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Biomedical subjects

Julia Hippisley-Cox

Publications and source records attributed to Julia Hippisley-Cox.

At least 19 recordsLinked to original sources
PubMed2026

Factors Associated With Menopause Symptoms: A Systematic Review and Meta-Analysis.

BACKGROUND: Menopause, marked by hormonal decline and menstrual cessation, is associated with various symptoms. Socio-demographic and behavioural factors may influence symptom type and severity. Understanding these associations can inform better symptom management. OBJECTIVES: To identify factors associated with the presence and severity of menopausal symptoms through systematic review and meta-analysis. SEARCH STRATEGY: We searched Medline, Embase, CINAHL and Cochrane for studies on demographic, behavioural, or health factors linked to vasomotor, vaginal dryness and joint symptoms in women aged 40-60. SELECTION CRITERIA: Studies reporting odds ratios or raw numbers for symptom presence or severity were included. DATA COLLECTION AND ANALYSIS: Studies were combined for meta-analysis, reporting odds ratios and 95% confidence intervals. Quality assessment was performed to quantify the risk of bias. RESULTS: Of 9228 screened articles, 61 were meta-analysed. Compared with White women, Black women had higher odds of vasomotor symptom presence (OR 1.65, 1.41-1.94) and severity (OR 1.91, 1.10-3.29), and vaginal dryness presence (OR 1.27, 1.10-1.47), while Asian had lower vasomotor symptom presence and severity (OR 0.40, 0.22-0.72; OR 0.55, 0.53-0.56). Higher education (OR 1.31, 1.09-1.56), high income (OR 1.41, 1.01-1.97) and depression (OR 2.36, 1.51-3.70) were associated with increased presence of vasomotor symptoms. Smoking and obesity were associated with both presence (OR 1.63, 1.30-2.04 and 1.35, 1.02-1.78) and severity (OR 1.56, 1.07-2.27 and 1.42, 1.11-1.83) of vasomotor symptoms. CONCLUSION: Socio-demographic and behavioural factors, including ethnicity, education, income, smoking, obesity and depression, influence menopausal symptoms, highlighting the need for personalised care. TRIAL REGISTRATION: PROSPERO number: CRD42023459154.

Humans↗
PubMed2006

Developing a national primary care-based early warning system for health protection--a surveillance tool for the future? Analysis of routinely collected data.

The increasing threat of infections with pandemic potential such as influenza has focussed attention on the information needed to inform those managing a pandemic. The Health Protection Agency, Nottingham University and EMIS have developed a new national health protection surveillance system using QRESEARCH, an established primary care-derived database, to provide timely and local information on trends in community illness and prescribing. This article describes the first year of the surveillance project. Data on consultations and prescribing were extracted from routinely generated computerized consultation records between November 2004 and December 2005. Weekly consultation and prescribing rates for a range of conditions including influenza-like illness and prescription of anti-viral drugs for influenza and vomiting were developed as 'key indicators'. These indicators were presented in a weekly bulletin showing data to strategic health authority level for use by those working in public health. The particular value of this scheme is the ability to produce timely data on illness to local level and to link prescribing to morbidity. The data were used 'real time' to reassure about lack of illness following the Buncefield Fuel Depot incident. This scheme is being further developed to provide daily local influenza-related information needed in an influenza pandemic.

Ambulatory Care Information Systems↗
PubMed2006

Sex inequalities in access to care for patients with diabetes in primary care: questionnaire survey.

BACKGROUND: Health experiences differ between men and women. The health services have focused their attention on gynaecological health problems in women, however women with non-gynaecological health problems could be unintentionally neglected. Given the increased prevalence of diabetes, the healthcare needs and experiences of women with diabetes are increasing. AIM: To determine the extent of sex inequalities in access to care for diabetes in primary care. DESIGN OF STUDY: Cross-sectional population-based questionnaire study. SETTING: Twenty-three general practices spread through 23 different primary care trusts in the former Trent Region, UK. METHOD: The study consisted of a random sample of 1,673 patients with diabetes. Outcomes measured were odds ratios adjusted for age for measures of physical access to the GP's surgery; ease of obtaining appointments; access to primary care professionals; levels of routine diabetes care received; barriers to physical activity, problems eating and psychological distress as measured by the 18 score Diabetes Health Profile. RESULTS: Women were less likely than men to report that they had talked to their GP or practice nurse about their diabetes in the previous 12 months and were less likely to report that they were able to book routine appointments at convenient times. Almost 40% of all patients with diabetes reported difficulty in visiting the GP's surgery for their diabetes care, and women were more likely to report difficulties in visiting the surgery than men. Women were more likely than men to be afraid to go out alone (7.9% versus 3.6%) and more likely to be housebound (6.8% versus 2.4%). Women had significantly higher scores for eating problems and barriers to physical activity than men. CONCLUSIONS: Women report more problems with access to diabetes care than men. If the ambitions of the National Service Framework are to be met, then positive action needs to be taken to improve access to care for women with diabetes.

Aged↗
PubMed2006

General practice characteristics associated with rates of testing and detection of hepatitis C: cross-sectional study in Nottingham and Derbyshire.

The aim of this study was to determine general practice characteristics associated with testing rates for hepatitis C virus (HCV) and the proportion of tests with a positive result. The study included all patients tested for HCV from all general practices in the primary care trusts in Nottingham and Southern Derbyshire, UK over 2 years. There was a large variation between practices in HCV testing rates and the proportion of positive tests. Single-handed practices had higher testing rates and rates of positive results. Practices where at least half of the GPs were female had higher testing rates but lower positivity rates. The variation observed was not explained by deprivation or rurality of the practice.

Adult↗
PubMed2005

Risk of adverse gastrointestinal outcomes in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis.

OBJECTIVE: To determine the risk of an adverse upper gastrointestinal event in patients taking different cyclo-oxygenase-2 inhibitors compared with non-selective non-steroidal anti-inflammatory drugs. DESIGN: Nested case-control study. SETTING: 367 general practices contributing to the UK QRESEARCH database, spread throughout every strategic health authority and each health board in England, Wales, and Scotland. PARTICIPANTS: Patients aged 25 or more with a first ever diagnosis of an adverse upper gastrointestinal event (peptic ulcer or haematemesis) between 1 August 2000 and 31 July 2004 and up to 10 controls per case matched for age, sex, calendar time, and practice. MAIN OUTCOME MEASURES: Unadjusted and adjusted odds ratios for adverse upper gastrointestinal events associated with celecoxib, rofecoxib, ibuprofen, diclofenac, naproxen, other selective and non-selective non-steroidal anti-inflammatory drugs, and aspirin. RESULTS: The incidence of adverse upper gastrointestinal events was 1.36 per 1000 person years (95% confidence interval 1.34 to 1.39). We identified 9407 incident cases and 88 867 matched controls. Increased risks of adverse gastrointestinal events were associated with current use of cyclo-oxygenase-2 inhibitors and with conventional non-steroidal anti-inflammatory drugs. Risks were reduced after adjustment for confounders but remained significantly increased for naproxen (adjusted odds ratio 2.12, 95% confidence interval 1.73 to 2.58), diclofenac (1.96, 1.78 to 2.15), and rofecoxib (1.56, 1.30 to 1.87) but not for current use of celecoxib (1.11, 0.87 to 1.41). We found clinically important interactions with current use of ulcer healing drugs that removed the increased risks for adverse gastrointestinal events for all groups of non-steroidal anti-inflammatory drugs except diclofenac, which still had an increased odds ratio (1.49, 1.26 to 1.76). CONCLUSION: No consistent evidence was found of enhanced safety against gastrointestinal events with any of the new cyclo-oxygenase-2 inhibitors compared with non-selective non-steroidal anti-inflammatory drugs. The use of ulcer healing drugs reduced the increased risk of adverse gastrointestinal outcomes with all groups of non-steroidal anti-inflammatory drugs, but for diclofenac the increased risk remained significant.

Adult↗
PubMed2005

Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis.

AIMS: To determine the comparative risk of myocardial infarction in patients taking cyclo-oxygenase-2 and other non-steroidal anti-inflammatory drugs (NSAIDs) in primary care between 2000 and 2004; to determine these risks in patients with and without pre-existing coronary heart disease and in those taking and not taking aspirin. DESIGN: Nested case-control study. SETTING: 367 general practices contributing to the UK QRESEARCH database and spread throughout every strategic health authority and health board in England, Wales, and Scotland. SUBJECTS: 9218 cases with a first ever diagnosis of myocardial infarction during the four year study period; 86 349 controls matched for age, calendar year, sex, and practice. OUTCOME MEASURES: Unadjusted and adjusted odds ratios with 95% confidence intervals for myocardial infarction associated with rofecoxib, celecoxib, naproxen, ibuprofen, diclofenac, and other selective and non-selective NSAIDS. Odds ratios were adjusted for smoking status, comorbidity, deprivation, and use of statins, aspirin, and antidepressants. RESULTS: A significantly increased risk of myocardial infarction was associated with current use of rofecoxib (adjusted odds ratio 1.32, 95% confidence interval 1.09 to 1.61) compared with no use within the previous three years; with current use of diclofenac (1.55, 1.39 to 1.72); and with current use of ibuprofen (1.24, 1.11 to 1.39). Increased risks were associated with the other selective NSAIDs, with naproxen, and with non-selective NSAIDs; these risks were significant at < 0.05 rather than < 0.01 for current use but significant at < 0.01 in the tests for trend. No significant interactions occurred between any of the NSAIDs and either aspirin or coronary heart disease. CONCLUSION: These results suggest an increased risk of myocardial infarction associated with current use of rofecoxib, diclofenac, and ibuprofen despite adjustment for many potential confounders. No evidence was found to support a reduction in risk of myocardial infarction associated with current use of naproxen. This is an observational study and may be subject to residual confounding that cannot be fully corrected for. However, enough concerns may exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs.

Adult↗
PubMed2005

Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis.

OBJECTIVE: To determine the effect of combinations of statins, aspirin, beta blockers, and angiotensin converting enzyme inhibitors in the secondary prevention of all cause mortality in patients with ischaemic heart disease. DESIGN: Open prospective cohort study with nested case-control analysis. SETTING: 1.18 million patients registered with 89 general practices across 23 strategic health authority areas within the United Kingdom. Practices had longitudinal data for a minimum of eight years and were contributing to QRESEARCH, a new database. PATIENTS: All patients with a first diagnosis of ischaemic heart disease between January 1996 and December 2003. Cases were patients with ischaemic heart disease who died. Controls were patients with ischaemic heart disease who were matched for age, sex, and year of diagnosis and were alive at the time their matched case died. MAIN OUTCOME MEASURES: Odds ratio with 95% confidence interval for risk of death in cases compared with controls. Exposure was current use of different combinations of statins, aspirin, beta blockers, and angiotensin converting enzyme inhibitors before death in cases, or the equivalent date in controls. RESULTS: 13,029 patients had a first diagnosis of ischaemic heart disease (incidence rate 338 per 100,000 person years). 2266 cases were matched to 9064 controls. Drug combinations associated with the greatest reduction in all cause mortality were statins, aspirin, and beta blockers (83% reduction, 95% confidence interval 77% to 88%); statins, aspirin, beta blockers, and angiotensin converting enzyme inhibitors (75% reduction, 65% to 82%); and statins, aspirin, and angiotensin converting enzyme inhibitors (71% reduction, 59% to 79%). Treatments associated with the smallest reduction in all cause mortality were beta blockers alone (19% reduction, 37% reduction to 4% increase), angiotensin converting enzyme inhibitors alone (20% reduction, 1% to 35%), and combined statins and angiotensin converting enzyme inhibitors (31% reduction, 57% reduction to 12% increase). CONCLUSIONS: Combinations of statins, aspirins, and beta blockers improve survival in high risk patients with cardiovascular disease, although the addition of an angiotensin converting enzyme inhibitor conferred no additional benefit despite the analysis being adjusted for congestive cardiac failure.

Adrenergic beta-Antagonists↗
PubMed2005

A randomized controlled trial of the effect of providing information on accidental injury admissions and their costs to Primary Care Groups and Trusts.

BACKGROUND: Primary Care Groups and Trusts (PCG/Ts) are responsible for improving the health of local populations, but there is little evidence of their strategic involvement in accident prevention. OBJECTIVE: To determine the effect of providing information on local accidental injuries to PCG/Ts on the development of accident prevention strategies. METHODS: The study is a randomized controlled trial in PCG/Ts in the former Trent Region. Intervention PCG/Ts were sent profiles containing PCG/T specific information on hospital admissions for accidental injury and their costs and on accident prevention interventions. Health promotion leads were surveyed at baseline and three and fifteen months. The primary outcome was whether the PCG/T had a written accident prevention strategy. Secondary outcome measures included other accident prevention activities, prioritization of accident prevention, and knowledge and attitudes towards accident prevention. RESULTS: At three months 38% of PCG/Ts in the intervention arm had a written accident prevention strategy, compared with 42% in the control arm [difference -4%, 95% confidence interval (CI) -31% to 25%]. At fifteen months these values were 55% in the intervention arm and 50% in the control arm (difference 5%, CI -24% to 33%). There were no statistically significant differences between the groups for any outcome measures. CONCLUSIONS: Providing profiles containing information on accidental injuries to PCG/Ts did not significantly increase the development of accident prevention strategies, however this study only had sufficient power to detect substantial changes. Larger national studies would be required to detect moderate effects of tailored packages in changing PCG/T behaviour.

Accident Prevention↗
PubMed2005

Coronary heart disease prevention and age inequalities: the first year of the National Service Framework for CHD.

BACKGROUND: The National Service Framework for Heart Disease sets national standards and defines service models for coronary heart disease (CHD). Little is known about the impact of this intervention on age inequalities. AIM: To determine the changes in the uptake of coronary prevention measures before and after the first year of implementation of the National Service Framework for Coronary Heart Disease, and to compare these changes in uptake of coronary prevention in patients aged 75 years and over with younger patients. DESIGN OF STUDY: Repeated cross-sectional survey using routinely collected data. SETTING: Seventeen general practices in 17 primary care groups in the Trent Region. METHOD: All registered patients at baseline and follow-up aged >/=35 years were categorised into three groups: those with either coronary heart disease or a history of stroke; those with diabetes or hypertension who were not in in the first group; and the remaining population. Data from electronic records was collected to show differences in the proportions of patients with coronary risk factors recorded in the previous year. Data was also collected about differences in the proportions of patients with adequate disease control measures. RESULTS: Improvements were demonstrated in the recording of coronary risk factors and of disease control measures. However, compared with patients aged <75 years, older patients were significantly less likely to have a serum cholesterol level recorded at baseline; to be on lipid lowering drugs; to be on beta blockers post myocardial infarction and to have well controlled blood pressure. These differences persisted at follow-up. CONCLUSION: There have been substantial improvements in both the recording of coronary risk factors and disease control measures following the implementation of the National Service Framework for Coronary Heart Disease. However, there needs to be an effort to strengthen the focus on the care of older patients.

Adult↗
PubMed2004

Association of deprivation, ethnicity, and sex with quality indicators for diabetes: population based survey of 53,000 patients in primary care.

OBJECTIVES: To determine the effect of deprivation and ethnicity on the achievement of quality indicators for patients with diabetes and the extent of any inequalities between the sexes. DESIGN: Population based cross sectional survey using electronic general practice records. SETTING: 237 UK practices contributing to the QRESEARCH database. PARTICIPANTS: 54,180 patients with diabetes, derived from a population of 1.8 million patients. MAIN OUTCOME MEASURES: Adjusted odds ratios for 18 indicators for diabetes from the new general medical services contract for UK general practitioners and comparisons between patients from the most deprived and most affluent fifths (areas of high and low ethnicity) and between men and women. RESULTS: The prevalence of diabetes was 3.0%, and there was a large variation between practices in achievement of indicators. Compared with patients from affluent areas, those from deprived areas were less likely to have body mass index and smoking status recorded. They were also less likely to have records for HbA1c concentration; an HbA1c value < 7.5% or < 10%; retinal screening; blood pressure; testing for neuropathy or microalbuminuria, or flu vaccination. Compared with patients from areas of low ethnicity those from areas of high ethnicity were less likely to have many measures recorded. Women were significantly less likely to have records for body mass index; pulses; blood pressure values below 145/85 mm Hg; testing for microalbuminuria; serum cholesterol concentration; serum cholesterol values < 5 mmol/l; and angiotensin converting enzyme inhibitors given in the presence of proteinuria or microalbuminuria. CONCLUSIONS: Practices in areas of high deprivation and high ethnicity will have to work harder to achieve the quality indicators for diabetes, and it is possible that those practices that most need the resources are the ones least likely to get them.

Adolescent↗
PubMed2003

The electronic patient record in primary care--regression or progression? A cross sectional study.

OBJECTIVES: To determine whether paperless medical records contained less information than paper based medical records and whether that information was harder to retrieve. DESIGN: Cross sectional study with review of medical records and interviews with general practitioners. SETTING: 25 general practices in Trent region. PARTICIPANTS: 53 British general practitioners (25 using paperless records and 28 using paper based records) who each provided records of 10 consultations. MAIN OUTCOME MEASURES: Content of a sample of records and doctor recall of consultations for which paperless or paper based records had been made. RESULTS: Compared with paper based records, more paperless records were fully understandable (89.2% v 69.9%, P=0.0001) and fully legible (100% v 64.3%, P < 0.0001). Paperless records were significantly more likely to have at least one diagnosis recorded (48.2% v 33.2%, P=0.05), to record that advice had been given (23.7% vs 10.7%, P=0.017), and, when a referral had been made, were more likely to contain details of the specialty (77.4% v 59.5%, P=0.03). When a prescription had been issued, paperless records were more likely to specify the drug dose (86.6% v 66.2%, P=0.005). Paperless records contained significantly more words, abbreviations, and symbols (P < 0.01 for all). At doctor interview, there was no difference between the groups for the proportion of patients or consultations that could be recalled. Doctors using paperless records were able to recall more advice given to patients (38.6% v 26.8%, P=0.03). CONCLUSION: We found no evidence to support our hypotheses that paperless records would be truncated and contain more local abbreviations; and that the absence of writing would decrease subsequent recall. Conversely we found that the paperless records compared favourably with manual records.

Adult↗
PubMed2003

Cross sectional survey of effectiveness of lipid lowering drugs in reducing serum cholesterol concentration in patients in 17 general practices.

OBJECTIVE: To compare the effectiveness of lipid lowering drugs in lowering serum cholesterol concentrations. DESIGN: Cross sectional study. SETTING: 17 practices within 17 primary care groups in Trent region, United Kingdom. PARTICIPANTS: Patients aged 35 years or over taking lipid lowering drugs and with at least two serum cholesterol concentrations recorded on computer. MAIN OUTCOME MEASURES: Proportion of patients achieving serum cholesterol concentration of < or =5 mmol/l and mean percentage reduction in serum cholesterol concentration. RESULTS: 1353 of 2469 (54.8%) patients receiving lipid lowering treatment had a last recorded serum cholesterol concentration of < or =5 mmol/l. Significantly more patients taking statins achieved the target value for serum cholesterol (5 mmol/l) than those taking fibrates (1307 (57%) v 46 (26%); P<0.0001). Atorvastatin and simvastatin were the most effective drugs in achieving the target. Significant differences were found between lipid lowering drugs for the pretreatment serum cholesterol concentration, the most recent cholesterol concentration, and the associated percentage reduction. Atorvastatin and simvastatin achieved the greatest percentage reduction in serum cholesterol concentrations (30.1%, 95% confidence interval 28.8% to 31.4%, and 28.0%, 26.7% to 29.3%, respectively). Although the mean serum cholesterol concentrations in this unselected population tended to be higher than those in clinical trials, the percentage reduction was consistent with the trials. CONCLUSION: The ability of individual statins to lower serum cholesterol concentration varied, with atorvastatin and simvastatin being the most effective. The percentage reductions agreed with those of randomised controlled trials indicating likely benefits in unselected patients in primary care. As the initial serum cholesterol concentrations were higher than those in randomised controlled trials, target serum cholesterol values of < or =5 mmol/l may be unrealistic even for patients taking the most efficacious drugs. Also, the higher initial levels could mean that the absolute reduction in cardiovascular risk in primary care patients is greater than thought.

Adult↗
PubMed2003

Accidental injury: a neglected area within Primary Care Groups and Trusts?

Our objective was to assess accidental injury prevention activity within Primary Care Groups/Trusts (PCG/Ts), and current knowledge and attitudes towards accidental injuries and their prevention amongst PCG/T board members. We used a cross-sectional postal questionnaire survey design. Participants were board members of 51 PCG/Ts in Trent. The main outcome measures were prioritization of accidental injury prevention and factors influencing prioritization, perceptions of the accidental injury rates in the population served by the PCG/T, accidental injury prevention activity undertaken by the PCG/T, attitudes towards accidental injury prevention and towards the PCG/Ts involvement in accidental injury prevention, knowledge of accidental injury mortality, and beliefs in the effectiveness of interventions. Many (66%) PCG/T board members see accident prevention as the least important of the priority areas in the Government's health strategy for England. Half the PCG/Ts (49%) had formally discussed accidents at a PCG/T meeting, 34% had taken action and 29% had written an accident prevention strategy. The median number of agencies PCG/Ts were working with on accident prevention was 2. GPs held less positive attitudes about accident prevention than other board members (Z = -10.01, P < 0.001), but had a greater knowledge about injury mortality (Z = -3.92, P < 0.001). Health promotion leads had more positive attitudes towards accident prevention than other board members (Z = -3.70, P < 0.001). There were misconceptions amongst health promotion leads about the effectiveness of some accident prevention interventions. We conclude that there is little evidence of prioritization of accidents as an area for health improvement. Although some PCG/Ts are undertaking accidental injury prevention, a minority have demonstrated strategic planning with respect to accident prevention or collaboration with a wide range of agencies. Accident prevention and the PCG/Ts role within this are not viewed positively by all board members. Gaps in knowledge about accidents and their prevention are apparent. PCG/Ts will need help and support to fully develop their potential in preventing accidental injuries.

Accident Prevention↗
PubMed2003

A case-control study on the effect of hormone replacement therapy on ischaemic heart disease.

BACKGROUND: Many clinicians believe that hormone replacement therapy (HRT) protects against coronary heart disease (CHD) in women. However, recent reports have cast some doubt on this because of lack of dose-response or duration-response effects. Since CHD is common in women--about half of all postmenopausal women will get it and about a third of these will die from it--the effect of HRT on CHD is of great public health importance. AIM: To determine the degree of cardioprotection conferred by HRT, including the effect of duration, time since last issue, the addition of progestogens, route of administration, and dose. DESIGN: Population-based case-control study. SETTING: Nine general practices recruited from the Trent Focus Collaborative Research Network. METHOD: A total of 417 female cases with CHD matched by age and practice to 2435 controls with a case-control ratio of 1:5.8 were studied. The main outcome measure was the odds ratio for CHD calculated by conditional logistic regression adjusted for diabetes, hypertension, body mass index, and smoking. RESULTS: No evidence was found, either from univariate analysis or multivariate analysis, that use of HRT was associated with reduced risk of CHD (odds ratio = 1.32; 95% confidence interval = 0.93 to 1.87). Indeed, the trend was in the opposite direction. There was no association for different types of HRT (opposed or unopposed) or routes of administration. Similarly, there was no association for current or past use and no effect for dose or duration. CONCLUSION: This study adds to growing evidence that HRT does not confer cardioprotection. Until there is robust evidence to the contrary, general physicians need to assess risks and benefits of HRT independently of any possible reduction in risk of CHD.

Administration, Oral↗
PubMed2002

Married couples' risk of same disease: cross sectional study.

OBJECTIVE: To determine whether people whose marital partners have depression, diabetes, hypertension, ischaemic heart disease, stroke, hyperlipidaemia, peptic ulcer disease, or asthma or chronic obstructive pulmonary disease are at increased risk of the same disease. DESIGN: Cross sectional study. SETTING: 10 practices from the Trent Focus Collaborative Research Practice Network. PARTICIPANTS: 8386 married couples (16 772 individuals) from a population of 29 014 participants aged 30-74 years. OUTCOMES: Risk of disease in participants whose marital partner had that disease compared with those whose partner did not. RESULTS: After both partners' age, smoking, and obesity and which general practice they attend were adjusted for, participants whose marital partner had asthma, depression, hypertension, hyperlipidaemia, and peptic ulcer disease were at increased risk of having the same disease. The adjusted odds ratios were 1.69 (95% confidence interval 1.43 to 2.98) for asthma, 2.08 (1.71 to 2.54) for depression, 1.32 (1.04 to 1.67) for hypertension, 1.44 (1.19 to 1.75) for hyperlipidaemia, and 2.01 (1.48 to 2.73) for peptic ulcer disease. CONCLUSION: Partners of people with specific diseases are at increased risk of the disease themselves-at least 70% increased risk for asthma, depression, and peptic ulcer disease. This implicates shared environmental causes in some diseases in addition to any genetic or distant exposure or shared behaviours with respect to seeking health care.

Adult↗