Affluent Areas Research Articles

Socioeconomic differences in recruitment and sickness absence in a large NHS health organisation: a cross-sectional study

ObjectiveThis study investigates the distribution of the workforce of one large National Health Service (NHS) employer in relation to socioeconomic deprivation and how sickness absence rates varied across these levels...

546 Health Disparities Among Rural Burn Patients

IntroductionSocioeconomic status is a risk factor for sustaining a burn and for burn mortality. Patients from rural areas make up a minority of the population but are frequently more isolated from life-saving care and burn centers. Lower socioeconomic status patients may delay seeking treatment of their burns for concern over medical costs, time away from work, and overall distance from accredited burn centers. We aim to explore disparities in burn outcomes at our institution based on patient socioeconomic status.MethodsBetween January 2020 and January 2021, patients presenting for management of acute burns were reviewed. Patient demographics and outcomes were collected, including time to presentation, total body surface area burned, presence of inhalational injury, and mortality. Patient socioeconomic status and rural designations were assigned based on a validated metric derived from Census endpoints, with higher scores reflecting lower socioeconomic status.ResultsA total of 524 patients were identified. Overall, 30% of our patients were from areas defined as being small towns or rural by the Census. Racial demographics did not differ between rural and urban areas (p = 0.099), but Hispanic ethnicity was less common (16% vs. 29%, p = 0.002). Rates of alcohol, tobacco, and illicit drug use did not differ between groups. Compared to the urban/suburban cohort, rural patients were from less affluent areas (63.6 vs. 58.5, p = 0.001) and traveled farther to our center (112 miles vs. 70 miles, p = 0.029). Despite these distances, rural patients did not have a higher rate of delayed presentation (35.7% vs. 43.3%, p = 0.105), or longer average time to presentation (3.4 days vs 4.4 days, p = 0.222). Flame burns were the most common mechanism overall (44.3%) and were significantly more common in the rural population (59.2% vs. 37.8%, p < 0.001), Scalds, the second most common burn mechanism (25.9%), occurred less frequently in rural patients (18.5% vs. 29.2%, p = 0.011). Controlling for age, TBSA, inhalational injury, and ventilator requirement, patients from rural areas were at a significantly higher risk of mortality (OR 24, p = 0.024).ConclusionsRural burn patients face many challenges receiving appropriate care following a burn. They frequently come from less affluent backgrounds, limiting their ability to access care, and they must travel greater distances to a qualified burn surgeon. Despite these barriers, our rural patient population did not present any later following a burn compared to our more urban patients. Rural patients sustained more extensive burns but were not hospitalized at a greater rate. Even when controlling for numerous factors associated with burn mortality, rural patients were still at an increased risk. Burn prevention strategies targeting rural communities should address the unique challenges facing these areas.

Residential segregation of migrants: Disentangling the intersectional and multiscale segregation of migrants in Shijiazhuang, China

Residential segregation, especially of rural migrants, is of growing concern in China. A key question is whether this spatial separation is entirely due to income – rural migrants priced out of affluent areas – or whether other factors, such as institutional discrimination or social prejudice or homophily, are also at work. We employ state-of-the-art methods to yield a more detailed and nuanced picture of segregation in Shijiazhuang, a second-tier Chinese city. We use a multilevel modelling approach that allows us not only to quantify the extent of segregation at different spatial scales, but also to disentangle the intersectional nature of segregation: the extent to which segregation is due to migrant status or low income alone. We find that migrant status is actually more important than occupation in determining segregation. These findings emphasise the imperative to decompose intersectional segregation into its constituent parts, a task recently made possible by developments in multilevel modelling.

Local development challenge in lagging-behind areas: insights from new & evolutionary economic geography.

Lagging-behind regions, as an example of the failure of convergence in a country, has attracted the attention of many researchers who are attempting to adopt applicable policies and strategies to overcome the problem of low growth paths. The present study focuses on the policy proposals in the context of new economic geography and evolutionary economic geography for lagging-behind areas. Industrial agglomeration, as an essential element of the new economic geography, has restricted the potential for policy-making in lagging-behind regions. Creating regional advantages, as a policy in evolutionary economic geography, has provided diversified policy options for lagging-behind regions. However, this approach faces multi-level challenges in lagging-behind regions, including the lack of critical mass about low diversity and the gap in the knowledge base between lagging-behind and affluent areas. Therefore, if this policy is to be the basis for creating regional objectives, it should provide a structure for simulating external knowledge links and distinguishing the nature of the various related industries.

Abstract P031: Does The Place Of Residence Influence Your Risk Of Being Hypertensive? A Case Study From Nepal

Introduction: Area level factors could be an independent risk factor for disease and negative health outcomes. Despite the multiple studies on risk factors for hypertension, area-level influence is poorly investigated especially in low- and middle-income countries. Hypothesis: This study aims to test the hypothesis that area-level deprivation (AD) is significantly associated with the risk of hypertension independent of individual risk factors in the context of Nepal. Methods: The study is based on the latest Nepal Demographic Health Survey conducted in 2016. The area-level deprivation index was constructed and validated based on the material (household assets, household structure), social and geospatial features. The index ranged from 52 to 146 with higher scores representing higher levels of deprivation. Individuals aged 15 and above were identified as hypertensive if they met any of the following criteria: i) systolic blood pressure ≥140 mmHg; ii) diastolic blood pressure ≥90 mmHg; iii) taking antihypertensive medication irrespective of their blood pressure readings during the survey; iv) history of earlier diagnosis of hypertension by any health care provider. Associations between the quartiles of AD and hypertension were investigated using two-level logistic regression. Further, potential cross-level interaction and mediated pathways between AD and hypertension were explored. Results: The overall prevalence of hypertension was approximately 23% of which nearly 50% were unaware of their high blood pressure status at the time of the survey. Individuals from the least deprived areas seemed to have higher odds of hypertension compared to highly deprived areas (Odds Ratio=1.54 (95% CI 1.26, 1.89); p-trend=&lt;0.001). Literate individuals from deprived areas were likely to have a higher risk of hypertension compared to those without formal education. However, the association was not significant in the least deprived areas (p-interaction &lt;0.001). Overweight/obesity seems to explain a significant magnitude of the indirect pathway (67%) between AD and hypertension in the context of Nepal. Conclusion: Residing in the least deprived or more affluent areas might increase an individual’s risk of being hypertensive. Association between individual risk factors and hypertension is likely to vary across the areas with varying levels of deprivation. These results seem paradoxical and are inconsistent with epidemiological data from high-income countries. Over-nutrition and changing lifestyle, driven by affluence and higher disposable income, could explain this counterintuitive association in the context of a country like Nepal which is undergoing a rapid socio-demographic and epidemiological transition.

Care for Chiari malformation type I: the role of socioeconomic disadvantage and race.

There is little research on the effect of social determinants of health on Chiari malformation type I (CM-I). The authors analyzed data on all children evaluated for CM-I at a single institution to assess how socioeconomic factors and race affect the surgical treatment of this population. Medical records of patients treated for CM-I at the authors' institution between 1992 and 2017 were reviewed. Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes for each patient were used to measure neighborhood disadvantage. Non-Hispanic White patients were compared to non-White patients and Hispanic patients of any race (grouped together as non-White in this study) in terms of insurance status, ADI, and RUCA. Patients with initially benign CM-I, defined as not having undergone surgery within 9 months of their initial visit, were then stratified by having delayed symptom presentation or not, and compared on these same measures. The sample included 665 patients with CM-I: 82% non-Hispanic White and 18% non-White. The non-White patients were more likely to reside in disadvantaged (OR 3.4, p < 0.001) and urban (OR 4.66, p < 0.001) neighborhoods and to have public health insurance (OR 3.11, p < 0.001). More than one-quarter (29%) of patients underwent surgery. The non-White and non-Hispanic White patients had similar surgery rates (29.5% vs 28.9%, p = 0.895) at similar ages (8.8 vs 9.7 years, p = 0.406). There were no differences by race/ethnicity for symptoms at presentation. Surgical and nonsurgical patients had similar ADI scores (3.9 vs 4.2, p = 0.194), RUCA scores (2.1 vs 2.3, p = 0.252), and private health insurance rates (73.6% vs 74.2%, p = 0.878). A total of 153 patients underwent surgery within 9 months of their initial visit. The remaining 512 were deemed to have benign CM-I. Of these, 40 (7.8%) underwent decompression surgery for delayed symptom presentation. Patients with delayed symptom presentation were from less disadvantaged (ADI 3.2 vs 4.2; p = 0.025) and less rural (RUCA 1.8 vs 2.3; p = 0.023) areas than those who never underwent surgery. Although non-White patients were more likely to be socioeconomically disadvantaged, race and socioeconomic disadvantage were not associated with undergoing surgical treatment. However, among patients with benign CM-I, those undergoing decompression for delayed symptom presentation resided in more affluent and urban areas.

Vegetation cover within and around schools in Santiago de Chile: Are schools helping to mitigate urban vegetation inequalities?

Vegetation within cities is key for urban sustainability, as it provides several ecosystem services positively influencing the urban quality of life. However, urban vegetation is often unevenly distributed within cities, typically concentrating the large proportion of vegetated areas in more affluent neighborhoods. Thus, developing strategies for reducing urban vegetation inequalities is fundamental to fostering more sustainable cities. Since schools are widely distributed in urban areas, they could be key for decreasing vegetation inequalities, in particular, if schools’ precincts in lower-income areas are managed to contain high levels of vegetation. Nevertheless, studies analyzing the potential role of schools in ameliorating vegetation inequalities in cities are largely missing in the literature. In this study we use remote sensing techniques to estimate the vegetation cover of 1579 schools and their surrounding areas in Santiago-Chile, aiming to evaluate whether vegetation within schools is helping to mitigate the high levels of vegetation inequalities characteristic of this city. We performed the analysis for public, subsidized and private schools, for the whole city and each of the 34 municipalities comprising the city. Our results show that schools are not helping to mitigate vegetation inequalities, but they tend to replicate the unequal distribution of vegetation within Santiago. This pattern holds whether the analysis is made for all schools or each of the three school types independently, and is also a prevalent pattern when the assessment is performed at the municipal level. Private schools, usually located in greener more affluent areas of the city, have significant larger proportion of vegetation, revealing that high-income students do not only live in greener neighborhoods but also have access to greener schools. These results reveal how deeply rooted in some cities are vegetation inequalities, and the urgency of modifying public policies related to how vegetation within schools is funded, planned and managed.

Does unemployment worsen babies’ health? A tale of siblings, maternal behaviour, and selection

We study in-utero exposure to economic fluctuations on birth outcomes by exploiting geographical variation in the unemployment rate across local areas in England, and by comparing siblings born to the same mother. Using rich individual data from hospital administrative records for 2003–2012, babies’ health is found to be strongly pro-cyclical. This overall result masks marked differences between babies born in the most affluent areas whose health at birth improves in a recession, and babies born in the average-to-lowest income deprived areas whose health deteriorates. Maternal alcohol consumption, smoking, and delay in the first antenatal care assessment - combined with parental income loss, are found to drive the results. While differences in maternal risky behaviours can explain the heterogenous effects.

Is green space associated with reduced crime? A national-scale study from the Global South

Assumptions about the link between green space and crime mitigation are informed by literature that overwhelmingly originates in the Global North. Little is known about the association between green spaces and crime in the Global South. We utilized 10 years of precinct-level crime statistics (n = 1152) over South Africa, a global crime hotspot, to test the hypothesis that green space is associated with reduced crime rates. We found that, after controlling for a number of socio-demographic confounders (unemployment, income, age, education, land use and population density), for every 1% increase in total green space there is a 1.2% (0.7 to 1.7%; 95% confidence interval) decrease in violent crime, and 1.3% (0.8 to 1.8%) decrease in property crime, with no effect on sexual crimes. However, the direction of the association changed for property crimes when exploring the effect of green space characteristics including tree cover and park accessibility. Property crimes increase by 0.4% (0.1 to 0.7%) with a percentage increase in tree cover, and by 0.9% (0.5 to 1.3%) with every kilometer increase in proximity to a public park. Further research, including experimental studies, is needed to better isolate causal mechanisms behind crime-green space associations, especially considering that green space may map to race and income inequality and that there may be more crime reporting in affluent areas. Nevertheless, our results provide a complementary contribution to the evidence from the Global North, highlighting the need for more nuanced definitions of green space and its characteristics when considering links to crime. When viewed in light of the broader suite of ecosystem services provided by green space, our results support urban greening as a major strategy towards achieving just and sustainable cities and towns.

Excess years of life lost to COVID-19 and other causes of death by sex, neighbourhood deprivation, and region in England and Wales during 2020: A registry-based study.

Deaths in the first year of the Coronavirus Disease 2019 (COVID-19) pandemic in England and Wales were unevenly distributed socioeconomically and geographically. However, the full scale of inequalities may have been underestimated to date, as most measures of excess mortality do not adequately account for varying age profiles of deaths between social groups. We measured years of life lost (YLL) attributable to the pandemic, directly or indirectly, comparing mortality across geographic and socioeconomic groups. We used national mortality registers in England and Wales, from 27 December 2014 until 25 December 2020, covering 3,265,937 deaths. YLLs (main outcome) were calculated using 2019 single year sex-specific life tables for England and Wales. Interrupted time-series analyses, with panel time-series models, were used to estimate expected YLL by sex, geographical region, and deprivation quintile between 7 March 2020 and 25 December 2020 by cause: direct deaths (COVID-19 and other respiratory diseases), cardiovascular disease and diabetes, cancer, and other indirect deaths (all other causes). Excess YLL during the pandemic period were calculated by subtracting observed from expected values. Additional analyses focused on excess deaths for region and deprivation strata, by age-group. Between 7 March 2020 and 25 December 2020, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL in England and Wales, equivalent to a 15% (95% CI: 14 to 16) increase in YLL compared to the equivalent time period in 2019. There was a strong deprivation gradient in all-cause excess YLL, with rates per 100,000 population ranging from 916 (95% CI: 820 to 1,012) for the least deprived quintile to 1,645 (95% CI: 1,472 to 1,819) for the most deprived. The differences in excess YLL between deprivation quintiles were greatest in younger age groups; for all-cause deaths, a mean of 9.1 years per death (95% CI: 8.2 to 10.0) were lost in the least deprived quintile, compared to 10.8 (95% CI: 10.0 to 11.6) in the most deprived; for COVID-19 and other respiratory deaths, a mean of 8.9 years per death (95% CI: 8.7 to 9.1) were lost in the least deprived quintile, compared to 11.2 (95% CI: 11.0 to 11.5) in the most deprived. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were much higher in younger age groups, but similar for those aged 85 or over. There was marked variability in both all-cause and direct excess YLL by region, with the highest rates in the North West. Limitations include the quasi-experimental nature of the research design and the requirement for accurate and timely recording. In this study, we observed strong socioeconomic and geographical health inequalities in YLL, during the first calendar year of the COVID-19 pandemic. These were in line with long-standing existing inequalities in England and Wales, with the most deprived areas reporting the largest numbers in potential YLL.

Trends and characteristics of hospitalisations from the harmful use of opioids in England between 2008 and 2018: Population-based retrospective cohort study.

SummaryObjectiveTo examine the trends and characteristics of opioid-related hospital admissions in England over 10 years, and its burden for the National Health Service and public finances.DesignPatient-level data from the Hospital Episode Statistics database to examine all opioid-related hospitalisations from 2008 to 2018, stratified by type of opioid admission and patient demographics.SettingAll National Health Service hospitals in England.ParticipantsPatients hospitalised from the harmful use of opioids.Main outcome measuresThe number of opioid-related hospitalisations, length of stay, in-hospital mortality, 30-day readmission rate and treatment costs.ResultsOpioid-related hospitalisations increased by 48.9%, from 10,805 admissions in 2008 to 16,091 admissions in 2018, with total treatment costs of £137 million. The growth in opioid-related hospitalisations was 21% above the corresponding rate for all other emergency admissions in England. Relative changes showed that hospitalisations increased most for individuals older than 55 years (160%), those living in the most affluent areas of England (93.8%), and suffering from four co-morbidities (627.6%) or more. Hospitals reduced mean patient length of stay from 2.8 days to 1.1 days over 10 years. Mean in-hospital mortality was 0.4% and mean 30-day readmission risk was 16.6%.ConclusionOpioid use is an increasing public health concern in England, though hospitalisation and mortality rates are less pronounced than in other countries. There are concerns about significant rises in hospitalisations from older, less deprived and sicker population groups. Our findings should prompt policymakers to go beyond monitoring mortality statistics when assessing the impacts of harmful use of opioids.

Health inequity in the UK: exploring health inequality and inequity

In this article, the first of two, Vanessa Heaslip et al examine the factors that lead to certain groups having poorer health outcomes in the UK Practice nurses are ideally placed within local communities to have a significant impact on addressing health inequities. However, to achieve this they need to understand the many factors that lead to certain groups having poorer health outcomes. Advances in longevity do not automatically match advances in health and wellbeing across all social groups. In the UK, someone living in a deprived area of England is more likely to die eight and a half years younger than someone living in a more affluent area. The COVID-19 pandemic has highlighted health inequities faced by ethnic minority groups in particular. This article, the first of two, will define the terminology used, explore access to health services in the UK and present the evidence driving healthcare policy.

Evolution of socioeconomic inequalities in cancer incidence between 2006 and 2016 in France: a population-based study.

The existence of socioeconomic inequalities in cancer incidence is now well established and their reduction is a priority in many countries. This study aimed to measure the evolution of socioeconomic inequalities in the incidence of the most common cancers in France, over an 11-year period. The study focused on 19 cancer entities (16 solid tumors and 3 hematological malignancies). Data are obtained from the French Network of Cancer Registries, representing 604 205 cancer cases. Each patient address was geolocalized and assigned to an IRIS, the smallest geographic unit in France. The French version of the European Deprivation Index was used to measure the level of deprivation in each IRIS. A generalized linear mixed model was used to account for the longitudinal nature of the data and to assess the evolution of socioeconomic inequalities. A significant evolution of the social gradient of incidence over time was highlighted for five cancer entities and all entities combined. For lung cancer for both sexes and bladder cancer in men, more frequent in deprived areas, the social gradient in incidence tended to decrease over time. For breast cancer in women and lymphocytic leukemia in men, more frequent in affluent areas, the gap continues to widen. Cancer entities with large disparities continued to present social inequalities in incidence without exacerbation with time. The few temporal evolutions observed do not show a worsening of the social gradient of incidence to the disadvantage of the most deprived areas, but rather an increase in incidence that is greater in the most affluent areas.

Spatial-temporal evolution and driving forces of provincial carbon footprints in China: An integrated EE-MRIO and WA-SDA approach

The reduction of carbon footprint (CF) induced by cross-province trade is equally important for China with unbalanced economic development under the background of “double carbon” and “dual circulation” strategy. Based on the environmentally-extended multi-regional input-output (EE-MRIO) and weighted average structural decomposition analysis (WA-SDA) model, this study explored the distribution characteristics and spatial-temporal evolution process of three-perspective CFs (By province, Per capita, and Per ¥GDP) at the provincial level, and accurately revealed the socio-economic driving factors of provincial CFs from 2007 to 2017. Here we show that China's CF increased from 6151.4 Mt. in 2007 to 8778.6 Mt. in 2017, with an average annual growth rate of 3.6%. With the socioeconomic development, the gravity centers of CFs and per capita CFs were gradually shifting from eastern affluent provinces and populous municipalities to underdeveloped western China, while the provinces with relatively low carbon footprint intensities (CFIs) were still concentrated in affluent eastern coastal areas. It will be conductive to the overall improvement of national emission mitigation effective through introducing the advanced production technologies and scientific consumption awareness of developed provinces to eastern China in the future. Meanwhile, the corresponding control measures on CF reduction should pay attention to the changes of per capita consumption and population especially for economically-developed populous regions such as Shandong, Jiangsu, Guangdong, and Zhejiang. For Inner Mongolia, the bidirectional adjustment of emission intensity and production structure will be necessary for its CF reduction. Moreover, the continuous optimization of consumption structure will be expected to contribute more impacts on CF reduction under the demand-side reform. The obtained results and policy implications are expected to provide corresponding and holistic reference for decision-makers to develop more efficient carbon mitigation and management policies.

An Examination of the Impact of Social and Cultural Traditions Contributing to Overweight and Obesity Among Black Women.

Black women living in Prince George’s (PG) County, Maryland, have high rates of overweight and obesity. Obesity significantly impacts Black women, leading to poor physical and mental health, decreased social well-being, and a financial strain on the healthcare system. Despite living in an affluent area and having middle to high incomes and high education levels, Black women living in PG County have difficulty managing their weight. This study explores how social and cultural factors and social networks impact the weight of Black women living in PG County, Maryland. A qualitative case study design guided by social cognitive theory was employed to conduct semi-structured interviews and focus groups with 15 women. Key social and cultural factors (income, family network, peer network, and living in PG County) influenced participants’ attitudes and behaviors toward their weight and strategies to manage their weight. Additionally, participants expressed that Black culture is more accepting of larger and curvier body types, and this reinforces a positive body image and less desire to achieve an ideal BMI. Participants also expressed that COVID-19 impacted their weight management strategies. This study adds to the literature by better explaining some of the underlying factors that influence decision-making around weight management among Black women who live in PG County, Maryland.

Do health trajectories predict neighborhood outcomes? Evidence of health selection in a diverse sample of U.S. adults.

Across the United States, residents of lower income neighborhoods evince poorer health, on average, than residents of more affluent areas. Studies aiming to explain this pattern have focused largely on the effects of neighborhood characteristics on residents' health, often overlooking the possibility that the reverse causal process-that a person's health impacts where they live, or "health selection into neighborhoods"-also plays a role. We investigated processes of health selection using the Panel Study of Income Dynamics, a longitudinal survey of U.S. households. Using ordinary least squares linear regression, we estimated the effect of householders' self-rated health on their neighborhood socioeconomic status (SES, the Census tract-level family poverty rate) in 2013, adjusting for neighborhood SES and health in 2001 as well as sociodemographic characteristics and residential mobility. Poorer health was associated with residence in higher poverty neighborhoods overall. Stratified models indicated that while health selection was observed across both race/ethnicity and class boundaries, the relationship between poor health and neighborhood poverty was stronger among non-Hispanic Black respondents, those with low income, and respondents who either moved moderate distances or did not move at all during the study period. We conclude with a call for future work exploring the mechanisms leading those in worse health to reside in higher poverty neighborhoods, and for public health policies that seek not only to improve health supporting conditions in economically disadvantaged neighborhoods, but that also support the economic and social needs of residents struggling with health problems.

Pathupattil Vazhamaisarntha Edangal

Aboriginal methods depend on cultural factors such as the habitat and lifestyle of the people. An examination of the place-names in ancient Tamil literature reveals that they possessed these characteristics. It can be seen that our ancestors named these places Ur, Perur, Muttur, City (a) Capital, Port City and Commercial City according to their structure. That article sets out to explore the affluent areas of residential space that are categorized into the six categories mentioned above.

Enhanced electromagnetic wave absorption properties integrating diverse loss mechanism of 3D porous Ni/NiO microspheres

The research and development of electromagnetic wave absorbing materials with light weight, thin thickness, powerful absorption, and wide frequency bandwidth is a long-term pursuing. Here, Ni/NiO microspheres were synthesized through hydrothermal reaction followed by thermal reduction process. The experimental results indicated that the electromagnetic parameters and electromagnetic wave absorption performance were seriously affected by the morphology, composition and loading of Ni/NiO microspheres. When the reduction temperature rose to 550 °C, Ni/NiO550 showed a special porous-microsphere structure which assembled by irregular Ni/NiO core-shell nanorods. The micro-size combination of porous and core-shell structures, the affluent surface area, sufficient NiO-Ni interface, high-concentration active sites were conducive to the impedance matching and diverse loss mechanism including conductive loss, interfacial polarization, dipole polarization, natural/exchange resonance and multiple scattering. Finally, 45 wt% porous Ni/NiO/paraffin composite exhibited high reflection loss (− 52.15 dB) and broad effective frequency bandwidth (3.22 GHz) at a thickness of 2.17 mm.

Sexual Minority Adults in England Have Greater Odds of Chronic Mental Health Problems: Variation by Sexual Orientation, Age, Ethnicity, and Socioeconomic Status.

Purpose: Sexual minority adults report worse mental health than heterosexual peers, although few empirical studies are large enough to measure variation in these disparities by sexual orientation, age, ethnicity, and socioeconomic status (SES). We investigate chronic mental health problems among sexual minority adults. Methods: Sex-disaggregated logistic regressions examined associations between self-reported chronic mental health problems and sexual orientation, age, ethnicity, and SES in a 2015-2017 dataset from the nationally representative English General Practice Patient Survey data (n = 1,341,339). Results: Bisexual adults, especially young bisexual females, reported the highest rates of chronic mental health problems. Sexual minority females 18-24 years of age had five times the odds of reporting chronic mental health problems of their heterosexual peers, with 32% of sexual minority females 18-24 years of age reporting the outcome. Sexual minority identity was also strongly associated with chronic mental health problems for adults who were White and lived in more affluent areas. Conclusion: The very high odds of chronic mental health problems among bisexual adults, especially younger bisexual females, may reflect simultaneous isolation from sexual minority and heterosexual communities. Elevated odds at younger ages may reflect disproportionate social media use and bullying. It is plausible that those who are subject to minority stress associated with SES and ethnicity may develop resilience strategies that they then apply to sexual minority stress. The results suggest that sexual minority identity is a source of minority stress, even for those who are affluent. Clinicians should be alert to the need to support the specific mental health concerns of their sexual minority patients.

Drug company payments to General Practices in England: Cross-sectional and social network analysis.

Although there has been extensive research on pharmaceutical industry payments to healthcare professionals, healthcare organisations with key roles in health systems have received little attention. We seek to contribute to addressing this gap in research by examining drug company payments to General Practices in England in 2015. We combine a publicly available payments database managed by the pharmaceutical industry with datasets covering key practice characteristics. We find that practices were an important target of company payments, receiving £2,726,018, equivalent to 6.5% of the value of payments to all healthcare organisations in England. Payments to practices were highly concentrated and specific companies were also highly dominant. The top 10 donors and the top 10 recipients amassed 87.9% and 13.6% of the value of payments, respectively. Practices with more patients, a greater proportion of elderly patients, and those in more affluent areas received significantly more payments on average. However, the patterns of payments were similar across England's regions. We also found that company networks-established by making payments to the same practices-were largely dominated by a single company, which was also by far the biggest donor. Greater policy attention is required to the risk of financial dependency and conflicts of interests that might arise from payments to practices and to organisational conflicts of interests more broadly. Our research also demonstrates that the comprehensiveness and quality of payment data disclosed via industry self-regulatory arrangements needs improvement. More interconnectivity between payment data and other datasets is needed to capture company marketing strategies systematically.