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Reducing risk of hip fracture in women using data linkage.

PGR-P-733

Key facts

Type of research degree
PhD
Application deadline
Monday 1 June 2020
Project start date
Monday 5 October 2020
Country eligibility
UK and EU
Funding
Funded
Source of funding
Charity
Supervisors
Professor Janet Cade and Dr Darren Greenwood
<h2 class="heading hide-accessible">Summary</h2>

Dietary risk factors for hip fracture using the UK Women&rsquo;s Cohort Study (UKWCS) is the project focus. The UKWCS has followed ~35,000 women for &gt;20 years and is one of the largest and longest follow up studies of women with detailed dietary information. Active ageing depends on a variety of determinants including behavioural, physical, economic and social. Between the ages of 60 and 90 years, the incidence of osteoarthritis rises 20-fold in women as compared to 10-fold in men. Diet has been linked to hip fracture risk. This project will identify food, nutrient and socio-economic factors associated with incidence of hip fracture in the UKWCS. A recent, exciting development has allowed us to link the UKWCS to Hospital Episode Statistics (HES) data through the Consumer Data Research Centre in Leeds. HES use, to date, in cohort studies has been relatively limited; providing this project with an important opportunity to explore food choice behaviour in relation to incident hip fractures, for the first time, in a large UK cohort. The project will involve undertaking an umbrella review of risk factors for hip fracture; using the HES data to identify risk factors for hip fracture; explore variations in risk; develop a hip fracture risk prediction model. The resulting model will have the potential for use in policy development and planning decisions to reduce risk of hip fracture in older women in the community.

<h2 class="heading hide-accessible">Full description</h2>

<p><strong>Background</strong><br /> Active ageing depends on a variety of determinants including behavioural, physical, economic and social. These factors directly or indirectly affect well-being, the onset and progression of disease and how people cope with illness and disability. WHO report on Active Ageing in women calls for optimisation of opportunities for health to enhance quality of life as people age.</p> <p>Women have longer life expectancies than men. Non-communicable diseases, including heart disease and cancer, are leading causes of death and disability in women. Osteoarthritis and osteoporosis are associated with chronic pain, limited quality of life and disability. Between the ages of 60 and 90 years, the incidence of osteoarthritis rises 20-fold in women as compared to 10-fold in men. Diet has been linked to hip fracture risk. Higher protein intakes&nbsp;in elderly people is associated with lower risk. A higher adherence to a Mediterranean diet has been associated with lower risk of frailty&nbsp;and hip fracture. Adequate calcium and Vitamin D intake and combinations of various exercises may be preventive measures for osteoporosis in postmenopausal women. On the other hand, a higher dietary glycaemic index and load has been associated with increased risk of osteoporotic fractures. There is also substantial geographic heterogeneity in age and sex adjusted fracture incidence, with rates in Scotland almost 50% greater than those in London and South East England. Hip fracture is the most common serious injury in older people and costs the NHS and social care &pound;1 billion per year.</p> <p>The UK Women&rsquo;s Cohort Study (UKWCS) has followed ~35,000 women for over 20 years&nbsp;and is one of the largest and longest follow up studies of women with detailed dietary information. The aims of the UKWCS are to explore relationships between diet (including foods, nutrients, dietary supplements, dietary patterns and diet costs) and chronic disease. The baseline questionnaire included a range of socio-economic, lifestyle and health status questions. Detailed reproductive history; information on past health experience, sibling and parental health as well as physical activity assessment were obtained. A 217-item food frequency questionnaire was included, adapted for the large proportion of vegetarians included in this study. Initially, deaths and cancer registrations were linked to the cohort allowing us to study diet in relation to cancer outcomes.</p> <p>A recent, exciting development has allowed us to <strong>link the UKWCS to Hospital Episode Statistics (HES) </strong>data through the Consumer Data Research Centre in Leeds. The HES dataset offers a comprehensive resource for inpatient admissions, outpatient appointments and Accident &amp; Emergency attendance records in England. HES use, to date, in cohort studies has been relatively limited; providing this project with an important opportunity to explore food choice behaviour in relation to incident hip fractures, for the first time, in a large UK cohort.<br /> &nbsp;</p> <p><strong>Aims</strong></p> <ul> <li>To identify food, nutrient and socio-economic factors associated with incidence of hip fracture in the UKWCS.</li> <li>Implement a competing risks approach to extend survival analysis associating diet with hip fracture in this older cohort; acknowledging the likelihood of developing other conditions.</li> <li>Estimate wider population characteristics (such as income and place of residence) associated with hip fracture incidence in women across England.</li> <li>To develop a hip fracture prevention algorithm from the UKWCS, using factors identified in previous steps (diet, socio-economic, behavioural) by undertaking linear programming and tested in another cohort such as the UK Biobank.</li> </ul> <p><strong>Plan of work</strong><br /> 1. Umbrella review of risk factors for hip fracture<br /> With the increase in the number of systematic reviews available, a logical next step to provide decision makers in healthcare with the evidence is to conduct a review of existing systematic reviews. In this case, an umbrella review will be undertaken of reviews exploring risk factors (diet &ndash; foods, nutrients, patterns; social factors &ndash; housing, income, education; lifestyle factors &ndash; physical activity) associated with hip fracture risk.</p> <p>2. Identify risk factors for hip fracture from the UKWCS<br /> Using the new HES data linked to the UKWCS, survival analysis will be undertaken to explore food and nutrient intakes and dietary patterns in relation to risk of hip fracture. Other models will explore independent risks associated with the socio-economic characteristics of the women such as social class and education. We anticipate around 300,000 person years of follow up available, with an incidence of hip fractures of 155/10,000 person years in women &gt;50y&nbsp;this will result in around 4,650 hip fractures in the cohort. This will be one of the largest studies to explore this topic.<br /> We will extend the standard survival analysis approach to include competing risks methodology. This is being increasingly applied to cause of disease data as a way of obtaining &ldquo;real world&rdquo; probabilities of disease by specific causes. Competing risks are said to be present when an individual is at risk of more than one mutually exclusive event, such as a range of chronic diseases, and the occurrence of one of these will prevent any other event from ever happening. This information supports our understanding of risks for hip fracture faced by individuals according to their situation (eg. are they at greater risk of heart disease due to smoking habits; or accidents due to place of residence?)</p> <p>3. Explore variations in dietary patterns and risk of hip fracture<br /> We will explore variations in diet and dietary patterns across England generating dietary pattern data for the cohort and potentially exploring differences by income or place of residence.</p> <p>4. Development of a hip fracture risk factor guidance tool<br /> A data analytics approach will be used to develop a tool to predict risk of hip fracture and suggest optimisation of food choice to improve dietary behaviour. Linear programming methods have been used at a population level to derive optimal healthy eating guidelines for the UK (https://www.nhs.uk/live-well/eat-well/the-eatwell-guide/), meeting constraints imposed by 30+ dietary guidelines, whilst minimizing the change required from the current national diet. We will develop this approach as applied to reducing risk of hip fracture and include dietary, lifestyle, behavioural and socio-economic variables identified during the earlier stages of the project.<br /> Diet and lifestyle of women who develop a hip fracture will be optimised using linear programming to generate a suggested dietary pattern and lifestyle behaviours which would minimise risk of hip fracture. The UKWCS will be split into two for this process in order to 1) develop the model 2) validate/test the model.<br /> The resulting model has the potential for use in policy development and planning decisions to reduce risk of hip fracture in older women in the community.</p> <p><!--![endif]----><!--![endif]----><!--![endif]----><!--![endif]----><!--![endif]----></p> <p><!--![endif]----><!--![endif]----><!--![endif]----><!--![endif]----><!--![endif]----><!--![endif]----></p>

<h2 class="heading">How to apply</h2>

<p>Formal applications for research degree study should be made online through the&nbsp;<a href="http://www.leeds.ac.uk/rsa/prospective_students/apply/I_want_to_apply.html">University&#39;s website</a>. Please state clearly in the research information section&nbsp;that the research degree you wish to be considered for is Reducing Risk of Hip Fracture in Women using Data Linkage as well as&nbsp;Professor Janet Cade&nbsp; <a href="https://environment.leeds.ac.uk/food-nutrition/staff/7150/professor-janet-cade">https://environment.leeds.ac.uk/food-nutrition/staff/7150/professor-janet-cade</a>&nbsp;as your proposed supervisor.</p> <p>If English is not your first language, you must provide evidence that you meet the University&#39;s minimum English language requirements (below).</p> <p><em>We welcome applications from all suitably-qualified candidates, but UK black and minority ethnic (BME) researchers are currently under-represented in our Postgraduate Research community, and we would therefore particularly encourage applications from UK BME candidates. All scholarships will be awarded on the basis of merit.</em></p>

<h2 class="heading heading--sm">Entry requirements</h2>

Applicants to research degree programmes should normally have at least a first class or an upper second class British Bachelors Honours degree (or equivalent) in an appropriate discipline. The criteria for entry for some research degrees may be higher, for example, several faculties, also require a Masters degree. Applicants are advised to check with the relevant School prior to making an application. Applicants who are uncertain about the requirements for a particular research degree are advised to contact the School or Graduate School prior to making an application.

<h2 class="heading heading--sm">English language requirements</h2>

The minimum English language entry requirement for research postgraduate research study is an IELTS of 6.0 overall with at least 5.5 in each component (reading, writing, listening and speaking) or equivalent. The test must be dated within two years of the start date of the course in order to be valid. Some schools and faculties have a higher requirement.

<h2 class="heading">Funding on offer</h2>

<p>This Rank Prize and School of Food Science and Nutrition&nbsp;award will provide tuition fees at &pound;4,600, together with tax-free stipend at the UK research council rate of &pound;15,285, and a research training and support grant. The Award may be for full or part-time study.</p>

<h2 class="heading">Contact details</h2>

<p>For further information regarding the project, please contact Professor Cade by email:&nbsp; <a href="mailto:j.e.cade@leeds.ac.uk">j.e.cade@leeds.ac.uk</a>&nbsp;</p> <p>For further information regarding your application, please contact Doctoral College Admissions by email:&nbsp;&nbsp;<a href="mailto:maps.pgr.admissions@leeds.ac.uk">maps.pgr.admissions@leeds.ac.uk</a>&nbsp; .</p>


<h3 class="heading heading--sm">Linked research areas</h3>