Comparative Analysis of Multiple Indices of Wellbeing, Vitality and Multiple Deprivation For Communities in Newfoundland and Labrador, Canada

How well do area-based deprivation indices identify income- and employment-deprived individuals across Great Britain today?

Are fisheries-dependent communities in Scotland really maritime-dependent communities?

Healthcare should be judged by its equity as well as its quality. Both aspects depend not only on the characteristics of service delivery but also on the research and innovation that ultimately shape them. Conducting a fully-inclusive evaluation of the relationship between enrolment in primary research studies at University College London Hospitals NHS Trust and indices of deprivation, here we demonstrate a quantitative approach to evaluating equity in healthcare research and innovation. We surveyed the geographical locations, aggregated into Lower Layer Super Output Areas (LSOAs), of all England-resident UCLH patients registered as enrolled in primary clinical research studies. We compared the distributions of ten established indices of deprivation across enrolled and non-enrolled areas within Greater London and within a distance-matched subset across England. Bayesian Poisson regression models were used to examine the relation between deprivation and the volume of enrolment standardized by population density and local disease prevalence. A total of 54593 enrolments covered 4401 LSOAs in Greater London and 10150 in England, revealing wide geographical reach. The distributions of deprivation indices were similar between enrolled and non-enrolled areas, exhibiting median differences from 0.26% to 8.73%. Across Greater London, enrolled areas were significantly more deprived on most indices, including the Index of Multiple Deprivation; across England, a more balanced relationship to deprivation emerged. Regression analyses of enrolment volumes yielded weak biases, in favour of greater deprivation for most indices, with little modulation by local disease prevalence. Primary clinical research at UCLH has wide geographical reach. Areas with enrolled patients show similar distributions of established indices of deprivation to those without, both within Greater London, and across distance-matched areas of England. We illustrate a robust approach to quantifying an important aspect of equity in clinical research and provide a flexible set of tools for replicating it across other institutions.

This study reports the long-term visual and treatment outcomes in a whole-population, orthoptic-delivered pre-school visual screening (PSVS) programme in Scotland and further examines their associations with socioeconomic backgrounds and home circumstances. Retrospective case review was conducted on 430 children who failed PSVS. Outcome measures included best corrected visual acuity (BCVA), severity of amblyopia (mild, moderate and severe), binocular vision (BV) (normal, poor and none), ophthalmic diagnosis and treatment modalities. Parameters at discharge were compared to those at baseline and were measured against the Scottish index of multiple deprivation (SIMD) and Health plan indicator (HPI), which are indices of deprivation and status of home circumstances. The proportion of children with amblyopia reduced from 92.3% (373/404) at baseline to 29.1% (106/364) at discharge (p < 0.001). Eighty percent (291/364) had good BV at discharge compared to 29.2% (118/404) at baseline (p < 0.001). Children from more socioeconomically deprived areas (OR 2.19, 95% CI 1.01-4.30, p = 0.003) or adverse family backgrounds (OR 3.94, 95% CI 1.99-7.74, p = 0.002) were more likely to attend poorly and/or become lost to follow-up. Children from worse home circumstances were five times more likely to have residual amblyopia (OR 5.37, 95% CI 3.29-10.07, p < 0.001) and three times more likely to have poor/no BV (OR 3.41, 95% CI 2.49-4.66, p < 0.001) than those from better home circumstances. Orthoptic-delivered PSVS is successful at screening and managing amblyopia. Children from homes requiring social care input are less likely to attend and are more likely to have poorer visual outcomes.

Are we correctly assessing transplant outcomes by using deprivation indices?

PurposeChildren who live in areas of socioeconomic deprivation may be at higher risk of being victims of violent crime such as knife wounds. The current study investigated whether socioeconomic disparity was associated with higher risk of knife crime.MethodsAn observational study included patients aged ≤ 17 years at a UK Major Trauma Centre injured by knife trauma from 2016 to 2022. Indices of deprivation were recorded according to the zip code of residence and compared with those of all of England. These included Index of Multiple Deprivation (IMD); income; employment; education and skills; health and disability; crime; barriers to housing and services; living environment; and Income Deprivation Affecting Children Index (IDACI).ResultsThere were 139 patients (96% male) with median age of 16 years. When compared with the whole of England, patients had worse indices of IMD (p = 0.021); income (p < 0.001); employment (p < 0.001); education and skills (p < 0.001); health and disability; and IDACI (p < 0.001). There were no significant differences in indices of crime, barriers to housing and services or living environment.ConclusionsPaediatric knife injury was associated with poor socioeconomic status in multiple domains. Focussed efforts to address socioeconomic disparities should be a priority as a public health measure for vulnerable children.

Objectives: Analyse the variance associated with the domains of the English Index of Multiple Deprivation (2015) as predictors of antibiotic prescribing. Methods: Deprivation and prescribing data for Clinical Commissioning Groups in England were collected, tabulated and used to build regression models characterising the relationship between antibiotic prescribing and indices of deprivation in the domains of education, health, employment, income, services and living environment. Results: The Index and 6 out of the 7 deprivation domains predicted antibiotic prescribing as reported (<0.001) and explained 21-38% of the variance. The domain of Education, Training and Skills emerged as a key factor (R2=0.38266) whereas employment explained as much variance in prescribing as health (R2=0.23408 and 0.23549 respectively). Conclusions: Individual indices of deprivation such as education and employment can account for the variance in antibiotic prescribing to a similar or a greater extent than health or the Index as a whole. Predictive indices provide new insights into the ways in which socio-demographic deprivation affects prescribing and can serve in the design of future more targeted interventions, such as those to lower unwarranted antibiotic prescribing.

The correlation between indices of deprivation and health-related quality of life in patients with oral and oropharyngeal squamous cell carcinoma

The incidence of glioblastoma multiforme (GBM) varies across the world and also within subpopulations within each nation. Many cancers show correlation with socioeconomic status and we hypothesised that incidence of GBM also does the same. We performed a retrospective analysis of all patients treated with brain tumours at a single hospital over a 6-year period. For these patients we examined markers of socioeconomic status and reviewed their histopathological diagnosis. A total of 2859 patients had surgery between April 2006 and April 2012. Of these 880 had histological diagnosis of GBM. Records for all patients were reviewed. Based on postcodes, socioeconomic data was obtained at ward level from government sources. Markers were: average weekly household income, percentage unemployed, population density, indices of deprivation and percentage of households with no car. Data was analysed for trends between incidence per ward and socio-economic markers. Increasing incidence of GBM was associated with increasing wage (p = 0.044), less unemployment (p = 0.0002), Indices of Multiple Deprivation (p = 0.05), lower population density (p = 0.0015) and greater ownership of cars (p = 0.0005). There are unique socioeconomic characteristics for patients with GBM. Although a link to aetiology cannot be established from this limited epidemiological study, these results identify issues that these patients are more likely to face. These should be taken into account when planning support services and patient care following surgery.

We sought to determine the 1-year survival following craniotomy for tumour resection in a public healthcare system and analyse the effect of indices of multiple deprivation (IMD) as well as smoking, alcohol, BMI, ASA grade and medical co-morbidities on post-operative morbidity and mortality. This is a retrospective, single-centre study in a high volume neurosurgical centre, over a 2-year period. All patients undergoing a craniotomy for a brain tumour were included. Data was collected from the neuro-oncology database and electronic patient records. Individual patient IMD data was obtained using their postcode from a national government database. Each English postcode being ranked from 1 to 32,844, with 1 being the most deprived and 32,844 the most affluent. Descriptive results are described along with further data analysis using multiple linear and logistic regression analyses. 630 patients underwent an elective or urgent craniotomy for tumour. 10% of all patients underwent urgent surgery. 68% (95% CI: 64 to 71%) survived at least 1-year post-surgery. Our study found that social deprivation (IMD postcode rank) was not associated with mortality at 1year after adjusting for potential confounding factors. Those from decile 1 had the lowest risk of death at 12months for all tumour types (p = 0.0070). Previous smokers carried an increased risk of death at 12months when compared with people who had never smoked RR 1.40 CI 1.10-1.78 (p = 0.006) but this risk was not evident in current smokers RR 0.92 CI 0.65-1.31 (p = 0.64). Increasing age and male gender were also found to be associated with higher mortality at 1year (p = < 0.001). In the UK despite the discrepancy in the health of the general population between the north and south, social deprivation does not appear to be detrimental to neurooncological outcomes although smoking status, advancing age and male sex are.

IntroductionHbA1c requests are not routinely performed in the paediatric population unless there is a suspicion of diabetes. Nottingham Children’s Hospital noted a rise in GP requests for HbA1c value interpretations...

Communities thrive on diversity in the long-run. Our communities are filled with diverse individuals and diverse groups of residents who, though they share a common place, may not experience their communities exactly the same as their fellow residents. Broad strokes are needed in our quests to better understand diversity, inclusion, and inclusiveness indicators in our communities. These three concepts are the building-blocks to high levels of community well-being. This chapter synthesizes recent conceptualizations and research on these three concepts. Diversity is described as a community resource. Inclusion is highlighted as a community process, and inclusiveness is described as a community outcome. Three tools are proposed to leverage these building-blocks to increase community well-being. The three tools are policy, development, and enrichment in communities. This chapter proposes that community policy is best suited to address changes regarding indicators of diversity. Community development is best suited for inclusion, and community enrichment is best concentrated on inclusiveness.

Identify associations between dental arch relationship scores, oral health status and deprivation index in patients with complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). Ninety-two 5-year-old children with non-syndromic complete UCLP and thirty-nine 5-year-old children with non-syndromic complete BCLP from the United Kingdom. Data were collected from the 5-year audit outcomes submitted to the Cleft Registry and Audit Network (CRANE). The index of multiple deprivation (IMD) and Welsh index of deprivation were used to assess a relative measure of deprivation. Comparisons of 5-year-old index/BCLP Deciduous Dentition Yardstick outcome against IMD and dmft are performed using multivariable linear regression models. Both UCLP and BCLP had a high percentage of children with dmft >0 (47% and 49%, respectively). The mean dmft for the UCLP cohort was 2.8 and 2.6 for the BCLP cohort. In the UCLP group, a poorer 5-year-old index was associated with an increased dmft score (P=.023) and higher level of deprivation (P=.010). In the BCLP group, there was no significant associations between BCLP Deciduous Dentition Yardstick, dmft and IMD. A poorer dental arch relationship outcome may be associated with higher level of area deprivation and oral health status, in children with UCLP. Those with a poor outcome for the 5-year-old Index are more likely to have increased caries experience.

Community well-being is a function of many factors working in concert to promote an optimal quality of life for all members of a community. It is argued here that attention to gender equity including the education and health of girls and women has a direct impact on numerous indicators of community well-being. Numerous international studies suggest that attention to gender equity creates human and social capital that enables community well-being. Human capital is the knowledge, skills and health embodied in individuals and social capital refers to the patterns and qualities of relationships in a community characterized by norms of trust and reciprocity. Women’s education has been linked to a reduction in infant and childhood mortality, socio-economic development, community development, physical and mental well-being as well as other factors. Attention to gender equity and in particular girls and women’s education, leads to greater human and social capital which in turn leads to community well-being.

How well does the Scottish Index of Multiple Deprivation identify income and employment deprived individuals across the urban-rural spectrum and between local authorities?