Affluent Areas Research Articles

THE INFLUENCE OF SOCIO-ECONOMIC DEPRIVATION ON MULTIMORBIDITY: A SYSTEMATIC REVIEW

Introduction: Multimorbidity poses a current global health challenge due to its increasing prevalence and burden on individuals and health systems. Evidence suggests that more socially disadvantaged individuals share a disproportionate burden of multimorbidity. The evidence on the relationship between area-level socioeconomic disadvantage and multimorbidity is unclear. Thus, the aim of the current study is to synthesise evidence on the association between area-level socio-economic disadvantage and multimorbidity. Methods: A systematic review was conducted of published literature from inception to January 2020. Search strategy was applied to identify evidence on PubMed (Medline), Ovid (Medline, Embase, Psycinfo) and Web of Science. Studies were selected according to the inclusion and exclusion criteria. Newcastle Ottawa Scale for observational studies was used for quality assessment of included studies. Evidence was synthesised narratively. Results: We identified eight out of 2588 studies identified in the search as per the inclusion and exclusion criteria. Out of the eight studies, five studies confirmed a positive association between area-level socio-economic disadvantage and multimorbidity, two studies presented a negative association, and one study presented no association. Three studies found individuals in deprived areas to have higher multimorbidity than those in affluent areas. Two studies established that individuals in rural areas had higher multimorbidity than their urban counterparts. Two studies found individuals in urban areas to have a higher multimorbidity than those in rural areas. Conclusion: Evidence shows that association between area-level socioeconomic disadvantage and multimorbidity exist. Except for area of residence, clear positive associations were confirmed between area deprivation and multimorbidity.
 
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The Inequality of Sleep Quality: Social Deprivation and Ethnicity Affect the Sleep Quality of Middle Aged and Older Adults

Background: Duration and other sleep characteristics change as we age. The effects of other demographics on sleep are less clear, although US studies suggest that sleep disorders and duration are influenced by social deprivation and race. Here we use UK Biobank data from almost half-a million adults living in Britain to test the hypothesis that sleep quality shows a ‘social gradient’ in sleep. Methods: Data for this prospective analysis were sourced from the UK Biobank. These consisted of self-reports relating to sleep (duration, waking in the night, sleeping in the day, difficulty waking and snoring), personal wealth (household income, property owning etc), ethnic group, employment and education, as well as post-code-based Townsend indices of social deprivation from c0.5m adults aged 40-70 years. Analyses considered prevalence of each sleep characteristic, and a Positive Sleep Index was derived by combining sleep-related responses. Findings: Almost one-third of participants reported sleeping shorter (24.7%) or longer (7.7%) than age-corrected recommended sleep durations, with the incidence of shorter or longer sleep increasing with social deprivation and varying with ethnicity. Snoring, waking during the night, finding it difficult to get up in the morning and sleeping in the daytime, were subject to similar effects. Regression analyses of our Positive Sleep Index showed that being younger, male, employed, owning one’s home, having a higher household income, higher level of educational achievement and time in education, were all associated with better sleep, as were living in a more affluent area and being white. Interpretation: Sleep quality in the UK shows a social gradient, independently of a range of other demographic and social influences. These sleep inequalities suggest that the protective and recuperative effects of sleep may be disproportionately distributed across the UK and should encourage us to consider the potential benefits of community specific sleep interventions. Funding Information: Funds received from Unilever UK Central Resources Limited to cover application fees, no other funding supported this research. Declaration of Interests: JAG has received research funding, consultancy, travel support, and speaking fees from various industrial companies. PH is employed by Unilever UK Central Resources Limited. Ethics Approval Statement: This retrospective cohort study is based on data from the UKB study that was approved by the North West Multi-Centre Research Ethics Committee; participants provided written informed consent for data collection, data analysis, and record linkage. Re-analysis of UKB data is part of UK Biobank project (NHS National Research Ethics Service 16/NW/0274).

Do accountable care organizations differ according to physician-hospital integration?: A retrospective observational study.

Physician-hospital integration among accountable care organizations (ACOs) has raised concern over impacts on prices and spending. However, characteristics of ACOs with greater integration between physicians and hospitals are unknown. We examined whether ACOs systematically differ by physician-hospital integration among 16 commercial ACOs operating in Massachusetts.Using claims data linked to information on physician affiliation, we measured hospital integration with primary care physicians for each ACO and categorized them into high-, medium-, and low-integrated ACOs. We conducted cross-sectional descriptive analysis to compare differences in patient population, organizational characteristics, and healthcare spending between the three groups. In addition, using multivariate generalized linear models, we compared ACO spending by integration level, adjusting for organization and patient characteristics. We identified non-elderly adults (aged 18–64) served by 16 Massachusetts ACOs over the period 2009 to 2013.High- and medium-integrated ACOs were more likely to be an integrated delivery system or an organization with a large number of providers. Compared to low-integrated ACOs, higher-integrated ACOs had larger inpatient care capacity, smaller composition of primary care physicians, and were more likely to employ physicians directly or through an affiliated hospital or physician group. A greater proportion of high-/medium-integrated ACO patients lived in affluent neighborhoods or areas with a larger minority population. Healthcare spending per enrollee in high-integrated ACOs was higher, which was mainly driven by a higher spending on outpatient facility services.This study shows that higher-integrated ACOs differ from their counterparts with low integration in many respects including higher healthcare spending, which persisted after adjusting for organizational characteristics and patient mix. Further investigation into the effects of integration on expenditures will inform the ongoing development of ACOs.

Waterbirth: a national retrospective cohort study of factors associated with its use among women in England

BackgroundWaterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water.This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015–16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water.MethodsData were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth.Results46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35–39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18–24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30–34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)).There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)).ConclusionsIn this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth.

Persistent Disparity: Socioeconomic Deprivation and Cancer Outcomes in Patients Treated in Clinical Trials.

PURPOSEPatients with cancer living in socioeconomically disadvantaged areas have worse cancer outcomes. The association between socioeconomic deprivation and outcomes among patients with cancer participating in clinical trials has not been systematically examined.METHODSWe examined survival outcomes for patients enrolled in phase III and large phase II clinical trials for major cancers conducted by the SWOG Cancer Research Network from 1985 to 2012. Socioeconomic deprivation was measured using trial participants' residential zip codes linked to the Area Deprivation Index (ADI). Five-year overall survival, progression-free survival, and cancer-specific survival were examined using Cox regression frailty models, adjusting for age, sex, and race, and separately for insurance status, prognostic risk, and rural or urban residency.RESULTSWe examined 41,109 patients from 55 trials comprising 24 cancer histology and stage-specific cohorts. Compared with trial participants in the most affluent areas (ADI, 0%-20%), trial participants from areas with the highest socioeconomic deprivation (ADI, 80%-100%) had worse overall (hazard ratio [HR] = 1.28, 95% CI, 1.20 to 1.37, P < .001), progression-free (HR = 1.20, 95% CI, 1.13 to 1.28, P < .001), and cancer-specific survival (HR = 1.27, 95% CI, 1.18 to 1.37, P < .001). The results were similar after adjusting for insurance status, prognostic risk, and rural or urban residency. There was a continuous increase in risk of all outcomes as the ADI quintile increased.CONCLUSIONIn patients with cancer with access to protocol-directed care in clinical trials, high area-level socioeconomic deprivation was associated with worse survival. Future research should examine whether the etiology of this residual disparity is related to reduced access to supportive care or postprotocol therapy and/or to differences in health status not reflected by protocol selection criteria.

Inequalities in general practice remote consultations: a systematic review.

BackgroundCOVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.AimTo explore the impact of remote consultations in general practice, compared to face-to-face consultations, on utilisation and clinical outcomes across socioeconomic and disadvantaged groups.Design & settingSystematic review.MethodThe authors undertook an electronic search of MEDLINE, EMBASE, and Web of Science from inception to June 2020. The study included studies that compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data were synthesised narratively.ResultsBased on 13 studies that explored telephone and internet-based consultations, this review found that telephone consultations were used by younger people of working age, the very old, and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socioeconomic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.ConclusionRemote consultations in general practice are likely to be used more by younger, working people, non-immigrants, older patients, and women, with internet-based consultations more by younger, affluent, and educated groups. Widespread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

Socioeconomic status during youth and risk of car crash during adulthood. Findings from the DRIVE cohort study

BackgroundYoung drivers of low socioeconomic status (SES) have a disproportionally high risk of crashing compared with their more affluent counterparts. Little is known if this risk persists into adulthood and...

Association between caregiver perceived green space quality and the development of prosocial behaviour from childhood to adolescence: Latent class trajectory and multilevel longitudinal analyses of Australian children over 10 years

BackgroundStudies investigating the potential role of neighbourhood green space quality on the development of prosocial behaviour among children are sparse. This study aimed to investigate the longitudinal association between caregiver perceived green space quality and child prosocial behaviour, and identify potential effect modifiers of the association. MethodsThis was a longitudinal study using data from the Longitudinal Study of Australian Children, involving 4,969 children aged 4–5 years that were biannually followed-up from 2004 to 2014. Prosocial behaviour was assessed using a prosocial scale from Goodman's Strengths and Difficulties Questionnaire. Green space quality was measured based on caregiver perception of the availability of neighbourhood parks, playgrounds, and play spaces of good quality. Latent class analysis was used to partition children into groups denoting different levels of caregiver perceptions of green space quality accumulated over 10 years. Multinomial logistic regression was used to examine the likelihood of being in groups with favourable perception of green space quality. Multilevel linear regression was used to examine associations between trajectory groups and prosocial behaviour. Separate multivariate models were developed to assess the potential role of quality green space in reducing prosocial behaviour related inequalities. Furthermore, two-way interaction terms were added into the models to identify potential effect moderation. ResultsThere were six trajectory classes of green space quality perceived by caregivers. The likelihood of being in groups with better green space quality varied by neighbourhood circumstances. Children with consistently very good quality green space had higher prosocial behaviour (β = 0.35; 95%CI = 0.23, 0.47) than those with low quality green space. Better prosocial behaviour was also observed among children whose caregiver perception of green space quality trended from good to very good (β = 0.23; 95%CI = 0.11, 0.35) and from very good to good (β = 0.31; 95%CI = 0.20, 0.42) compared to children with consistently low quality green space. Very good quality green space perceived by caregivers over time potentially reduces socioeconomic inequalities in prosocial behaviour. Green space quality-prosocial behaviour association was stronger among boys, children speaking only English at home, those living in more affluent areas, and remote areas. ConclusionTrajectory of caregiver perceived green space quality was positively associated with child prosocial behaviour. The findings suggest that improving the quality of green space to be very good quality, particularly in deprived and less accessible areas may help improve prosocial behaviour in children.

Greener neighbourhoods, healthier birth outcomes? Evidence from Australia.

Growing body of research recognizes the importance of green spaces on the perinatal outcomes however, further evidence from different geographies are warranted. We aimed to investigate association between, and differential responses to, maternal exposure to green space and birthweight. Birth records (n=82,221) were extracted from the Perinatal Data Collection (PDC) in Sydney's metropolitan area between January 2016 and December 2017. Association between green space quantity and birthweight, term birthweight, low birthweight, term low birthweight and preterm were assessed using linear and logistic regressions. Potential modification by area-level socioeconomic status and maternal country of birth were tested using interaction terms. Difference in birth weight for the ≥40% versus <20% green space within SA2s was 59.0g (95%CI: 42.9, 75.3) in unadjusted models which dropped to 25.6g (95%CI: 13.0, 38.2) in adjusted models. Stratified analysis suggested stronger associations for babies of mothers from affluent neighbourhoods, while statistically significant association was not observed in deprived areas. Furthermore, the association was more pronounced among babies to mothers who were born overseas. Associations were consistent for term births. Higher levels of green space were associated with lower odds of preterm birth in adjusted models. However, we did not identify statistically significant association between green space quantity and the risk of low birthweight (LBW). Our study suggests that green space may support healthier birth outcomes and help to reduce the birthweight gap between newborns of mothers born in Australia and overseas. However, disproportionate benefits among women in affluent neighbourhoods may widen socioeconomic inequities in birthweight.

Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom.

Pre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation. A cohort study using prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ≤16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with a priori specified covariates. Analysis was performed on 2160 children (41% females), with a median age of 3.8 years (interquartile range, 0.2-9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters, greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95% confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95% confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95% confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model. Socioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children from more affluent areas were more likely to receive a pre-emptive transplant.

Preoperative Factors Affecting the Patient-Reported Outcome Measures following Total Knee Replacement: Socioeconomic Factors and Preoperative OKS Have a Clinically Meaningful Effect.

The Oxford Knee Score (OKS) is a patient-reported outcome questionnaire typically used to assess function and pain in patients undergoing total knee replacement (TKR). However, research is inconclusive as to which preoperative factors are important in explaining variation in outcome following TKR. The operative records of 12,709 patients who underwent primary TKR over a 9-year period were analyzed. The following variables were collected for each patient: age, sex, body mass index (BMI), Index of Multiple Deprivation decile rank, side of operation, diagnosis, the American Society of Anaesthesiologists (ASA) grade, preoperative OKS, EQ-5D index score, EuroQol visual analog scale (EQ-VAS) score, the postoperative OKS at 1 and 2 years. Generalized linear regression models were performed at 1 and 2 years to investigate the effect of the preoperative variables on the postoperative OKS. The effect of age, sex, BMI, Index of Multiple Deprivation decile rank, diagnosis, ASA grade, preoperative OKS, EuroQoL five-dimensional (EQ-5D) index score, and EQ-VAS score were all statistically significant in explaining the variation in OKS at 1 and 2 years postoperatively, with critical level of significance of 0.05 (5%). Being male aged 60 to 69 years of normal BMI, ASA grade I (fit and healthy), living in an affluent area, not reporting preoperative anxiety/depression, were associated with an enhanced mean postoperative OKS at both 1 and 2 years. When adjusted for potential confounding, age of 60-69 years, male sex, normal BMI, lower ASA grade, higher Index of Multiple Deprivation and higher pre-operative EQ-5D, EQ-VAS and OKS were identified as factors that resulted in higher post-operative OKS after primary TKR.

Food Assistance Deserts in Central Florida: Identifying Service Gaps Using Spatial Analysis

Food assistance works to relieve food insecurity, a persistent problem in the United States disproportionately affecting marginalized communities. In this study, we take a closer look at geographical service gaps in food assistance using Geographic Information System (GIS) analysis to measure food assistance deserts, a term for areas where the nearest food assistance location is more than a mile away from the population centroid of a block group. By combining geographic data with data from the American Community Survey, we identified characteristics and predictors of food assistance deserts. Our results indicate that locations of food assistance in Central Florida are generally responsive to the needs of the community but are lacking in more affluent areas. This research was made possible through a partnership between our institution and Second Harvest Food Bank of Central Florida. The affordability and accessibility of this project should serve as a model for assessing spatial inequality in social service agencies through collaborative community-based research.

Evaluation of the anti-COVID-19 vaccination campaign in the Metropolitan Area of Milan (Lombardy Region, Northern Italy).

to present an evaluation of the campaign for vaccination against COVID-19 in the territory covered by the Agency for Health Protection of the Metropolitan Area of Milan from 01.01.2021 to 30.09.2021. descriptive study of vaccine adherence; predictive study of the factors associated with vaccine adherence, efficacy of vaccination in terms of hospitalization and mortality, and factors that increase the risk of hospital admission following full vaccination. population-based study with subjects aged >18 years eligible for vaccination (N. 2,981,997). An information system obtained by integrating various administrative healthcare sources made it possible to analyse socioeconomic characteristics, COVID-19 related hospitalizations, and general mortality in subjects eligible for vaccination. full vaccination (2 doses); COVID-19-related hospitalizations, COVID-19-related hospitalizations occurring more than 15 days after the second dose, general mortality. in the first nine months of the vaccination campaign, 74.7% of the subjects (N. 2,228,915) was fully vaccinated, whereas 15.6% (N. 465,829) did not even receive one dose. Women have a lower probability of getting vaccinated than men; the 50-59 years and 70+ years age groups emerge as the most problematic to reach, while the younger one (<40) is the most adherent. A social gradient emerged, with residents of more disadvantaged areas progressively less incline to get vaccinated than those living in more affluent areas. Adherence is greater in Italian citizenship and is likely to increase with an increase in the number of chronic conditions. Hospitalizations amounted to 1.22% (N. 5,672) in the unvaccinated population compared to 0.05% (N. 1,013) in the vaccinated population; general mortality was 4.51% (N. 15,198) in the unvaccinated population against 0.32% (N. 8.733) in the vaccinated population. Sociodemographic factors and the presence of previous health conditions are important predictors of hospitalization outcomes even within the fully vaccinated population. Specifically, the highest hazard ratios are found in subjects with heart failure (HR 2.15; 95%CI 1.83-2.53), in immunocompromised patients (HR 2.02; 95%CI 1.52-2.69), and in transplant recipients (HR 1.92; 95%CI 1.10-3.33). vaccination campaign adherence is affected by the sociodemographic characteristics of the population and is a determining factor in preventing hospitalizations for COVID-19 and death. The persistent higher risk of hospitalization in chronic subjects following the second dose emphasizes the need to direct booster doses to the more vulnerable. Information systems proved to be effective monitoring tools in the absence of specific trials.

Impacts of the COVID-19 Crisis: Evidence from 2 Million UK SMEs

The Covid-19 crisis led to a sharp drop in economic activity in the UK, which hit small and medium enterprises (SMEs) harder than larger businesses. We introduce a novel loan level dataset for 2 million UK SMEs (~5 billion data points) to document a few important facts during Covid-19: (1) The average SME contracted 30 percentage points in terms of turnover growth; (2) There was significant heterogeneity in the turnover shock across SMEs, with the biggest reductions for SMEs in consumer-facing sectors in Scotland and London; (3) SMEs in the hospitality sector in more affluent areas of the country were most likely to use the main government-guaranteed loan scheme for SMEs. Our dataset and analysis provides useful means to monitor SMEs as the sector recovers from the pandemic.

Mental Illness Inequalities by Multimorbidity, Use of Health Resources and Socio-Economic Status in an Aging Society.

Background: Mental illness, multi-morbidity, and socio-economic inequalities are some of the main challenges for the public health system nowadays, and are further aggravated by the process of population aging. Therefore, it is widely accepted that health systems need to focus their strategies for confronting such concerns. With guaranteed access to health care services under universal coverage in many health systems, it is expected that all services be provided equally to patients with the same level of need. Methods: In this paper, we explore the existence of inequalities in the access to services of patients with mental illness taking into account whether they are multimorbid patients, their socioeconomic status, and their age. We take advantage of a one-year (2010–2011) database on individual healthcare utilization and expenditures for the total population (N = 2,262,698) of the Basque Country. Results: More comorbidity leads to greater inequality in prevalence, being the poor sicker, although with age, this inequality decreases. All health services are more oriented towards greater utilization of the poor and sicker, particularly in the case of visits to specialists and emergency care. Conclusions: Mental health inequalities in prevalence have been identified as being disproportionally concentrated in the least affluent areas of the Basque Country. However, inequalities in the utilization of publicly-provided health services present a pro-poor orientation. As this region has adopted a system-wide transformation towards integrated care, its mental health delivery model offers excellent potential for international comparisons and benchlearning.

Impacts of the Covid-19 Crisis: Evidence from 2 Million UK SMEs

We introduce a novel data set to analyze the impact of the Covid-19 crisis on SME cash flows. The crisis led to a sharp drop in economic activity in the UK, which hit SMEs harder than larger businesses. The data set comprises monthly information on all 2 million SMEs that have current accounts or debt with nine major banking groups, with roughly 5 billion data points in total. We document a few basic facts on UK SME cash flows during Covid-19. (1) The virus and the public health interventions coincided with a 30 percentage point reduction in turnover growth for the average SME. (2) There was significant heterogeneity in the turnover shock across SMEs, with the biggest reductions for younger SMEs in consumer-facing sectors in Scotland and London. (3) Cash flows were broadly flat on average and there was much less heterogeneity across SMEs. (4) SMEs with average turnover growth in 2020 were most likely to use the main government-guaranteed loan scheme for SMEs, as well as those in the hospitality sector in more affluent areas of the country. Our analysis provides a framework to monitor SMEs as the sector recovers from the pandemic.

Nearly four pharmacies per week closed last year, with deprived areas hit worst

More than four times as many pharmacies closed in the most deprived parts of England in 2020 than in the most affluent areas of the country, an analysis by The Pharmaceutical Journal has found. The analysis, which used the UK government’s index of multiple deprivation to analyse the latest available NHS Digital data on pharmacy openings and […]

Trends and Racial/Ethnic, Socioeconomic, and Geographic Disparities in Maternal Mortality from Indirect Obstetric Causes in the United States, 1999-2017.

Background:This study examines trends and inequalities in US maternal mortality from indirect obstetric causes (ICD-10 codes: O98-O99) and specific chronic conditions by maternal race/ethnicity, socioeconomic status, nativity/immigrant status, marital status, place and region of residence, and cause of death.Methods:National vital statistics data from 1999 to 2017 were used to compute maternal mortality rates by sociodemographic factors. Rate ratios and log-linear regression were used to model mortality trends and differentials.Results:During 1999-2017, maternal mortality from indirect causes showed an upward trend; the annual rates increased by 11.2% for the overall population, 12.9% for non-Hispanic Whites, and 9.4% for non-Hispanic Blacks. The proportion of all maternal deaths due to indirect causes increased from 12.0% in 1999 to 26.9% in 2017. Maternal mortality from CVD increased sharply over time, from 0.40/100,000 live births in 1999 to 1.82 in 2017. During 2013-2017, compared to non-Hispanic Whites, non-Hispanic Blacks had 83% higher, Hispanics 51% lower, and Asian/Pacific Islanders 55% lower mortality from indirect causes. Non-Hispanic White women with <12 years of education had 4.4 times higher mortality than those with a college degree. Unmarried, US-born, and women living in rural areas and deprived areas had 90%, 80%, 60%, and 97% higher maternal mortality risks than married, immigrant, and women in urban areas and affluent areas, respectively. Maternal mortality from infectious diseases, including HIV, was 4.1 times greater and from respiratory diseases 2.9 greater among non-Hispanic Black women compared to non-Hispanic White women.Conclusions and Global Health Implications:While maternal mortality from direct obstetric causes has declined during the past two decades, maternal deaths due to indirect causes, particularly from pre-existing medical conditions, including CVD and metabolic disorders, have increased. Understanding complex interactions among social determinants, indirect causes, and proximate/direct causes is important to reducing maternal mortality and improving maternal health.

Associations between socioeconomic deprivation and pharmaceutical prescribing in primary care in England

BackgroundSocioeconomic deprivation is associated with health inequality. Previous studies have described associations between primary care prescribing rates and deprivation for individual drugs or drug classes. We explore the correlation between...

A surge in the incidence of telogen effluvium in minority predominant communities heavily impacted by COVID-19

To the Editor: In March 2020, New York City (NYC) experienced a surge of coronavirus infections, becoming the epicenter of the global pandemic. Low-income, communities of color were the hardest hit, with morbidity and mortality far outweighing that of more affluent white areas.1 Our dermatology departments operate out of 2 safety net hospitals in Brooklyn and Manhattan serving racially diverse neighborhoods that experienced some of the highest death rates in NYC.2 Beginning in July, we began to notice an abrupt uptick in cases of hair shedding in our clinics.