Areas Of England Research Articles

Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis.

In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age. This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018-2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area-level deprivation. The analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post-approval. The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre-approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post-approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.

The rural–urban poverty gap in England after the 2008 financial crisis: exploring the effects of budgetary cuts and welfare reforms

ABSTRACT A rural–urban poverty gap exists in most countries around the world, and this paper employs a novel approach to explain this difference, using logistic regression to examine the effects of rural–urban residence type, individual socio-economic and demographic characteristics, and changes in government policies on the likelihood of being poor in England. Unusually, rural areas in England have lower poverty rates than urban areas, so the direction of the typical rural–urban poverty gap is reversed, but the method employed here would be applicable in either direction. We disaggregate micro-data from the Understanding Society Survey (USS) into three residence types (predominantly rural; significantly rural and predominantly urban), and combine these USS data with information on changes in councils’ spending power, in service spending and in per capita income lost from cuts to welfare benefits since 2010. The results demonstrate that rural residence provides a buffer against poverty in England, a so-called ‘rural advantage effect’, but this is reduced or becomes non-significant after controlling for individual socio-economic and demographic characteristics and changes in government policies. Furthermore, working-age poverty has increased more rapidly in rural areas than urban between 2010 and 2018. Our analysis also reveals how national policies have differential spatial impacts on local populations according to their diverse characteristics.

“Friendly, local and welcoming” – evaluation of a community mental health early intervention service

PurposeHalf of adulthood mental health challenges begin by the age of 14-years-old, making the need for early-intervention clear. This study aims to evaluate a new service model that promotes early-intervention through a community based low-intensity Hub.Design/methodology/approachClinical data from 2,384 young people were analysed through within-group, pre- and post-comparisons and qualitative survey, and interview data was analysed through content analysis.FindingsOverall, participants reported that they were highly satisfied with the Hub and the low-intensity brief interventions met their needs. Participants reported that learning new skills, having a place to talk and positive therapeutic relationships were beneficial. The Hub appeared to be less successful for young people with complex mental health difficulties. As a service, the adoption of the Hub model reduced waiting list times by more than half.Research limitations/implicationsThe quantitative data demonstrated that engaging with the Hub reduced symptoms of psychological distress. Qualitative analyses suggest that access to local, community, welcoming and “less clinical” support was beneficial, and the type of brief interventions offered was less important than therapeutic relationships.Originality/valueThis is the first study of a novel “Hub” model for low-intensity brief interventions in a socio-economically deprived area of England. Local knowledge, community integrated support, therapeutic relationships and a welcoming environment were viewed as more beneficial than the type of brief interventions offered. Consequently, community spaces can be created to be therapeutic and beneficial for mental health outside of a traditional conceptualisation of clinical support.

A REVISION ARTHROPLASTY NETWORK HAS SIGNIFICANTLY REDUCED EARLY RE-REVISION RATES FOLLOWING REVISION TOTAL KNEE ARTHROPLASTY COMPARED WITH THE REST OF ENGLAND: AN ANALYSIS OF THE EAST MIDLANDS SPECIALIST ORTHOPAEDIC NETWORK USING A NATIONAL ADMINISTRATIVE DATA SET

AbstractIntroductionRevision total knee arthroplasty (RTKA) is a complex procedure with higher rates of re-revision, complications and mortality compared to primary TKA. We report the effects of the establishment of a Revision Arthroplasty Network (The East Midlands Specialist Orthopaedic Network; EMSON).MethodologyThe Revision Arthroplasty Network was established in January 2015 and covered the Nottinghamshire and Lincolnshire areas of England. This comprises a collaborative weekly multidisciplinary meeting where upcoming RTKA procedures are discussed, and a plan agreed.Using the Hospital Episode Statistics database, RTKA procedures carried out between 2011 and 2018 from the five EMSON hospitals were compared to all other hospitals in England. Age, sex, and Hospital Frailty Risk scores were used as covariates.The primary outcome was re-revision surgery within 1 year of the index revision. Secondary outcomes were re-revision surgery within two years, any complication within one and two years and median length of stay.Results33,828 RTKA procedures were performed across England; 1,028 (3.0%) were conducted within EMSON. Re-revision rates within 1 year were 11.6% and 7.4% pre- and post-intervention respectively within the network. This compares to a pre-post change from 11.7% to 9.7% for the rest of England. In comparative interrupted time-series analysis, there was a significant immediate improvement in re-revision rates for EMSON hospitals compared to the rest of England at 1 year (p = 0.024) and 2 years (p=0.032).ConclusionRe-revision rates for RTKA improved significantly at one and two years with the introduction of EMSON, when compared to the rest of England.

Unravelling the variations of the society of England and Wales through diffusion mapping analysis of census 2011.

We propose a new approach to identify geographical clustering and inequality hotspots from decadal census data, with a particular emphasis on the method itself. Our method uses diffusion mapping to study the 181 408 output areas in England and Wales (EW), which enables us to decompose the census data's EW-specific feature structures. We further introduce a localization metric, inspired by statistical physics, to reveal the significance of minority groups in London. Our findings can be adapted to analogous datasets, illuminating spatial patterns and differentiating within datasets, especially when meaning factors for determining the datasets' structure are scarce and spatially heterogeneous. This approach enhances our ability to describe and explore patterns of social deprivation and segregation across the country, thereby contributing to the development of targeted policies. We also underscore the method's intrinsic objectivity, guaranteeing its ability to offer comprehensive and unbiased analysis, unswayed by preconceived hypotheses or subjective interpretations of data patterns.

Rural lives during COVID-19: crisis, resilience and redistributing societal risk

ABSTRACT This paper explores the redistribution and rescaling of societal risk in rural Britain during the COVID-19 pandemic, as one episode of the permacrisis. Drawing on empirical work in three contrasting areas of Scotland and England, we analyse individuals’ experiences of risk and of the institutions which offer them support in times of crisis (markets, state, voluntary and community organisations, and family and friends). Our findings reveal the unequal distribution of societal risk during the pandemic, exacerbated by a legacy of precariatisation and individualisation in the labour market and welfare reforms. Although the state acted to mitigate risk and financial hardship during the lockdown, it was often voluntary and community organisations that filled the gaps left by the inability of the state to reach effectively into rural areas. Social infrastructure and institutional capital are therefore central to the mitigation of vulnerability and societal risk. This raises important questions about the capacity of institutions to provide support in times of crisis to rural citizens. Unless there is societal pooling of risk through such institutions to ensure social protection and that nobody is disadvantaged by where they live, future episodes of the permacrisis are likely to exacerbate inequalities and vulnerabilities in rural communities.

“Figuring stuff out myself” – a qualitative study on maternal vaccination in socially and ethnically diverse areas in England

BackgroundMaternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in London in the Covid-19 context.MethodsIn 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach.ResultsThe sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements.ConclusionsOur study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers.

Socioeconomic disparities in surgery for carotid artery disease in England.

Carotid artery disease and stroke are more prevalent in socioeconomically deprived areas. The aim was to investigate socioeconomic disparities in carotid artery disease surgery rates and in outcomes following surgery. The study used population-based ecological and cohort study designs, 31 672 census areas in England, hospital admissions from April 2006 to March 2018, the Index of Multiple Deprivation 2010 as the area-level deprivation indicator, and Poisson, logistic, and Cox regression. A total of 54 377 patients (67 per cent men) from a population aged 55 years and older of 14.7 million had carotid artery disease procedures (95 per cent carotid endarterectomy). Carotid endarterectomy rates were 116 per cent (95% c.i. 101 to 132) higher in men and 180 per cent (95% c.i. 155 to 207) higher in women aged 55-64 years in the most compared with the least socioeconomically deprived areas by quintile. However, this difference diminished and appeared to reverse with increasing age, with 24 per cent (95% c.i. 14 to 33) and 12 per cent (95% c.i. -3 to 24) lower carotid endarterectomy rates respectively in men and women aged 85 years and older in the most deprived areas. Patients in deprived areas having carotid endarterectomy were more likely to have been admitted as symptomatic emergency carotid artery disease admissions. Mortality, and a combined outcome of mortality or stroke-related re-admission, were both worse in patients living in more deprived areas and were only partially accounted for by the higher prevalence of co-morbidities. There was, however, no clear pattern of association between deprivation and elective waiting time for carotid endarterectomy. These results provide evidence of socioeconomic disparities in surgery for carotid artery disease. Clear policies are needed to address these disparities.

Adaptation and Implementation of a Shared Decision-Making Tool From One Health Context to Another: Partnership Approach Using Mixed Methods.

Osteoarthritis is a leading cause of pain and disability. Knee osteoarthritis accounts for nearly four-fifths of the burden of osteoarthritis internationally, and 10% of adults in the United Kingdom have the condition. Shared decision-making (SDM) supports patients to make more informed choices about treatment and care while reducing inequities in access to treatment. We evaluated the experience of a team adapting an SDM tool for knee osteoarthritis and the tool's implementation potential within a local clinical commissioning group (CCG) area in southwest England. The tool aims to prepare patients and clinicians for SDM by providing evidence-based information about treatment options relevant to disease stage. This study aimed to explore the experiences of a team adapting an SDM tool from one health context to another and the implementation potential of the tool in the local CCG area. A partnership approach using mixed methods was used to respond to recruitment challenges and ensure that study aims could be addressed within time restrictions. A web-based survey was used to obtain clinicians' feedback on experiences of using the SDM tool. Qualitative interviews were conducted by telephone or video call with a sample of stakeholders involved in adapting and implementing the tool in the local CCG area. Survey findings were summarized as frequencies and percentages. Content analysis was conducted on qualitative data using framework analysis, and data were mapped directly to the Theoretical Domains Framework (TDF). Overall, 23 clinicians completed the survey, including first-contact physiotherapists (11/23, 48%), physiotherapists (7/23, 30%), specialist physiotherapists (4/23, 17%), and a general practitioner (1/23, 4%). Eight stakeholders involved in commissioning, adapting, and implementing the SDM tool were interviewed. Participants described barriers and facilitators to the adaptation, implementation, and use of the tool. Barriers included a lack of organizational culture that supported and resourced SDM, lack of clinician buy-in and awareness of the tool, challenges with accessibility and usability, and lack of adaptation for underserved communities. Facilitators included the influence of clinical leaders' belief that SDM tools can improve patient outcomes and National Health Service resource use, clinicians' positive experiences of using the tool, and improving awareness of the tool. Themes were mapped to 13 of the 14 TDF domains. Usability issues were described, which did not map to the TDF domains. This study highlights barriers and facilitators to adapting and implementing tools from one health context to another. We recommend that tools selected for adaptation should have a strong evidence base, including evidence of effectiveness and acceptability in the original context. Legal advice should be sought regarding intellectual property early in the project. Existing guidance for developing and adapting interventions should be used. Co-design methods should be applied to improve adapted tools' accessibility and acceptability.

An Analysis of Domestic Fire Smoke/Toxic Fumes Inhalation Injuries

Previous studies indicated that inhalation of smoke and toxic fumes is the most common form of domestic fire injury. In this article we examine the socio-demographic, contributory, and firefighting behaviour factors associated with accidental dwelling fire smoke / toxic fumes inhalation injuries. In particular, we examine age band, gender, occupancy level, deprivation, alcohol / drug consumption, and attempting to fight a domestic fire in the Merseyside area of North-West England covered by Merseyside Fire and Rescue Service over the period 2011 to 2022. Smoke / toxic fumes inhalation injuries occurred more in single occupancy as opposed to multiple occupancy dwellings by a ratio of 2 to 1 over the period studied. The majority of the accidental dwelling fire smoke / toxic fumes inhalation injuries occurred in areas with the highest level of deprivation within the area studied. Alcohol / drug consumption was a contributory factor in roughly 14% of the smoke / toxic fumes inhalation injuries. Smoke / toxic fumes inhalation injuries sustained attempting to fight the fire constituted roughly 12% of the total number of smoke / toxic fumes inhalation injuries over the period studied.

Facilitating cardiopulmonary resuscitation training in high-risk areas of England: A study protocol

IntroductionBystanders’ interventions improve chances of survival from out-of-hospital cardiac arrest (OHCA) before Emergency Medical Services arrive. Some areas in England are of concern. These high-risk areas have a higher incidence of cardiac arrest combined with lower-than-average bystander CPR rates and are characterised by higher proportions of minority ethnic group residents and deprivation.Collaborating with people from the Black African and Caribbean and South Asian minority communities in deprived areas of England, we aim to develop and evaluate the implementation of theoretically informed intervention(s) to address factors contributing to lower bystander intervention rates. MethodsThe study is a collaborative realist enquiry, informed by the Theoretical Domains Framework and associated Behaviour Change Wheel. It consists of 1) a realist evidence synthesis to produce initial program theories developed from primary workshop data and published evidence. It will include identifying factors contributing to the issue and potential interventions to address them; 2) theoretically informed intervention development, using the initial program theories and behaviour change theory and 3) a realist mixed methods implementation evaluation with embedded feasibility.Public involvement (PPI) as study team and public advisory group members is key to this study.We will conduct realist evidence synthesis, qualitative and statistical analyses appropriate to the various methods used. DisseminationWe will develop a dissemination plan and materials targeted to members of the public in high-risk areas as well as academic outputs. We will hold an event for participating community groups and stakeholders to share findings and seek advice on next steps. Study registrationISRCTN90350842. Registration date 28.03.2023. The study was registered after its start date.

Estimate long-term impact on battery degradation by considering electric vehicle real-world end-use factors

Many estimates of battery capacity degradation are based on accelerated lab tests that involve charge-discharge cycles or rely on data or electrochemical modeling. These methods are reasonable for technology benchmarking but rarely consider real-world end-use factors. To address this issue, this study develops the Battery Run-down under Electric Vehicle Operation (BREVO) model. It links the driver's travel pattern to physics-based battery degradation and powertrain energy consumption models. The model simulates the impacts of charging behavior, charging rate, driving patterns, and multiple energy management modules on battery capacity degradation. It finds that, over a 10-year timespan, firstly, for a random driver situated in the New England area, daily direct-current fast charging (60 kW) could lead to up to 22% less battery capacity when compared to daily Level-1 charging (1.8 kW). Second, the battery thermal management system can delay battery degradation by approximately 0.5% in the New England area. Third, warmer ambient temperatures enhance BEV battery usage. The model indicates that the battery capacity in the Los Angeles area is 6% higher than that in the New England area. The BREVO model provides crucial information for consumers and BEV manufacturers on range anxiety, BEV battery design, and decision support of battery warranty.

Sustainability strategies and stakeholder management for upland farming

Upland farming provides important benefits to society. To retain these benefits, measures to encourage farms to adopt practices that balance economic, environmental and social aspects of sustainability are required. This study used survey data from a sample of farms located in less-favoured areas in Northern England to identify the trade-offs between the three dimensions of farm-level sustainability and the impacts of farm behaviours on them, including diversification, participation in agri-environmental policies and stakeholder management. Results showed that farm businesses may face a trade-off between improving economic and environmental performance through their decisions about participating in agri-environmental schemes and that strengthening relationships with some stakeholders is critical for achieving sustainability. This suggests that future policy design may simultaneously improve three dimensions of sustainability by promoting environmental conservation activities through non-economic incentives and by encouraging farm businesses to build good working relationships with their stakeholders.

A protocol for a multi-site cohort study to evaluate child and adolescent mental health service transformation in England using the i-THRIVE model.

The National i-THRIVE Programme seeks to evaluate the impact of the NHS England-funded whole system transformation on child and adolescent mental health services (CAMHS). This article reports on the design for a model of implementation that has been applied in CAMHS across over 70 areas in England using the 'THRIVE' needs-based principles of care. The implementation protocol in which this model, 'i-THRIVE' (implementing-THRIVE), will be used to evaluate the effectiveness of the THRIVE intervention is reported, together with the evaluation protocol for the process of implementation. To evaluate the effectiveness of i-THRIVE to improve care for children and young people's mental health, a cohort study design will be conducted. N = 10 CAMHS sites that adopt the i-THRIVE model from the start of the NHS England-funded CAMHS transformation will be compared to N = 10 'comparator sites' that choose to use different transformation approaches within the same timeframe. Sites will be matched on population size, urbanicity, funding, level of deprivation and expected prevalence of mental health care needs. To evaluate the process of implementation, a mixed-methods approach will be conducted to explore the moderating effects of context, fidelity, dose, pathway structure and reach on clinical and service level outcomes. This study addresses a unique opportunity to inform the ongoing national transformation of CAMHS with evidence about a popular new model for delivering children and young people's mental health care, as well as a new implementation approach to support whole system transformation. If the outcomes reflect benefit from i-THRIVE, this study has the potential to guide significant improvements in CAMHS by providing a more integrated, needs-led service model that increases access and involvement of patients with services and in the care they receive.

Dynamic data-enabled stratified sampling for trial invitations with application in NHS-Galleri.

Participants of health research studies such as cancer screening trials usually have better health than the target population. Data-enabled recruitment strategies might be used to help minimise healthy volunteer effects on study power and improve equity. A computer algorithm was developed to help target trial invitations. It assumes participants are recruited from distinct sites (such as different physical locations or periods in time) that are served by clusters (such as general practitioners in England, or geographical areas), and the population may be split into defined groups (such as age and sex bands). The problem is to decide the number of people to invite from each group, such that all recruitment slots are filled, healthy volunteer effects are accounted for, and equity is achieved through representation in sufficient numbers of all major societal and ethnic groups. A linear programme was formulated for this problem. The optimisation problem was solved dynamically for invitations to the NHS-Galleri trial (ISRCTN91431511). This multi-cancer screening trial aimed to recruit 140,000 participants from areas in England over 10 months. Public data sources were used for objective function weights, and constraints. Invitations were sent by sampling according to lists generated by the algorithm. To help achieve equity the algorithm tilts the invitation sampling distribution towards groups that are less likely to join. To mitigate healthy volunteer effects, it requires a minimum expected event rate of the primary outcome in the trial. Our invitation algorithm is a novel data-enabled approach to recruitment that is designed to address healthy volunteer effects and inequity in health research studies. It could be adapted for use in other trials or research studies.

Spatial dimensions of water quality value in New England river networks

Households' willingness to pay (WTP) for water quality improvements-representing their economic value-depends on where improvements occur. Households often hold higher values for improvements close to their homes or iconic areas. Are there other areas where improvements might hold high value to individual households, do effects on WTP vary by type of improvement, and can these areas be identified even if they are not anticipated by researchers? To answer these questions, we integrated a water quality model and map-based, interactive choice experiment to estimate households' WTP for water quality improvements throughout a river network covering six New England states. The choice experiment was implemented using a push-to-web survey over a sample of New England households. Voting scenarios used to elicit WTP included interactive geographic information system (GIS) maps that illustrated three water quality measures at various zoom levels across the study domain. We captured data on how respondents maneuvered through these maps prior to answering the value-eliciting questions. Results show that WTP was influenced by regionwide quality improvements and improvements surrounding each respondent's home, as anticipated, but also by improvements in individualized locations identifiable via each respondent's map interactions. These spatial WTP variations only appear for low-quality rivers and are focused around particular areas of New England. The study shows that dynamic map interactions can convey salient information for WTP estimation and that predicting spatial WTP heterogeneity based primarily on home or iconic locations, as typically done, may overlook areas where water quality has high value.

Small-area analysis of social inequalities in exposure to environmental noise across four urban areas in England

Noise from transport is a major environmental problem in urban areas. The distribution of noise in cities may be linked to socio-economic characteristics and evaluating the social distribution of noise is important for planning more equal, liveable and sustainable cities. However, to date, there is no strong base of evidence pointing towards a positive or a negative relationship between transport noise and socio-economic disadvantage. Results across studies are mixed and have mainly focused on road noise. Little information is available on other sources of noise or combined exposures. This paper examines associations between socio-economic factors and transportation noise at a small-area level in four different urban areas in England. To this end, the paper investigates associations across different city characteristics, individual and combined noise exposures (i.e. road, rail, air), different noise levels, as well as different socio-economic indicators. The results show non-homogeneous and complex patterns of socio-economic inequalities in exposure to transport-related noise across the urban areas studied. The relationships are influenced by the type of socio-economic indicator, the noise indicator, the noise source, the noise level as well as by the area's local characteristics. This highlights that inequalities in noise exposure should be considered along with other contextual factors.

Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis.

Food prepared out of home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase such food. The number of accessible food outlets through these services can influence how frequently they are used. Anecdotally, food outlet access through online food delivery services increased in England between 2020 and 2022, in the context of the COVID-19 pandemic. However, the extent to which this access changed is poorly understood. We aimed to investigate monthly changes in online access to food prepared out of home in England in the context of the first 2 years of the COVID-19 pandemic compared with November 2019 and the extent to which any changes were associated with deprivation. In November 2019 and monthly between June 2020 and March 2022, we used automated data collection to construct a data set containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts, we identified the number and percentage of food outlets registered to accept orders and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural/urban classification) to investigate the change in outcomes compared with prepandemic levels (November 2019). We stratified analyses by deprivation quintile (Q). Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. Across postcode districts, the median percentage of food outlets registered to accept orders online increased from 14.3 (IQR 3.8-26.0) in November 2019 to 24.0 (IQR 6.2-43.5) in March 2022. The median number of food outlets accessible online decreased from 63.5 (IQR 16.0-156.0) in November 2019 to 57.0 (IQR 11.0-163.0) in March 2022. However, we observed variation by deprivation. In March 2022, the median number of outlets accessible online was 175.0 (IQR 104.0-292.0) in the most deprived areas (Q5) compared with 27.0 (IQR 8.5-60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022 compared with November 2019 (incidence rate ratios: 1.10, 95% CI 1.07-1.13). In the least deprived areas, we estimated a 19% decrease (incidence rate ratios: 0.81, 95% CI 0.79-0.83). The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in online food access were associated with changes in online food delivery service use and the possible implications on diet quality and health.

Modelling socio-economic mortality at neighbourhood level

AbstractIn this study, we quantify the relationship between socio-economic status and life expectancy and identify combinations of socio-economic variables that are particularly useful for explaining mortality differences between neighbourhoods in England. We achieve this by examining socio-economic variation in mortality experiences across small areas in England known as lower layer super output areas (LSOAs). We then consider 12 socio-economic variables that are known to have a strong association with mortality. We estimate the relationship between those variables and mortality rates using a random forest algorithm. Based on the resulting estimate, we then create a new socio-economic mortality index – the Longevity Index for England (LIFE). The index is constructed in a way that eliminates the impact of care homes that might artificially increase mortality rates in LSOAs with care homes compared to LSOAs that do not contain a care home. Using mortality data for different age groups, we make the index age-dependent and investigate the impact of specific socio-economic characteristics on the age-specific mortality risk. We compare the explanatory power of the LIFE index to the English Index of Multiple Deprivation (IMD) as predictors of mortality. While we find that the IMD can explain regional mortality differences to some extent, the LIFE index has significantly greater explanatory power for mortality differences between regions. Our empirical results also indicate that income deprivation amongst the elderly and employment deprivation are the most significant socio-economic factors for explaining mortality variation across LSOAs in England.

Diagnosis of Rural Development Processes Based on the Stock of Social Capital and Social Networks: Approach from E-I Index

Europe’s rural areas have suffered a continuous loss of human and economic capital from the beginning of the 20th century to the present day. In an attempt to alleviate the effects of this dynamic, the European Union has implemented the LEADER rural development programme since the 1990s (Liaisons Entre Actions de Développement de L’Economie Rurale). Among the many objectives of this policy, the social articulation of its populations stood out as a way of strengthening development processes. This article aims to provide a methodological approach to analyse and quantify the stock of social capital (SC) present in the social networks of rural areas after more than thirty years of European rural policy. Based on 160 interviews with stakeholders linked to rural development processes in rural areas of Spain and England from institutional, economic, social and technical sectors. The methodological approach of Social Network Analysis (SNA) has been used, and within this, the study of SNA indicators and the analysis of the E-I index have been integrated in order to analyse the stock of internal (bonding) and external (bridging) SC. The conclusions of this study clarify the role of stakeholders and their contribution to the stock of SC. The studied rural areas present a balance in internal and external relations, which shows a high stock of SC and an encouraging scenario for the development processes and, thus, for the success of the LEADER programme. Nevertheless, the participation of the actors in the LEADER programme in Spain still shows a worrying project class.