What the 45 and Up Study told us in 2023

Researchers have used the 45 and Up Study, Australia’s largest ongoing study of health and ageing, to produce ground-breaking papers on important health issues. Here are some of the highlights from 2023:

AI predicts cardiovascular risk from survey responses

The risk of someone dying or being hospitalised from cardiovascular disease can now be predicted by artificial intelligence using self-reported survey responses, according to an Australian-first study.

Researchers from UNSW Sydney used survey responses from 187,000 participants in the 45 and Up Study along with linked data on mortality and hospitalisations to develop risk prediction models.

Previous Australian studies used clinical data such as blood tests or cardiac imaging.

Factors linked with a greater risk of cardiovascular mortality were higher age, lower household income, no employment, use of anti-hypertensive medication, and less time spent standing.

Study authors said the models had good prediction performance and could be used to lower the cost of comprehensive cardiovascular risk evaluation, particularly in rural and remote areas.

World-first research on cancer and pain

A first-of-its-kind study compared pain in people with and without cancer, offering new insight into one of the most feared symptoms of cancer.

The research compared the pain experiences of 16,000 participants in the 45 and Up Study who had had a cancer diagnosis with a control group of over 100,000 cancer-free Study participants. The study also looked at pain in different cancer types and stages separately.

Investigators from the Australian National University found pain levels varied markedly depending on the type of cancer. Survivors of blood cancers such as multiple myeloma or leukaemia had a greater burden of pain than people without cancer, as did those with cancers with a poorer prognosis, such as lung cancer.

The good news is that pain levels experienced by many cancer survivors are similar to the general population.

Healthy lifestyle in 60s linked to avoiding aged care when older

Having a healthy lifestyle in your 60s is linked to a dramatically lower risk entering a nursing home in later life, according to research from the University of Sydney that looked at 125,000 participants in the 45 and Up Study.

Researchers found that having the healthiest type of lifestyle is linked to a lower risk of entering aged care compared to those with the unhealthiest lifestyles across all age groups, but particularly among 60-64 year olds.

Survey responses from 45 and Up Study participants on physical activity, smoking status, sitting time, sleeping time and diet were used to assign participants a lifestyle score. The researchers then linked this data with participants’ medical records via the Medicare Benefits Schedule (MBS) and hospital data, allowing them to monitor for aged care admissions over 10 years. 

Participants needed to report these lifestyle behaviours to have the best lifestyle score: be physically active for more than 300 minutes a week; be a non-smoker; sleep between 7 and 9 hours a day; sit less than 7 hours a day; and follow a diet with high intake of fruit and vegetables and low intake of red and processed meat.

This is the first time in Australia that a study has quantified the individual and combined association of lifestyle factors with nursing home admission.

Fracture risk often overlooked in patients with chronic conditions

People with multiple chronic conditions who experience a bone fracture are not likely to be investigated or treated for osteoporosis, according to research from the Garvan Institute of Medical Research.

The study looked at 10,000 people from the 45 and Up Study who experienced a bone fracture between 2005 and 2017 and had a high risk of future fracture. 

Researchers found that a person with four or more chronic conditions is up to 57% less likely to be tested for osteoporosis, and 65% less likely to be treated, compared with someone who has one or no chronic conditions.

This research will help inform new guidelines for how fractures in patients with complex medical conditions are investigated and treated by clinicians. 

Adult tooth loss linked to higher risk of diabetes

Significant tooth loss in older adults is linked to developing diabetes, according to research using data from 200,000 participants in the 45 and Up Study. 

Researchers from the University of Sydney found that older adults with fewer than 20 of their own teeth increased their later risk of diabetes by up to 20%.

Survey data on tooth loss as reported by participants was used for this research – the 45 and up Study is one of the few datasets to collect self-reported oral health information. Researchers also used linked data on participants’ medical and pharmaceutical claims and hospitalisations.

Tooth loss is viewed as a general indicator of oral health, often caused by untreated gum disease. As to why there’s a link between gum disease and diabetes, study co-author Dr Shalinie King said that a popular theory is that gum disease could cause general inflammation in the body which increases the risk of diabetes.

What’s next for the 45 and Up Study?

2024 is set to be another big year for the Study, with new data from our fourth major survey being made available to researchers in early 2024. If you’d like to stay up to date on the Study, sign up for our newsletter or explore more of the research here.