Levels Of Area Deprivation Research Articles

Modeling the effect of area deprivation on COVID-19 incidences: a study of Chennai megacity, India

ObjectivesSocio-economic inequalities may affect coronavirus disease 2019 (COVID-19) incidence. The goal of the research was to explore the association between deprivation of socio-economic status (SES) and spatial patterns of COVID-19 incidence in Chennai megacity for unfolding the disease epidemiology. Study designThis is an ecological (or contextual) study for electoral wards (subcities) of Chennai megacity. MethodsUsing data of confirmed COVID-19 cases from May 15, 2020, to May 21, 2020, for 155 electoral wards obtained from the official website of the Chennai Municipal Corporation, we examined the incidence of COVID-19 using two count regression models, namely, Poisson regression (PR) and negative binomial regression (NBR). As explanatory factors, we considered area deprivation that represented the deprivation of SES. An index of multiple deprivations (IMD) was developed to measure the area deprivation using an advanced local statistic, geographically weighted principal component analysis. Based on the availability of appropriately scaled data, five domains (i.e., poor housing condition, low asset possession, poor availability of WaSH services, lack of household amenities and services, and gender disparity) were selected as components of the IMD in this study. ResultsThe hot spot analysis revealed that area deprivation was significantly associated with higher incidences of COVID-19 in Chennai megacity. The high variations (adjusted R2: 72.2%) with the lower Bayesian Information Criteria (BIC) (124.34) and Akaike's Information Criteria (AIC) (112.12) for NBR compared with PR suggests that the NBR model better explains the relationship between area deprivation and COVID-19 incidences in Chennai megacity. NBR with two-sided tests and P <0.05 were considered statistically significant. The outcome of the PR and NBR models suggests that when all other variables were constant, according to NBR, the relative risk (RR) of COVID-19 incidences was 2.19 for the wards with high housing deprivation or, in other words, the wards with high housing deprivation having 119% higher probability (RR = e0.786 = 2.19, 95% confidence interval [CI] = 1.98 to 2.40), compared with areas with low deprivation. Similarly, in the wards with poor availability of WaSH services, chances of having COVID-19 incidence was 90% higher than in the wards with good WaSH services (RR = e0.642 = 1.90, 95% CI = 1.79 to 2.00). Spatial risks of COVID-19 were predominantly concentrated in the wards with higher levels of area deprivation, which were mostly located in the northeastern parts of Chennai megacity. ConclusionsWe formulated an area-based IMD, which was substantially related to COVID-19 incidences in Chennai megacity. This study highlights that the risks of COVID-19 tend to be higher in areas with low SES and that the northeastern part of Chennai megacity is predominantly high-risk areas. Our results can guide measures of COVID-19 control and prevention by considering spatial risks and area deprivation.

Trends in response rates and respondent characteristics in five National Maternity Surveys in England during 1995\u20132018

BackgroundThe National Perinatal Epidemiology Unit in England has conducted five National Maternity Surveys (NMS) at varying intervals since 1995. This paper aims to describe the changes in NMS response rates over time and to compare the demographic characteristics of respondents to each NMS.MethodsThis paper is based on secondary data analysis of the NMS (cross-sectional postal surveys) from 1995 to 2018. All women aged 16 years and over who gave birth in England (and Wales in 1995) during specified time periods from 1995 to 2018 were eligible to be selected. For each survey, between 3570 and 16,000 women who were 3–6 months postpartum were selected at random by the Office for National Statistics, using birth registrations. Women could participate on paper, by telephone (from 2006) or online (from 2010).ResultsThe response rate to the NMS decreased from 67% in 1995 to 29% in 2018. The decline was evident across demographic groups. In all NMS, response rates were higher in women who were older (crude prevalence ratios (PR) for 16–24 years versus 30–34 years = 0.51–0.73 (across surveys)), married (crude PR for sole versus married registrants = 0.41–0.62), born in the UK (crude PR for non UK-born versus UK-born = 0.70–0.84), and living in less deprived areas (crude PR for least versus most deprived = 0.42–0.63). However, the association between each demographic characteristic and response varied across surveys, with the youngest women, women who registered the birth of the baby in their sole name, and women living in the most deprived areas becoming relatively less likely to respond over time. In multivariable analysis in 2014 and 2018, the effects of age, marital status, country of birth and level of area deprivation on response were attenuated but all four demographic characteristics remained statistically significantly associated with response.ConclusionsResponse rates to the NMS have declined significantly during the last 23 years. The demographic characteristics associated with response were consistent across surveys, but the size of the effect varied significantly, with underrepresented groups becoming relatively less likely to participate over time. It is important to find strategies to increase response rates, particularly amongst underrepresented groups, and to validate the data collected.

Socioeconomic Position and the Incidence, Severity, and Clinical Outcomes of Hospitalized Patients With Community-Acquired Pneumonia.

The influence of socioeconomic disparities on adults with pneumonia is not well understood. The objective of our study was to evaluate the relationship between community-level socioeconomic position, as measured by an area deprivation index, and the incidence, severity, and outcomes among adults with community-acquired pneumonia (CAP). This was an ancillary study of a population-based, prospective cohort study of patients hospitalized with CAP in Louisville, Kentucky, from June 1, 2013, through May 31, 2015. We used a race-specific, block group-level area deprivation index as a proxy for community-level socioeconomic position and evaluated it as a predictor of CAP incidence, CAP severity, early clinical improvement, 30-day mortality, and 1-year mortality. The cohort comprised 6349 unique adults hospitalized with CAP. CAP incidence per 100 000 population increased significantly with increasing levels of area deprivation, from 303 in tertile 1 (low deprivation), to 467 in tertile 2 (medium deprivation), and 553 in tertile 3 (high deprivation) (P < .001). Adults in medium- and high-deprivation areas had significantly higher odds of severe CAP (tertile 2 odds ratio [OR] = 1.2 [95% confidence interval (CI), 1.06-1.39]; tertile 3 OR = 1.4 [95% CI, 1.18-1.64] and 1-year mortality (tertile 2 OR = 1.3 [95% CI, 1.11-1.54], tertile 3 OR = 1.3 [95% CI, 1.10-1.64]) than adults in low-deprivation areas. Compared with adults residing in low-deprivation areas, adults residing in high-deprivation areas had an increased incidence of CAP, and they were more likely to have severe CAP. Beyond 30 days of care, we identified an increased long-term mortality for persons in high-deprivation areas. Community-level socioeconomic position should be considered an important factor for research in CAP and policy decisions.

Prevalence and attitudes to HIV testing among adults visiting public outpatient clinics in Rome: results of the MeDi (Measuring health Disparities in HIV prevention) survey. Part 1.

It is estimated that, in Italy, 12 000-18 000 (11-13% of 130 000) HIV-infected subjects are not aware of their serostatus. People in this condition may visit the healthcare system multiple times without being diagnosed. If tested on one of these occasions, they could modify their high-risk behaviours and benefit from treatment, factors that reduce HIV transmission. In Italy, no data on HIV testing in the general population are available so far and little is known on the relationship between socioeconomic determinants (at individual and neighbourhood levels) and testing uptake. A large anonymous survey was performed in 2012-2014 on more than 10 000 individuals 18-59 years old who underwent 21 public ambulatories in Rome to determine the proportion of subjects tested for HIV and factors related to testing uptake. Subjects' socio-demographic characteristics, sexual orientation, number of sexual partners, HIV risk behaviour, HIV testing uptake were collected by a self-administered questionnaire. Level of area deprivation was measured at the postal code level by the index of social disadvantage (ISD). Multilevel Poisson regressions were carried out to take heterogeneity between clusters (post code and clinics) into account. Among people participating in the study, 58.1% of subjects self-reported to have been tested at least once for HIV. Those who had one high risk behaviour for HIV-infection were 11% more likely to test than those not reporting any, and subjects who had had a STI (sexually-transmitted-infection) in the past were 12% more likely to test than those who had not had a STI. However only 44% (54% among subjects aged 18-35 years) of those with self-reported risks of contracting HIV had been tested at least once in life. This percentage increases, as expected, with the level of education, but, even so, about 40% of university educated subjects self-reporting risks of contracting HIV had never undergone an HIV test. This study highlights that, while the percentage of subjects tested is even higher than observed in other western nations, only 44% of subjects, self-reporting risks of contracting HIV, had tested at least once in life and about 40% of university educated subjects self reporting risks of contracting HIV had never tested.

HIV prevalence among adults in Rome: results of the MeDi (Measuring health Disparities in HIV prevention) survey. Part 2.

In Italy, out of 60 millions of inhabitants, 3000 (2700-4000) new HIV infections are estimated each year. As combined antiretroviral therapy (ART) prolongs life for HIV sufferers, the prevalence of HIV-infection is likely to increase over time. Few studies have assessed factors associated with being HIV positive in people accessing public outpatient clinics and, in particular, the influence of socio-economic circumstances on HIV prevalence. This study aims to evaluate the association between subjects' serostatus and socio-economic determinants measured at the individual and neighbourhood levels. Data from a large anonymous survey performed in 2012-2014 on more than 10 000 individuals 18-59 years old who underwent 21 public ambulatories in Rome were analysed. Subjects' socio-demographic characteristics, sexual orientation, number of sexual partners, HIV risk behaviour and HIV testing uptake were collected by a self-administered questionnaire. Level of area deprivation was measured at the postal code level by the index of social disadvantage (ISD). Multilevel Poisson regressions were carried out to take heterogeneity between clusters (post code and clinics) into account. Self-reported HIV-prevalence was 2.0% among subjects ever been tested (13.7% for the homosexual/lesbians 7.0% for the bisexual and 1.3% for the heterosexual). About 1% of subjects self-identified as low risk was HIV infected. This prevalence increased up to 2% in the age group 18-34 and up to 5% in the non-heterosexuals (i.e. self- identified homosexuals/lesbians and bisexuals). At the individual level, HIV-prevalence decreased linearly from lowest to highest levels of education. Living in a deprived neighbourhood was not associated with HIV-infection. Our study confirms high HIV prevalences among homosexuals/lesbians. Some infections occur in subjects who do not report high risk behaviours for HIV transmission.

Area Deprivation, Urbanicity and Severe Mental Illness – A Population-Based Linkage Study Using Routinely Collected Primary and Secondary Care Data

Background There is a long-standing debate regarding the associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs).&#x0D; Main Aim We investigated the associations between area deprivation, urbanicity and risk of SMIs in a population cohorts in Wales.&#x0D; Methods/Approach We extracted primary and secondary care electronic health records from 2004 to 2015 from Wales’s population. We identified prevalent and incident individuals with SMIs (schizophrenia related disorders and bipolar disorder) and their level of deprivation and urbanicity. We used the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator to measure the level of area deprivation and urbanicity respectively for all lower layer super output areas, the geographic units used in the reporting of small area statistics comprised of approximately 1,500 individuals.&#x0D; Results Prevalence and incidence of SMIs is not evenly distributed in Wales. Increased prevalence and incidence of SMIs occur in more deprived and urban areas. Such associations occur for both schizophrenia related disorders and bipolar disorder and in both the primary and secondary care cohorts.&#x0D; Conclusion These findings have implications for resource allocation, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.

The association between area-based deprivation and change in body-mass index over time in primary school children: a population-based cohort study in Hampshire, UK.

Childhood obesity is a serious public health challenge. Cross-sectional evidence indicates that childhood obesity is strongly linked to area deprivation level, yet longitudinal research is scarce. We assessed the association of home-based and school-based deprivation indices with change in childhood body-mass index (BMI) z-score and BMI status over 6 years in Hampshire, England. This longitudinal study linked the National Child Measurement Programme data for children aged 4-5 years (2007-08 to 2009-10) to 10-11 years. The dataset was stratified into two groups: 18,733 children for whom home deprivation quintiles, according to the Index of Multiple Deprivation (IMD), remained constant, and 6153 children who moved home deprivation quintiles between the two time points. The associations between IMD quintiles and change in BMI z-score and status were analysed. 63.7% of children remained a healthy weight, 3.1% remained overweight, 5.3% remained with obesity, 8.3% became overweight, and 10.3% developed obesity. Children living in the most deprived quintile increased their BMI z-score by 0.13 units more than those in the least deprived quintile (95% CI: 0.08-0.19). Home-based deprivation displayed associations with change in BMI status. (Relative risk for the most deprived quintile: become overweight 1.47, 1.21-1.78, remain obese 1.82, 1.34-2.40, become obese 2.07, 1.73-2.48.) School-based deprivation was not associated with change in BMI z-score or BMI status. Moving home to a more deprived quintile was associated with developing obesity (1.22, 1.04-1.43). More children living in deprived areas developed obesity over time. Home-based deprivation level is more strongly associated with adverse change in childhood weight than school-based deprivation. Scholarly settings can provide opportunities for interventions, however obesity prevention interventions should tackle the obesogenic environment combining family and area-based measures.

Screen, Ration and Churn: Demand Management and the Crisis in Children’s Social Care

Abstract This article presents findings from a quantitative study of the national data-sets for statutory children’s social care services in England. The aim of the study was to examine how demand management varied in local authorities with differing levels of area deprivation. About 152 local authorities census returns and other statistical indicators covering the period 2014–2017 were combined into a single data-set. Statistical analysis was undertaken to explore trends over time and correlations between indicators that might indicate patterns in the way demand was managed. Findings showed that high levels of deprivation have continued to be strongly linked to high levels of activity and that local authorities have continued to increase their use of protective interventions relative to referrals. Evidence was found for three interconnected mechanisms, through which local authorities tended to manage demand for services: screening, rationing and workforce churn. The article describes these mechanisms and comments on their significance for the current crisis of demand in the sector.

The Intersection of Residence, Community Vulnerability, and Premature Mortality.

Rural communities often experience higher rates of mortality than their urban counterparts, with gaps widening in the foreseeable future. However, the underlying level of socioeconomic vulnerability (area deprivation) among rural communities can vary widely. This study examines rural-urban differences in mortality-related outcomes within comparable levels of deprivation. Rural-urban differences in Years of Potential Life Lost (YPLL), derived from the County Health Rankings, were examined across comparable levels of area deprivation using a quantile regression approach. Rural-urban differences in YPLL were estimated at the 10th, 25th, 50th, 75th, and 90th percentiles across levels of deprivation. Compared to the reference population (urban counties/least deprived) a clear increase in YPLL among both rural and urban counties was noted across levels of deprivation, with the highest level of YPLL occurring in counties with the most deprivation. While YPLL increased across levels of deprivation, the magnitude of these differences was markedly higher in rural counties compared to urban, particularly among the most deprived counties. Rural counties experienced an advantage at the lowest percentiles and levels of deprivation. However, this advantage quickly deteriorated, revealing significant rural disparities at the highest level of deprivation. This study noted a differential effect in mortality-related outcomes among rural counties within comparable levels of community deprivation. Findings contribute to evidence that many, but not all rural communities face a double disadvantage. This underscores the need for a continued focus on the development and implementation of multiple policies aimed at reducing differences in poverty, education, and access to care.

Deprivation, urbanisation and Perthes' disease in Northern Ireland.

It has been suggested that Perthes' disease is more prevalent in urban areas, and that the risk increases with deprivation. We present the findings of a preliminary analysis of Perthes' disease in Northern Ireland, which is shown to have one of the highest national annual rates of incidence in the world (11.6 per 100000). Of the 313 children diagnosed over a seven-year period, 311 were allocated to the enumeration districts of the 1991 census, thus allowing the incidence to be calculated using both spatial and non-spatial aggregation. The cases were grouped according to the size of the settlement from highly urbanised to open countryside and by level of area deprivation. While the incidence of Perthes' disease was found to be associated with indicators of the level of deprivation for areas, there was no evidence to suggest that there was an increased risk in urban areas; the highest rate was found in the most deprived rural category.

Inequalities in the prevalence of diabetes mellitus and its risk factors in Sri Lanka: a lower middle income country

BackgroundExplorations into quantifying the inequalities for diabetes mellitus (DM) and its risk factors are scarce in low and lower middle income countries (LICs/LMICs). The aims of this study were to assess the inequalities of DM and its risk factors in a suburban district of Sri Lanka.MethodsA sample of 1300 participants, (aged 35–64 years) randomly selected using a stratified multi-stage cluster sampling method, were studied employing a cross sectional descriptive design. The socioeconomic indicators (SEIs) of the individual were education level and occupational category, and at the household level, the household income, social status level and area deprivation level. DM was diagnosed if the fasting plasma glucose was ≥126 and a body mass index (BMI) of > 27.5 kg/m2 was considered high. Asian cut-off values were used for high waist circumference (WC). Validated tools were used to assess the diet and level of physical activity. The slope index of inequality (SII), relative index of inequality (RII) and concentration index (CI) were used to assess inequalities.ResultsThe prevalence of DM and its risk factors (at individual or household level) showed no consistent relationship with the three measures of inequality (SII, RII and CI) of the different indices of socio economic status (education, occupation, household income, social status index or area unsatisfactory basic needs index).The prevalence of diabetes showed a more consistent pro-rich distribution in females compared to males. Of the risk factors in males and females, the most consistent and significant pro-rich relationship was for high BMI and WC. In males, the significant positive relationship with high BMI for SII ranged from 0.18 to 0.35, and RII from 1.56 to 2.25. For high WC, the values were: SII from 0.13 to 0.27 and RII from 1.9 to 3.97. In females the significant positive relationship with high BMI in SII ranged from 0.13 to 0.29, and RII from 2.3 to 4.98. For high WC the values were: SII from 028 to 0.4 and RII 1.99 to 2.39.Of the other risk factors, inadequate fruit intake showed a consistent significant pro-poor distribution only in males using SII (− 0.25 to − 0.36) and in both sexes using CI. Smoking also showed a pro-poor distribution in males especially using individual measures of socio-economic status (i.e. education and occupation).ConclusionsThe results show a variable relationship between socioeconomic status and prevalence of diabetes and its risk factors. The inequalities in the prevalence of diabetes and risk factors vary depending on gender and the measures used. The study suggests that measures to prevent diabetes should focus on targeting specific factors based on sex and socioeconomic status. The priority target areas for interventions should include prevention of obesity (BMI and central obesity) specifically in more affluent females. Males who have a low level of education and in non-skilled occupations should be especially targeted to reduce smoking and increase fruit intake.

4.4-O2A retrospective analysis of variations in antenatal care initiation in an ethnically diverse maternal population in the UK with high levels of area deprivation

4.4-O2A retrospective analysis of variations in antenatal care initiation in an ethnically diverse maternal population in the UK with high levels of area deprivation

Risk factors for type 2 diabetes after gestational diabetes: a population-based cohort study

BackgroundGestational diabetes affects 4% of UK pregnancies, and women affected are estimated to be seven times as likely as those without the disorder to develop subsequent type 2 diabetes. We aimed to determine incidence of and risk factors for type 2 diabetes after a pregnancy affected by gestational diabetes. MethodsThis longitudinal population-based cohort made use of the Hampshire Health Record, a health-care database covering around 1·2 million residents in Hampshire, UK. All women diagnosed with gestational diabetes between Sept 30, 2007, and Sept 30, 2015, were identified. If women had multiple pregnancies affected by gestational diabetes during the study period, only the first pregnancy was included. Multivariable Cox proportional hazards regression modelling was used to assess clinically significant risk factors, based on previous evidence, that were available in the dataset including body-mass index (BMI) before pregnancy, ethnicity, family history of diabetes, treatment type for gestational diabetes, age (at time of diagnosis), area deprivation level, hypertension, hyperlipidaemia, cardiovascular disease, and a history of gestational diabetes. Diagnoses of type 2 diabetes during the study period were used to calculate incidence of type 2 diabetes after gestational diabetes. Findings3033 women with gestational diabetes were identified. 171 of 2654 women who were tested for type 2 diabetes during the study period (6·4%, 95% CI 5·5–7·3) were diagnosed with this condition (mean follow-up 4·1 years [SD 2·2]). Obesity was the strongest risk factor, with adjusted hazard ratios (aHR) for obesity (BMI 30–35 kg/m2) of 2·8 (95% CI 1·5–5·3) and for severe obesity (>35 g/m2) of 3·4 (1·5–7·8; p<0·0001 for trend). Other significant risk factors included Asian ethnicity (aHR 2·9, 95% CI 1·6–5·3), previous gestational diabetes (1·7, 1·1–2·6), and pharmacological treatment for gestational diabetes (insulin 2·9, 2·0–4·2; oral medications 1·9, 1·2–3·1). InterpretationRoutinely collected electronic health-care data can be used to assess real-life risk factors for type 2 diabetes after gestational diabetes. Challenges include missing data and inaccurate coding, which can impact validity of findings. However, this study provides a basis to develop and test a regional risk-scoring system for prioritising referrals to interventions for diabetes prevention after gestational diabetes. FundingThis study formed the basis of JB's MSc Public Health dissertation, which was funded by Health Education England as part of the Wessex Public Health Specialty Training Programme.

Minority Embeddedness and Economic Integration: Is Diversity or Homogeneity Associated with Better Employment Outcomes?

Using data from the Managing Cultural Diversity Survey 2010 and the Ethnic Minority British Election Study 2010, we explore the activity and employment outcomes of majority and minority individuals in the UK, and examine their association with a variety of ethnic embeddedness measures. We do not find that white British respondents living in areas of high deprivation and diversity experience lower levels of economic activity or bad jobs. Deprivation rather than minority embeddedness stands out as the factor that serves to compound both majority and minority disadvantage. In the case of minorities, embeddedness does have some negative effects, although these are greatly attenuated once one takes into account the level of area deprivation.

The influence of mobility on mental health status in young people: The role of area-level deprivation

Residential mobility during childhood has been previously associated with poor mental health; however, this association could be mediated by several aspects of moving. This paper investigated the impact of mobility across different levels of area deprivation on the individual’s mental health status in Northern Ireland. Mobility towards deprived areas was associated with an elevated risk of reporting poor mental health in both house owners and renters. However, the number of residential moves appeared to be moderating the effect of area change on the individual’s mental health. Further exploration of this relationship is warranted through the use of more in-depth mental health measures.

Attitudes Toward Testicular Cancer and Self-Examination Among Northern Irish Males.

Testicular cancer incidence rates are increasing worldwide making it the most common malignancy in males aged 15 to 45 years. Without a known way to prevent the disease health professionals must promote awareness and early detection. A literature review identified a scarcity of information regarding awareness and knowledge of, and attitudes toward, testicular cancer and testicular self-examination among men in Northern Ireland. This study aimed to establish baseline data for Northern Ireland using a convenience sample of 150 men, aged 18 to 45 years. The sample was recruited from across the country and so represents a range of education and area deprivation levels. An online survey was used to collect data. Results showed that while 39% of respondents correctly identified the age group at highest risk for testicular cancer, only 17% of respondents had ever heard of a testicular self-examination. Analysis revealed knowledge, awareness, and attitudes differed by age groups and area deprivation quintiles. It is recommended that health promoters in Northern Ireland and elsewhere use these findings to tailor health promotion initiatives to engage men and raise testicular cancer and self-examination awareness.

Ambulatory Care-Sensitive Condition Hospitalizations Among Medicare Beneficiaries.

This study examined the association between the distribution of primary care physicians and Medicare beneficiaries' ambulatory care sensitive condition hospitalizations using both statistical and spatial analyses. Data from the 2014 County Health Rankings, 2013-2014 Area Resource File, and the 2014 Food Environment Atlas Data File were integrated to perform county-level ordinary least squares and geographically weighted regression. Analyses were conducted in late 2015. Primary care physician density was found to be negatively associated with Medicare beneficiaries' ambulatory care sensitive condition hospitalization rate in both ordinary least squares (β=-5.88, p=0.0037) and geographically weighted regression models (37.08% of all counties), with the latter model finding significant relationships in the South and Northeast. Preventable hospitalizations are high in areas of the U.S. that have low primary care physician density and other healthcare resources, large non-white populations, high levels of area deprivation, and rural designations.Using geospatial techniques helped document areas of greatest concern for potential intervention. Futureresearch needs to account for these regional differences and target surveillance accordingly.

병원 밖에서 발생한 심인성 심장정지환자의 생존 관련 요인 7년간 국가심장정지조사사업 자료 활용

Purpose The purpose of this study was not only to explore the factors associated with the survival of OHCA(Out-of-hospital Cardiac Arrest), but to provide ideas for improving the operation of emergency medical system in Korea. Method 90,734 OHCAs(Out-of-hospital Cardiac Arrest) with a cardiac etiology, who had been transported by 119 EMS ambulances for seven years from 2006 to 2012 in Korea, were analyzed. The data had a multilevel structure in that patient`s survival in the same region is interrelated, so two-level (patient-region) logistic regression analysis was applied to adjust this correlation. Results The adjusted OR in group who were given CPR(Cardiopulmonary Resuscitation) by a bystander were 1.40 for survival to discharge. In addition, the adjusted OR in the group with an implementation of AED (automated external defibrillator) before arriving in hospital was 2.98 for survival to discharge. we categorized some continuous variables (number of emergency physician, OHCAs volume fo hospital, area deprivation level) into five quintiles. The adjusted OR in the number of emergency physician compared with Q1(lowest) was 1.29(Q2), 2.89(Q3), 3.39(Q4), 4.07(Q5), respectively. the adjusted OR in OHCAs volume of each hospital compared with Q1(lowest) was 2.06(Q2), 3.06(Q3), 3.46(Q4), 4.36(Q5), respectively. Lastly, the adjusted OR in deprivation level compared with Q1(least deprived area) was 0.72(Q4), 0.64(Q5) so that the adjusted OR of survival to discharge tended to decrease in more deprived districts. Conclusion The survival to discharge was better significantly in group given CPR by a bystander and with the implementation of AED before arriving in hospital. The survival to discharge tended to be significantly better in hospitals with a larger number of emergency physicians and higher volume of OHCAs in less deprived districts.

Community environment, cognitive impairment and dementia in later life: results from the Cognitive Function and Ageing Study.

Background: few studies have investigated the impact of the community environment, as distinct from area deprivation, on cognition in later life. This study explores cross-sectional associations between cognitive impairment and dementia and environmental features at the community level in older people.Method: the postcodes of the 2,424 participants in the year-10 interview of the Cognitive Function and Ageing Study in England were mapped into small area level geographical units (Lower-layer Super Output Areas) and linked to environmental data in government statistics. Multilevel logistic regression was conducted to investigate associations between cognitive impairment (defined as MMSE ≤ 25), dementia (organicity level ≥3 in GMS-AGECAT) and community level measurements including area deprivation, natural environment, land use mix and crime. Sensitivity analyses tested the impact of people moving residence within the last two years.Results: higher levels of area deprivation and crime were not significantly associated with cognitive impairment and dementia after accounting for individual level factors. Living in areas with high land use mix was significantly associated with a nearly 60% reduced odds of dementia (OR: 0.4; 95% CI: 0.2, 0.8) after adjusting for individual level factors and area deprivation, but there was no linear trend for cognitive impairment. Increased odds of dementia (OR: 2.2, 95% CI: 1.2, 4.2) and cognitive impairment (OR: 1.4, 95% CI: 1.0, 2.0) were found in the highest quartile of natural environment availability. Findings were robust to exclusion of the recently relocated.Conclusion: features of land use have complex associations with cognitive impairment and dementia. Further investigations should focus on environmental influences on cognition to inform health and social policies.

지역 박탈수준과 중고령층의 활동제한의 연관성

Objectives: As the increasing of the length of the lifespan, more recent policy interest are concerned with how many years of life are lived without functional disability or activity limitation. We investigated the relationship between deprivation and activity limitation at the 251 local authority level. Methods: The data were derived from the 2010 Census 10% sample data. Crude and age-standardized activity limitation rates by gender at the ages of 50 or over and deprivation index were calculated. Mapping and multiple linear regression analysis were applied to explore relationship between area activity limitation and area deprivation. Results: There were considerable differences in activity limitation rate across the 251 local authorities. Age-standardized activity limitation rate in both male and female were strongly associated with the level of area deprivation. Especially, low social class, male unemployment, or non-apartment residents at the local level were strong positive association with local authorities’ age-standardized activity limitation. Conclusion: More policy attention is needed for tackling regional inequality in activity limitation among older adults.