Papers by Madhavi Bajekal
The following information contains new analysis of published data from the 1994 to 2002 Health Su... more The following information contains new analysis of published data from the 1994 to 2002 Health Surveys for England. The aim was to investigate any geographic variations from the national rates and to investigate whether trends for any SHAs differed from the national trends, and in particular to investigate whether there was a consistent pattern in relative rankings of SHAs over time and across health indicators.
The Actuary (2012), Oct 1, 2012
Widening inequalities have been observed not only for coronary Signs of maturity Lifestyle change... more Widening inequalities have been observed not only for coronary Signs of maturity Lifestyle changes and improvements in healthcare mean that deaths owing to heart disease continue to fall. Yet relative inequalities have widened. Dr Madhavi Bajekal investigates what growing old means for different social groups 01 OCT 2012 | DR MADHAVI BAJEKAL Photo: Ghetty Coronary heart disease (CHD) is the UK's biggest killer, resulting in two in five of all deaths, or 74,000 deaths in England in 2007. A third of these deaths occur between the ages of 75 and 84, with the remainder distributed fairly equally on either side of this peak. Age-adjusted CHD death rates have fallen by about 66% since 1981, which is estimated to have contributed about half of the increase in adult life expectancy in England over the latter half of the 20th century. Previous research by Unal B, Critchley J, Capewell S, 2004 (circ.ahajournals.org/content/109/9/1101.full) examined the fall in CHD mortality between 1981-2000 and concluded that half of the fall was attributable to the net effect of lifestyle changes, with the uptake of new medical therapies for CHD (like statins and coronary artery-bypass graft) explaining another 40%. The remaining 10% was unexplained. These findings were replicated across a range of countries, including the US,
The following information contains new analysis of published data from the 1994 to 2002 Health Su... more The following information contains new analysis of published data from the 1994 to 2002 Health Surveys for England. The aim was to investigate any geographic variations from the national rates and to investigate whether trends for any SHAs differed from the national trends, and in particular to investigate whether there was a consistent pattern in relative rankings of SHAs over time and across health indicators.
This report presents findings of a review of survey estimates of the prevalence of disability in ... more This report presents findings of a review of survey estimates of the prevalence of disability in Britain and the definitions of disability used in government social surveys. The study examines the relative merits and methodological robustness of a variety of estimates of the prevalence of disability produced by surveys. The review involved: A technical review of the existing surveys and estimates; A consultation exercise involving key stakeholders and users of disability estimates to explore their views on measurement and definitional issues of disability; An exploration of what might be done to ensure consistency over time of estimates and definitions of disability in Great Britain.
Journal of Epidemiology & Community Health, 2010
prevalence was 5.8% (3.9e7.7%) among all those with no qualifications and the SII had increased f... more prevalence was 5.8% (3.9e7.7%) among all those with no qualifications and the SII had increased from 1.0, in 1995, to 3.9; (from 1.8 to 5.1 among women). The prevalence of obesity increased across the surveys with minimal change in the inequality gap. among those with no qualifications the prevalence increased from 23.3% (21.2e25.3%) at baseline to 31.2% (26.5e35.8%) in 2008. In the corresponding years the SII for obesity had increased from 10.7 to 13.0. Difficulties in reporting alcohol consumption trends arise from changes in recording practices between surveys; approaches will be presented. Conclusions Individuals of lower socioeconomic status continue to carry the heaviest burden of CVD risk factors. There has been little, if no reduction in the inequality gap over time; indeed for some factors it may be growing.
SSM Annual Scientific Meeting
North American Actuarial Journal
British Actuarial Journal, 2012
Assessing longevity risk is crucial to the financial management of annuities and longevity-relate... more Assessing longevity risk is crucial to the financial management of annuities and longevity-related financial instruments. Actuaries have been using socio-economic circumstances (SEC) of individuals estimated through postcodes, pension size and occupation to price annuities for prospective customers. Differences in mortality rates of people in different SEC have been discussed extensively but less is known about how their mortality rates have changed over time.A lack of regular, consistent and credible mortality data for people in different SEC has hampered the study of historical mortality trends. This in turn has made forecasting a greater challenge. To address some of these data issues, we have obtained mortality and population data between 1981 and 2007 for England, divided into SEC quintiles (measured by the relative deprivation of the area of residence according to the Index of Multiple Deprivation (IMD) 2007). Using the data, we have analysed the mortality trends by SEC. These...
This study is an attempt to examine agrarian production in eighteenth century eastern Rajasthan a... more This study is an attempt to examine agrarian production in eighteenth century eastern Rajasthan at two levels. First, we attempt to establish the chronology of the trends in major indices of agricultural production using the annual revenue records of six representative qasbas or townships. The wealth of varied data available in the revenue and related records of the eighteenth century Jaipur state made it possible to estimate trends in the size of the agricultural product, the variations in cropping patterns and the secular movements of foodgrain prices. Second, a primary concern of the thesis has been to locate the secular trends in production within the context of the interaction between the state and the agrarian production system. A discussion of the environmental context of agriculture in the region leads to an analysis of the logic of the system of taxation that these realities predicated. The complexities of the functioning of the socio-economic system have been analysed by a...
The 2001 Health Survey for England (HSE01) consists of a general population sample and is designe... more The 2001 Health Survey for England (HSE01) consists of a general population sample and is designed to provide data at both national and regional level about the population living in private households in England. All private households in the general population sample are eligible for inclusion in the survey (up to a maximum of three households per address). Up to two children aged 0-15 are interviewed in each household, as well as up to 10 adults aged 16 and over. Information was obtained directly from persons aged 13 and over. Information about children under 13 was obtained from a parent with the child present.<br> An interview with each eligible person was followed by a nurse visit both using computer assisted interviewing. The survey is conducted throughout the year to take into consideration seasonal differences.<br> <br> For the third edition (April 2010), three new children's Body Mass Index (BMI) variables have been added to the individual data file (b...
Studies in health technology and informatics, 2020
Multimorbidity is a major problem for patients and health services. However, we still do not know... more Multimorbidity is a major problem for patients and health services. However, we still do not know much about the common trajectories of disease accumulation that patients follow. We apply a data-driven method to an electronic health record dataset (CPRD) to analyse and condense the main trajectories to multimorbidity into simple networks. This analysis has never been done specifically for multimorbidity trajectories and using primary care based electronic health records. We start the analysis by evaluating temporal correlations between diseases to determine which pairs of disease appear significantly in sequence. Then, we use patient trajectories together with the temporal correlations to build networks of disease accumulation. These networks are able to represent the main pathways that patients follow to acquire multiple chronic conditions. The first network that we find contains the common diseases that multimorbid patients suffer from and shows how diseases like diabetes, COPD, c...
Journal of Epidemiology & Community Health, 2014
ABSTRACT Background Between 2000 and 2010, coronary heart disease (CHD) mortality rates in Scotla... more ABSTRACT Background Between 2000 and 2010, coronary heart disease (CHD) mortality rates in Scotland fell by over one third. Important contributions came from reductions in blood pressure and serum cholesterol (primary prevention). However, the relative contributions from preventive medications (anti-hypertensives and statins) in individuals and from population-wide dietary changes remain unclear. We therefore examined the impact of differential effects on health inequalities. Methods We used the previously validated IMPACTsec model to estimate the contributions of population-level risk factor changes and treatment changes to the CHD mortality decline in Scotland between 2000 and 2010 for adults aged over 25. Data were stratified using the Scottish Index of Multiple Deprivation (SIMD), a small area measure of deprivation. Model outputs were quantified as deaths prevented or postponed (DPPs) by each intervention. Sensitivity analyses were conducted using Ersatz-based Monte Carlo simulations. Results Between 2000 and 2010, 5770 fewer CHD deaths than expected occurred in Scotland; an estimated 3570 (62%) were attributable to reductions in blood pressure and serum cholesterol. Declines in blood pressure were responsible for approximately 2285 DPPs (minimum estimate 1630, maximum estimate 2915). The vast majority (2130 DPPs) came from population-wide blood pressure falls, with bigger absolute mortality decreases in the most deprived quintile compared with the least deprived (460 vs. 340 DPPs respectively); relative contributions were similar (37.2% and 37.5%). Anti-hypertension medications resulted in only 155 fewer deaths, with similar DPPs in the most (35) and least (30) deprived quintiles. Reductions in serum cholesterol resulted in 1280 fewer deaths; approximately 515 of these were attributable to population-wide changes in diet with more deaths prevented in the most deprived quintile compared with the least deprived (170 vs. 45 DPPs; relative contribution 13.8% and 4.7%). Conversely, approximately 770 fewer deaths were attributable to statin use, with very similar absolute numbers of deaths prevented in most (140) and least (140) deprived quintiles, but relatively greater contributions in the least deprived (15.4% vs 11.2%). Statin uptake was higher in the most deprived areas (17% vs 13.2%). Conclusion Population-wide falls in blood pressure helped to reduce CHD mortality; however the benefit from hypertension treatment was small. Improved diet and statins for high-risk individuals both made important contributions to the fall in population cholesterol. Population-wide falls in blood pressure and reductions due to medical treatments for hypertension were equitable between socio-economic groups. Higher socio-economic groups appeared to benefit more from statins, probably due to better compliance; this may perpetuate inequalities.
1.1 Overall aims of the project..................................................................... more 1.1 Overall aims of the project.............................................................................. 6
Journal of Epidemiology & Community Health, 1997
Objective-To describe the areas affected and the scale of an epidemic of thunderstorm associated ... more Objective-To describe the areas affected and the scale of an epidemic of thunderstorm associated asthma on the night of24125 June 1994 and to explore the spatial and temporal relationship between the thunderstorm and the associated epidemic. Setting-The 29 offices ofa deputising service for general practitioners' (GP) out of hours calls (Healthcall). At the time of the storm the deputising service provided out of hours cover for about 8500 out of about 30 000 GPs in England, Scotland, and
Evidence-based Healthcare, 2002
Uploads
Papers by Madhavi Bajekal