Question 67

What are the most consequential diets?

Answer 67

Diets high in sodium or diets low in whole grains. These are strongly related with CVD. Excessive intake of red meat, sugary drinks or processed meat. Or too little milk, nuts, fruit and veg, legumes.

Question 68

Why is information about the risk of physical inactivity so important?

Answer 68

A study found lifestyle interventions to be twice as effective as a drug.

Question 69

What is excess mortality?

Answer 69

The number of deaths during a certain period of time is higher than we would typically expect, based on pervious knowledge and data. Covid 19 is a good example of this- many more winter deaths due to the pandemic.

Question 70

How is obesity typically measured?

Answer 70

BMI is how obesity is described, it is a measure of how heavy you are compared to your height. Obesity can also be measured by waste circumference, which is strongly correlated with BMI. A waist circumference of 102 for men and 88 for woman is associated with obesity.

Question 71

What is the most accurate measure of obesity?

Answer 71

MRI scans are the most accurate but also most expensive measure of obesity, they can separate muscle and fat mass, and show where fat is being stored.

Question 72

Why is it important to use obesity measurements that are easily accessible to most of the population?

Answer 72

Collecting worldwide data on weight allows us to track if obesity is increasing, this is known as surveillance. BMI is the best measure of weight as it is simple and easily accessible. Obesity is a large risk factor for many diseases so it is important that it is easy to track and measure.

Question 73

How does the relationship between mortality risk and BMI change with age?

Answer 73

Older people may gain a slight protective effect from BMI, as the risk at higher BMI decreases. This may be to do with extra body reserves to help fight illness.

Question 74

What can be done do negate the risk effects of obesity?

Answer 74

Being overweight but maintaining a high level of physical activity negates the negative risk of being obese.

Question 75

What are the guideline of eating fruit and veg?

Answer 75

400g or 5 pieces of fruit and veg a day, however eating more fruit and veg than this will continue to lower the risk- it is just expensive and unattainable for most.

Question 76

Why are vegetables healthier than fruit?

Answer 76

Contain less sugar and calories and more healthy fibers.

Question 77

Why are ultra processed foods bad for you?

Answer 77

Ultra-processed foods are linked with obesity, they typically contain much higher levels of sodium to enhance their flavor.

Question 78

Why is ultra processed food more popular than natural food?

Answer 78

Ultra-processed food is much cheaper and easier to make than natural food, it is therefore very prevalent in the population.

Question 79

Can you counteract an unhealthy diet with exercise?

Answer 79

No, doing exercise will have some protective effects against a bad diet but always worse than a good diet.

Question 80

Does an unhealthy lifestyle have a larger impact on lower income areas?

Answer 80

Yes, people in deprived areas tend to experience worse health outcomes compared to those living in affluent areas even when following the same lifestyle.

Question 81

What are the main focuses of reducing excess mortality?

Answer 81

Reducing alcohol consumption- minimum unit pricing reduced death by 13.4% Banning tobacco to lower lung cancer deaths Reducing air pollution and plastic packaging waste to reduce microplastics. Microplastics increase risk of CVD. Reducing climate change to combat unpredictable weather

Question 82

Why is BMI effective even though it doesn't separate fat and muscle mass?

Answer 82

BMI assumes the population isn't full of athletes. A bigger mass typically means more fat.

Question 83

What are the different categories of BMI?

Answer 83

Under 18.5 = underweight Between 18.5 and 25 = normal Between 25-30 = Overweight Between 30-35 = Obese class 1 Between 35-40 = Obese class 2 Over 40 = Obese class 3 = Severe obesity

Question 84

What is the difference between white and brown adipose tissue?

Answer 84

White adipose tissue stores excess energy as fat, brown adipose tissue uses chemical energy to produce heat.

Question 85

What is the most significant factor when trying to lose weight?

Answer 85

Diet is the most significant factor, however diet plus exercise is the most effective strategy.

Question 86

What influences obesity?

Answer 86

There are many factors that influence obesity such as genetics, age, social influences, individual psychology, food consumption and food production.

Question 87

What is the social ecological model?

Answer 87

A model which shows how a persons health can be influenced by a range of social and environmental factors. At its core is individual, then interpersonal, institutional, community and public policy.

Question 88

What is an example of a health intervention at each level of the social ecological model?

Answer 88

Public policy: government introduce sugar tax Community: campaign to promote physical activity Institutional: university encouraging students to walk 10000 steps a day Interpersonal: intervention within a social circle Individual: focus on one to one behavioral changes to lose weight.

Question 89

Why is it important to encourage a low level of physical activity to everyone?

Answer 89

The same activity will have different effect on different groups of the population. Getting an obese person to do physical activity significantly reduces risk compared to an active person.

Question 90

Why is traditional weight loss not being targeted in interventions anymore?

Answer 90

By aiming for a typical 5-10% weight loss, there was limited success rate. Most people didn't lose much weight, didn't adhere to high levels of physical activity in the long term and often compensated by eating more.

Question 91

What is the emerging view of how we can achieve fight obesity epidemic?

Answer 91

The emerging view is to aim to improve health irrespective of weight loss, changing the body composition through lifestyle changes and ensuring distribution of fat is not increasing mortality.

Question 92

Why is improving health irrespective of weight loss effective?

Answer 92

Fitness is much more important than weight in mortality risk, leading to health benefits regardless of weight.

Question 93

How did a lab based study uncover why physical activity irrespective of weight loss reduces mortality risk?

Answer 93

A lab is a controlled environment where food and exercise can be controlled- this intervention is on an individual level. Energy expenditure was measured using doubly labeled water which is radioactively tagged to measure release of fluid. MRI showed the distribution of fat. An oral glucose tolerance test measured how much insulin was produced. The results showed that exercise can change your body fat distribution compared to diet even though weight loss across both these groups was roughly the same. Exercise without a focus on weight loss changes the body composition and reduces mortality risk.

Question 94

What is FFIT?

Answer 94

A similar program to euro fit, a cultural level intervention to lower weight of middle aged men. Men do not achieve the same results through typical health interventions so this brought men to professional football clubs to undergo a 12 week training program. This controlled food, physical activity and made the members aware of alcohol, and long term behavior change strategies such as self monitoring and coping with a relapse. This resulted in a 5kg weight loss even after 12 months.