The 45 and Up Study has reached 500 papers – these five made a big impact

The Sax Institute’s 45 and Up Study recently passed the impressive milestone of 500 peer-reviewed publications based on data from the Study. It’s a sign of great output but also significant impact, as the papers have collectively earned 12,000 academic citations, 1250 mentions in news articles and 280 mentions in policy documents.

These achievements highlight the Study’s ongoing value, says Dr Kerrin Bleicher, Director of Research Assets at the Sax Institute.

“So many researchers have used the Study, and continue to use it, because it has the unique potential to solve health challenges,” she says.  

The 500th paper reports on the methodology behind the 45 and Up Study’s COVID-19 data collection, which was carried out between 2020 and 2022 in collaboration with the NSW Ministry of Health, a panel of scientific advisors and many other stakeholders. This data, now available through the 45 and Up Study’s Covid Data Hub, can be used by researchers to explore the impact of the pandemic on mental health, missed care and quality of life.  

“This paper really showcases how agile the 45 and Up Study is in responding to relevant issues and the needs of researchers and policymakers,” says Dr Bleicher.

“The Study is a powerful resource that’s only coming of age now. It will continue to provide extensive access to data on lifestyle and social determinants along with nationally important linked data for years, and decades, to come.”

The 45 and Up Study, which initially recruited more than 250,000 participants over the age of 45, is one of the world’s largest ongoing studies of healthy ageing. Participants’ survey responses are linked, with full consent and privacy protection, to a range of health and medical data including the Medical Benefits Schedule and the Pharmaceutical Benefits Scheme.

Five studies that got people talking

Of the 500 papers published, many have had a significant impact on research and policy. Here are five that have helped change the conversation around Australian health:  

2021: Smoking found to cause half of Aboriginal and Torres Strait Islander deaths over 45. This recent research was the first to analyse smoking mortality rates in Aboriginal and Torres Strait Islander peoples. The Tobacco Smoking and Mortality Among Aboriginal and Torres Strait Islander Adults in Australia paper used 45 and Up Study data to show that the risks posed by smoking were almost double that of previous estimates (which used international studies as a guide). Smoking was found to cause 37% of all deaths of Aboriginal and Torres Strait Islander people, increasing to about half of all deaths of those aged 45 and over. The paper has been reported in more than 100 news stories, sparking discussion on the legacies of colonialism and calls for more investment in anti-smoking programs.

2019: Leafy neighbourhoods are better for mental health. The Association of Urban Green Space With Mental Health and General Health Among Adults in Australia paper looked at what types of green spaces improve the mental health of people who live close by. It found that tree canopy has much more of a positive impact than just grass: adults with 30% or more of their neighbourhood covered in some form of tree canopy had 31% lower odds of developing psychological distress. The paper had a strong impact on the growing body of research into green space, with more than 120 citations in just a few years, and its findings have supported programs to protect and restore tree canopies in Australian cities.

2016: The link between obesity and lifespan goes global. The Body-Mass Index and All-Cause Mortality meta-analysis is by far the most-cited paper that includes 45 and Up Study data, earning 1342 academic citations. It found that people with a Body Mass Index (BMI) indicating moderate obesity lost three years of life compared to those with a normal range BMI. A group of international researchers looked at 3.9 million people’s data from 32 countries (including the 45 and Up Study cohort). They only included healthy non-smokers to gauge the impact of obesity, measured by a person’s Body Mass Index (BMI), on mortality. Research using BMI has been both praised and criticised and the debate on BMI’s usefulness continues.

2015: Australia gets its own mortality statistics for smoking. Look into the risks related to smoking and you’ll quickly come upon two key statistics: two-thirds of current Australian smokers will die from their habit and they will die more than ten years earlier than non-smokers.  These powerful numbers come from the Tobacco Smoking and All-Cause Mortality in a Large Cohort Study paper, which looked at data from more than 200,000 45 and Up participants over four years. For the first time, data from Australia rather than from overseas was used to calculate local risk – previously, one-half of smokers were predicted to die from smoking. The research also provided some encouraging news: death rates in former smokers who had quit before turning 45 were similar to never-smokers.The findings have had a significant impact on policy: they have been used in anti-smoking advertising, have helped inform tax increases to tobacco and been used by smoking cessation services.

2012: Big data reveals the risks of sitting.  The relationship between daily sitting time and risk of premature death was investigated using a large Australian cohort – the 45 and Up Study – and the findings were equally big. The Sitting Time and All-Cause Mortality Risk in 222,497 Australian Adults paper made headlines around the world for its findings that adults who sat for more than 11 hours a day had a 40% increased risk of dying within three years, compared to those who sat for less than four hours. It also found that people who sat for eight to 11 hours a day increased their risk by 15% compared to the same group. Importantly, the risks associated with daily sitting time were not affected by a person’s physical activity. This paper strengthened the findings of previous studies and helped to raise awareness of the health risks of sedentary behaviour, a topic which remains highly popular with researchers using the 45 and Up Study.