Areas Of High Deprivation Research Articles

Inequalities in local government expenditure on environmental and regulatory services in England from 2009 to 2020: a longitudinal ecological study

BackgroundGastrointestinal (GI) infections affect one in five people in the UK and local authorities play a crucial role in controlling these infections. However, there have been substantial reductions in funding...

OGC SO32 - Propensity score analysis of the impact of deprivation and the COVID-19 pandemic on Upper Gastro Intestinal (UGI) cancer surgery outcomes

Abstract Background Deprivation is a complex, multifaceted concept, not synonymous with poverty, but with the potential to widen health inequalities. This study aimed to explore demographic disparities in patients undergoing UGI cancer surgery in a UK regional cancer network during the COVID-19 pandemic. Method Consecutive 881 patients were studied prospectively (median age 67 (24 - 89) yr., 703 m, 178 f; 518 oesophageal, 363 gastric; 837 Adeno-, 44 SCC) over 13 years. The COVID-19 pandemic was defined as the 24-month period from February 1, 2020 to January 31, 2022, during which 118 patients were treated. The demographic profile of the pandemic cohort was compared with that of the 763 patients treated outside this period incorporating a propensity score analysis. Primary outcomes were operative morbidity, mortality, and one-year survival. Wales’ Index of Multiple Deprivation was used to assess deprivation disparity. Results A 24% reduction in the number of cancer operations was observed during the first pandemic year. No difference was observed in age, gender, histology, tumour site, ASA grade, or oncological treatment. During COVID-19 the proportion of patients from the two most deprived quartiles receiving potentially curative surgery fell from 53.2% to 40.7% (p=0.012). No difference was observed in severe morbidity (Clavien-Dindo >3, 22.2% vs. 19.8%, p=0.897), 30-day mortality (2.5% vs. 2.4%, p=0.886), or one-year survival (82.4% vs. 78.8%, p=0.374). Conclusion UGI cancer surgery safely continued during COVID-19, but patients from areas of high deprivation were over 20% less likely to access curative surgical treatment compared with before and after COVID-19. This emphasises the need for bespoke strategies to mitigate the disproportionate impact of any future pandemic on patients living in deprived geographical areas.

Inequalities in preterm birth in England: a national cohort study focusing on deprivation and ethnicity

BackgroundIn 2021, the UK's overall preterm birth rate increased for the first time in three years. Inequalities in preterm birth persisted and are incompletely understood, perpetuating cycles of health disadvantage with life-long consequences. This study aimed to quantify socioeconomic and ethnic inequalities in preterm birth rates using routinely collected maternity data in England from 2018 to 2021. MethodsWe conducted a retrospective cohort study using electronic health data from English hospitals. All women aged 13–55 years with a singleton livebirth (April, 2018 to March, 2021) at 24–42 weeks were included. Self-reported ethnicity and indices of multiple deprivation were used to create ethnic and deprivation groups. Multivariate Poisson regression was used to estimate rates of preterm birth (livebirth between 24+0 and 36+6 weeks) in each ethnic and deprivation group, with White women in the least deprived areas as the reference category. A post-hoc calculation identified the rate of preterm birth for each ethnic group at each level of deprivation. FindingsWe identified 1 111 045 livebirths. The rate of preterm birth was highest in women living in the 20% most deprived areas at 7·1% (95% CI 7·0–7·2), compared to 5·6% (95% CI 5·50–5·74) in women in the 20% least deprived areas. White women had the lowest preterm birth rate at 6·5% (95% CI 6·47–6·58) and South Asian women the highest rate at 6·9% (95% CI 6·76–7·04). The rate of preterm birth increased according to increased area-level deprivation across all ethnicity groups. In areas of high deprivation, preterm birth rates were similar across ethnicity groups. Conversely, in the least deprived areas there were marked inequalities between ethnicity groups. InterpretationDeprivation and ethnicity remain key drivers of inequalities in preterm birth. To reduce preterm birth and associated inequalities, prevention strategies need to address socioenvironmental and structural determinants of preterm birth in areas of high deprivation and minoritised ethnicity groups. FundingNational Institute of Health Research.

Engagement of adults with congenital heart disease in research: overcoming barriers relating to social deprivation

Abstract Background In adult congenital heart disease (ACHD), social deprivation is associated with adverse health outcomes, such as increased inpatient admissions and major adverse cardiovascular events (1). Research studies on this topic often rely on patients engaging with surveys, and the characteristics of non-respondents in relation to social deprivation remain unknown. Purpose We assessed the association between social deprivation and response to a research survey in the ACHD population. Methods We included all individuals in the UK who were invited to participate in the APPROACH-IS II study (2), which assessed patient-reported outcomes in ACHD. A validated index of relative deprivation was derived from household postcodes, based on the 2019 Index of Multiple Deprivation (IMD) scores for geographic units in England (3). A lower IMD decile indicates a greater degree of deprivation. We compared patient engagement rates between 2 centres utilising different recruitment approaches: a Southern centre (South) relying on recruitment during mainly telephone or video consultations, and a Northern centre (North) recruiting patients during face-to-face clinic appointment, with the help of an ACHD clinical and research nurse specialist. Results In total, 593 patients were asked to take part in APPROACH-IS II in the UK: 324 patients from the Southern centre and 269 patients from the Northern centre, of whom 130(40.1%) and 209(77.7%) responded, respectively (p<0.0001). In the South, patients approached were homogeneously spread amongst IMD deciles (6.0[4.0-9.0]) and respondents were significantly less deprived (higher IMD decile) than non-respondents (7.0[5.0-9.0] vs 6.0[4.0-8.0], p=0.02). Indeed, the response rate in areas of higher deprivation (IMD decile<=4) was significantly lower than in the least deprived areas (IMD >=8) (31.3% vs 47.0%, p=0.03). In the North, the distribution of deprivation in patients was skewed towards lower IMD deciles, with a significantly higher proportion of patients from areas of higher deprivation (Figure A, 26 vs 99(30.6%) in the South, p<0.0001). There was no difference in IMD decile between respondents and non-respondents in the North (Figure B, 5.0[2.0-7.0] vs 4.0[2.0-7.0], p=0.26). When comparing patients living in the most deprived areas (IMD <=4), there was a large and significant difference in response rate between centres (p<0.0001). Conclusions In our population, deprivation appears to have a significant impact on the likelihood of patients engaging with clinical research. An enhanced approach, involving face-to-face contact and the involvement of a dedicated clinical nurse specialist, can improve recruitment to research studies and abolish the effect of socioeconomic status on patient engagement.Figure 1A and B

Inequalities in preterm birth by deprivation and ethnicity: A national cohort study in England

Abstract Background Preterm birth has decreased in the UK; however, the extent of inequalities remains unclear. This study aimed to quantify socioeconomic and ethnic inequalities in preterm birth rates using routinely collected maternity data in England. Methods Retrospective analysis of cohort data from the NHS England Hospital Episode Statistics (HES). All women aged 13-55 with a singleton livebirth (April 2018 to March 2021) at 24-42 weeks were included. Multivariate Poisson regression was used to estimate the rate of preterm birth (livebirth between 24 + 0 and 36 + 6 weeks’) for each ethnic and deprivation postcode group, these were compared to white women from the least deprived 20% of areas. We iteratively developed the model, adjusting for covariates associated with preterm birth. A post-hoc calculation identified the rate of preterm birth for each ethnic group at each level of deprivation. Results We identified 1,111,045 livebirths between April 2018 and March 2021. The rate of preterm birth increased with socioeconomic deprivation and was highest at 7.1% per 100 livebirths (95%CI:7.00-7.20) in women living in the 20% most deprived areas, compared to 5.6% (95%CI:5.50-5.74) in women in the 20% least deprived areas. White women had the lowest preterm birth rate at 6.5% (95%CI:6.47-6.58) and South Asian women had the highest rate at 6.9% (95%CI:6.76-7.04) (Table 2). The rate of preterm birth increased according to increased area-level deprivation across all ethnic groups. In areas of high deprivation, the preterm birth rate was similar across ethnic groups. Whereas in less deprived areas, there were marked inequalities between ethnic groups. Conclusions Inequalities in preterm birth remain, despite overall decreases in preterm birth. We found area deprivation and individual ethnicity interact to increase the risk of preterm birth in marginalized communities. Interventions need to holistically consider the structural and socioenvironmental determinants of preterm birth. Key messages • Area deprivation and ethnicity remain key drivers of inequalities in preterm birth, despite overall decreases in preterm birth. • To reduce inequalities tailored prevention strategies are needed to address socioenvironmental and structural determinants of preterm birth in high deprivation areas and minoritized ethnicity groups.

The role of sociodemographic factors on herpes zoster vaccine uptake among hard-to-reach populations

Abstract Background The anti-Herpes Zoster (HZ) vaccination program was expanded with the adjuvated recombinant vaccine (HZR) in the Lazio Region, Italy, in 2022, restricting its use only to certain categories at risk due to pathological conditions, such as dialysis patients or immunocompromised individuals. This study focuses on the role of clinical and socio-demographic factors on HZR vaccine uptake within the fragile resident population of the Local Health Authority Rome 2 (ASL RM2). Methods This population-based, retrospective cohort study leveraged data from various registries and databases. The study population comprised 835,779 individuals aged ≥18 years who were both RM2 residents and registered with an RM2 general practitioner (GP). Among these, 143,242 individuals with at least one chronic condition were assessed for vaccination uptake using a multivariate logistic model, exploring associations with gender, age, nationality, marital status, household size, and level of deprivation. Results At the conclusion of the study period, a small fraction (1.5%) of the fragile subjects had received at least one dose of the HZR vaccine, and a majority (78%) completed the vaccination course of two doses. The analysis indicated that vaccine adherence was significantly higher in males (OR = 1.15) and individuals aged 65 + (OR = 1.13) while lower among residents in areas of medium (OR = 0.61) and high deprivation (OR = 0.44) and with specific living arrangements - widowed people living alone (OR = 0.66) and families ≥ 6 people (OR = 0.63). Conclusions The ASL RM2 vaccination strategy for hard-to-reach individuals includes an integrated approach, with the engagement of local healthcare facilities and hospitals. Despite these efforts, lower adherence in socioeconomically disadvantaged fragile patients suggests a pressing need for targeted communication strategies and interventions to ensure equitable access to the HZ vaccine, as these groups are more vulnerable to developing chronic diseases. Key messages • Socio-demographic factors significantly influence Herpes Zoster vaccine uptake in hard-to-reach populations, with lower adherence in socially deprived groups. • Tailored, equity-driven approaches are essential for enhancing vaccine coverage among hard-to-reach fragile individuals, mitigating the higher disease risks in these communities.

Multimorbidity and person-centred care in a socioeconomically deprived community: a qualitative study.

People with multimorbidity (>2 long-term conditions) have poorer outcomes in areas of high socioeconomic deprivation (SED). High-quality person-centred care (PCC) is important in those with multimorbidity, but socially vulnerable populations have not, to our knowledge, informed current PCC models. To explore how wider community factors influence management of multimorbidity in the context of high SED, how high-quality PCC is defined by patients, and whether this influences healthcare management. Ethnographically informed case study in a community experiencing high SED in Scotland. Participant observation (138 h) was undertaken within four community groups who also took part in two participatory workshops. There were 25 in-depth interviews with people with multimorbidity, recruited from local general practices; emerging findings were discussed with interviewees in one focus group. Field notes/transcripts were analysed using inductive thematic analysis. Key aspects of PCC were 'patient as person', 'strong therapeutic relationship', 'coordination of care', and 'power sharing'; power sharing was particularly enabling but rarely happened (barriers often unseen by practitioners). Shared community experiences of 'being known', 'stigma', and 'none of the systems working' influenced how people approached health services and healthcare decisions. High-quality PCC may have been particularly effective in this setting because of its influence on ameliorating wider shared negative community experiences. In a high SED setting PCC is important and can enhance engagement. Wider community factors have a critical influence on engagement with health care in areas of high SED and PCC may be particularly important in this context because of its influence ameliorating these. Policymakers should prioritise and resource PCC.

Implementing creative dance activities for primary school children to improve health and wellbeing: a qualitative study in the North East England.

Evidence suggests that group arts activities with children build resilience and positive mental wellbeing. However, insufficient attention has been paid to how such activities can be implemented in practice across different contexts, particularly in socio-economically disadvantaged areas. Therefore, we explored the implementation of a dance-based intervention in two primary schools situated in an area of high economic deprivation in North East England. Our study explored Year 1 (age 5-6) and Year 5 (age 9-10) children, their parents, teachers and dance artists' views of a creative dance intervention (South Tees Arts project; STAR) in two schools in North East England, using interviews and focus groups, combined with innovative data capture activities (i.e. movement activities, graffiti walls, songs and Vox Pops). Children felt that STAR contributed positively to their emotional wellbeing and physical health. Teachers noticed improved confidence, engagement, literacy, and social and motor skills and less disruptive behaviour in class. Benefits continued beyond school, with children exercising at home to practice their dance moves. Several implementation barriers were identified ranging from limited time, large classes, dealing with challenging behaviours, the impact of COVID-19, stigma and anxiety. In response to these challenges, several solutions were developed during project delivery, such as artists and children working in pairs and role modelling by teachers and dance artists. We found three underlying mechanisms for successful implementation: (1) constant communication between teachers, dance artists and parents was essential to managing challenging behaviours, building personal relationships with children, and helping parents to get involved and support their children at home. (2) Linking dance activities to the school curriculum (using narratives from existing reading schemes) helped to support skill gaps. (3) A strong ethos of partnership between school, dance and arts providers and researchers ensured the adaptability and flexibility of projects.

A cross-sectional study of the relative availability and prominence of shelf space allocated to healthy and unhealthy foods in supermarkets in urban Ireland, by area-level deprivation

BackgroundDiet-related noncommunicable diseases (NCDs) are a leading cause of ill-health and death across Europe. In Ireland, dietary intakes of saturated fat, free sugar and salt exceed World Health Organization recommendations, and excess consumption follows a social gradient increasing population risk of diet-related NCDs. The retail food environment can influence consumer food choice and subsequent dietary intakes. In high income countries, supermarkets are an increasingly influential actor in consumer food availability, choice, purchase, and subsequent food intake. This study aims to assess the relative availability and prominence of healthy and unhealthy foods in Irish supermarkets, by area-level deprivation.MethodsThis study used a cross-sectional study design, and applied a validated measure, as described in the INFORMAS Protocol: Food Retail – Food availability in supermarkets. Between October 2021 and February 2022, shelf space (m2) (height or depth (cm) × length (cm)) and prominence (visibility), of foods, classified as healthy and unhealthy and represented by a proxy indicator, were collected in supermarkets (n = 36) in County Dublin, Ireland. Overall the proportion of mean relative shelf space (m2), allocated to healthy and unhealthy foods, and its prominence, by area-level deprivation, and retailer, were determined. We used t-tests and one-way ANOVA to analyse possible differences between the proportion of relative shelf space available to healthy and unhealthy foods, and its prominence, by area-level deprivation and retailer.ResultsThe study found the proportion of shelf space measured allocated to unhealthy food was 68.0% (SD 10.6). Unhealthy foods were more likely to be in areas of high prominence. Overall, there was no statistically significant difference between the proportion of relative shelf space available to unhealthy foods in areas of high and low deprivation. A statistically significant difference in the proportion of relative shelf space allocated to healthy and unhealthy food by area level deprivation was found in one retailer.ConclusionUnhealthy foods had a higher proportion of shelf space and were more prominent than healthy foods in supermarkets in County Dublin, Ireland. The current availability and prominence of foods in supermarkets does not align with Food Based Dietary Guideline recommendations and does not support consumers to make healthier food choices. There is a need for supermarkets in Ireland to improve the availability and prominence of healthy foods to support consumers to make healthier food choices.

Socioeconomic and demographic patterning of family uptake of a paediatric electronic patient portal innovation.

Patient portals allowing access to electronic health care records and services can inform and empower but may widen existing sociodemographic inequities. We aimed to describe associations between activation of a paediatric patient portal and patient race/ethnicity, socioeconomic status and markers of previous engagement with health care. A retrospective single site cross-sectional study was undertaken to examine patient portal adoption amongst families of children receiving care for chronic or complex disorders within the United Kingdom. Descriptive and multivariable regression analysis was undertaken to describe associations between predictors (Race/Ethnicity, age, socio-economic deprivation status based on family residence, and previous non-attendance to outpatient consultations) and outcome. A sample of 3687 children, representative of the diverse 'real world' patient population, was identified. Of these 37% (1364) were from a White British background, 71% (2631) had English as the primary family spoken language (PSL), 14% (532) lived in areas of high deprivation, and 17% (643) had high (>33%) rates of non-attendance. The families of 73% (2682) had activated the portal. In adjusted analyses, English as a PSL (adjusted odds ratio [aOR] 1.58, 95% confidence interval 1.29-1.95) and multi-morbidity (aOR 1.26, 1.22-1.30) was positively associated with portal activation, whilst families from British Black African backgrounds (aOR 0.68, 0.50-0.93), and those with high rates of non-attendance (aOR 0.48, 0.40-0.58) were less likely to use the portal. Family race/ethnicity and previous low engagement with health care services are potentially key drivers of widening inequity in access to health care following the implementation of patient portals, a digital health innovation intended to inform and empower. Health care providers should be aware that innovative human-driven engagement approaches, targeted towards previously underserved communities, are needed to ensure equitable access to high quality patient-centred care.

Abstract C125: Improving access to genetic counseling and testing for underserved populations through telehealth

Abstract Introduction: A lack of access to genetic counseling for hereditary cancer risk in rural and underserved areas is well-documented and can exacerbate disparities in cancer risk reduction and early detection. Telehealth has the potential to bridge this gap, providing remote access to specialized care. The COVID-19 pandemic accelerated telehealth availability, allowing estimation of the causal effects of shifting to a model of virtual care delivery for genetic counseling services. Methods: The Stanford Cancer Genetic Counseling Clinic provided solely in-person care at two clinical sites (Palo Alto and San Jose, CA) until March 2020, and solely virtual care from April 2020 onward. We performed a regression discontinuity design, allowing outcomes comparison before and after the threshold of early 2020, to evaluate the impact of telehealth genetic counseling on access to care for patients living in areas of higher deprivation. The assignment variable (the exposure measured before versus after the threshold) was the three-month period during which the patients were seen, with the March-May 2020 quarter excluded because of disruption of care during the early COVID-19 pandemic. The primary endpoint was proportion of patients whose primary residence zip code had a state area deprivation index of at least 4. Secondary endpoints included driving distance to the primary clinic location in Palo Alto, CA, insurance type, race/ethnicity, and primary language. Results: The study included N=5,957 patients seen in the Stanford Cancer Genetics Program between January 2017 and February 2020, and N=9,469 patients seen between June 2020 and April 2024. The regression discontinuity analysis revealed a significant discontinuity at the threshold for telehealth in access for patients living in areas of higher deprivation, who accounted for 22% of patients seen just prior to telehealth implementation and 27% just after telehealth implementation, a proportional increase of 21% (p=0.006). Mean driving distance to Palo Alto, CA also increased, from 49 minutes just prior to the threshold to 56 minutes just after (p=0.003). There were no significant differences in insurance type, race/ethnicity, or primary language across the threshold. Conclusion: The implementation of telehealth services at the Stanford Cancer Genetic Counseling Clinic significantly improved access to genetic counseling for patients from areas with higher deprivation, as evidenced by a 21% increase in the proportion of such patients among those seen. These results quantify the effectiveness of telehealth in reducing geographical and socioeconomic barriers to specialized genetic counseling and testing services. Citation Format: Jennifer L. Caswell-Jin, Hao Tang, Mina Satoyoshi, Kerry Kingham, Allison W. Kurian. Improving access to genetic counseling and testing for underserved populations through telehealth [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C125.

Socioeconomic and ethnic disparities in preterm births in an English maternity setting: a population-based study of 1.3 million births

BackgroundPreterm birth is a major cause of infant mortality and morbidity and accounts for 7–8% of births in the UK. It is more common in women from socially deprived areas and from minority ethnic groups, but the reasons for this disparity are poorly understood. To inform interventions to improve child survival and their quality of life, this study examined the socioeconomic and ethnic inequalities in preterm births (< 37 weeks of gestation at birth) within Health Trusts in England.MethodsThis study investigated socioeconomic and ethnic inequalities in preterm birth rates across the National Health Service (NHS) in England. The NHS in England can be split into different units known as Trusts. We visualised between-Trust differences in preterm birth rates. Health Trusts were classified into five groups based on their standard deviation (SD) variation from the average national preterm birth rate. We used modified Poisson regression to compute risk ratios (RR) and 95% confidence intervals (95% CI) with generalised estimating equations.ResultsThe preterm birth rate ranged from 6.8/100 births for women living in the least deprived areas to 8.8/100 births for those living in the most deprived areas. Similarly, the preterm birth rate ranged from 7.8/100 births for white women, up to 8.6/100 births for black women. Some Health Trusts had lower than average preterm birth rates in white women whilst concurrently having higher than average preterm birth rates in black and Asian women. The risk of preterm birth was higher for women living in the most deprived areas and ethnicity (Asian).ConclusionsThere was evidence of variation in rates of preterm birth by ethnic group, with some Trusts reporting below average rates in white ethnic groups whilst concurrently reporting well above average rates for women from Asian or black ethnic groups. The risk of preterm birth varied substantially at the intersectionality of maternal ethnicity and the level of socioeconomic deprivation of their residency. In the absence of other explanations, these findings suggest that even within the same Health Trust, maternity care may vary depending on the women’s ethnicity and/or whether she lives in an area of high socioeconomic deprivation. Thus, social factors are likely key determinants of inequality in preterm birth rather than provision of maternity care alone.

Residential mobility amongst children and young people in Wales: A longitudinal study using linked administrative records.

Child poverty remains a major global concern and a child's experience of deprivation is heavily shaped by where they live and the stability of their local neighbourhood. This study examines frequencies and patterns of residential mobility in children and young people (CYP) at a population level using novel geospatial techniques to assess how often their physical environment changes and to identify geographical variations in social mobility. We used routinely collected administrative records held in the Secure Anonymised Information Linkage (SAIL) Databank for CYP aged under 18 years living in Wales between 2012 and 2022. We calculated the Moran's I statistic to assess the magnitude of Lower layer Super Output Area (LSOA)-level geographic variation in residential mobility and used the Local Indicator of Spatial Association (LISA) to identify clusters of LSOAs where there are higher rates of residential mobility. This study included 923,531 CYP, with 58% having moved at least once during the study period. A total number of 1,209,102 house moves were recorded, 59% of which occurred between the ages of 0 and 5 years. Almost 10% of the cohort resided in five or more dwellings before the age of 18 years. In terms of area-level (LSOA) deprivation, 75% of house moves were to areas with the same or higher levels of deprivation, leaving only 25% of house moves that achieved upward social mobility. Clustering of residential mobility was identified predominantly in areas of high deprivation. The findings of this study show that residential mobility is linked with socio-economic circumstances and is experienced by over half of CYP in Wales. Understanding where CYP live, their mobility patterns and which areas have high levels of influx and efflux is crucial for policymakers to generate well-informed, targeted and effective child-focused interventions.

Smoking prevalence and association with sociodemographic variables in cancer clinical trial participants.

Tobacco use (smoking) causes adverse clinical outcomes among patients with cancer, including increased cancer-related mortality. In participants in cancer clinical trials, the prevalence of tobacco use and the factors associated with tobacco use are not well described. Data were examined from participants enrolled in SWOG cancer clinical treatment trials between 2016 and 2022 who reported their smoking status at trial enrollment. Baseline variables (smoking status, insurance type, zip code, and demographic factors) were obtained from patient registration forms. Bivariate and multivariable associations were examined via logistic regression. Among 4326 patients enrolled in 29 trials, 48.1% reported currently/previously smoking, including 12.4% currently, 4.9% recently, and 30.7% formerly. Ever smoking was more commonly reported in males, patients aged ≥65 years, patients with Medicaid or no insurance, patients from areas of high socioeconomic deprivation, and rural patients. Patients of Hispanic ethnicity and Asian and Pacific Islander patients were less likely to have ever smoked. In multivariable regression, patients with lung cancer were most likely to report ever smoking compared to patients with breast cancer (odds ratio,4.98; p<.001). In the first comprehensive evaluation of smoking status among trial participants enrolled in National Cancer Institute network group treatment trials, nearly half reported ever smoking and one in six reported current or recent smoking. Smoking was more common among vulnerable population patients defined by demographic and socioeconomic factors. Tobacco use should be routinely assessed and reported in clinical trials to help reduce the negative cancer and overall health effects of persistent tobacco use and to address disparities among patients with cancer.

The association between socio-economic deprivation and receipt of long-acting reversible contraception at a single clinic visit

ObjectivesTo determine the relationship between area deprivation index (ADI) and obtaining single-visit long-acting reversible contraception (LARC). Study designWe utilized Poisson regression to determine the association between area deprivation and single-visit LARC insertion within a state-wide healthcare system between 2019–2021. ResultsAmong our cohort (N = 4417), 68.60% of patients desiring LARC obtained single-visit LARC. Participants living in high deprivation areas were less likely to receive single-visit LARC (aRR 0.72, 95% CI 0.65–0.80). ConclusionsLiving in areas of high deprivation is independently negatively associated with obtaining a single-visit LARC. ImplicationsWhile access to single-visit LARC should be universally improved, reducing barriers for patientswith a higher ADI may help limit inequities in reproductive healthcare.

Equity in the provision of helicopter emergency medical services in the United Kingdom: a geospatial analysis using indices of multiple deprivation

BackgroundHelicopter Emergency Medical Services (HEMS) in the United Kingdom (UK) are provided in a mixed funding model, with the majority of services funded by charities alongside a small number of government-funded operations. More socially-deprived communities are known to have greater need for critical care, such as that provided by HEMS in the UK. Equity of access is an important pillar of medical care, describing how resource should be allocated on the basis of need; a concept that is particularly relevant to resource-intensive services such as HEMS. However, the Inverse Care Law describes the tendency of healthcare provision to vary inversely with population need, where healthcare resource does not meet the expected needs in areas of higher deprivation. It is not known to what extent the Inverse Care Law applies to HEMS in the UK.MethodsModelled service areas were created with each small unit geography locus in the UK assigned to its closest HEMS operational base. The total population, median decile on index of multiple deprivation, and geographic area for each modelled service area was determined from the most recently available national statistics. Linear regression was used to determine the association between social deprivation, geographic area, and total population served for each modelled service area.ResultsThe provision of HEMS in the UK varied inversely to expected population need; with HEMS operations in more affluent areas serving smaller populations. The model estimated that population decreases by 18% (95% confidence interval 1–32%) for each more affluent point in median decile of index of multiple deprivation. There was no significant association between geographic area and total population served.ConclusionThe provision of HEMS in the UK is consistent with the Inverse Care Law. HEMS operations in more deprived areas serve larger populations, thus providing a healthcare resource inversely proportional with the expected needs of these communities. Funding structures may explain this variation as charities are more highly concentrated in more affluent areas.

A long way from Frome: improving connections between patients, local services and communities to reduce emergency admissions

BackgroundLow socio-economic status can lead to poor patient outcomes, exacerbated by lack of integration between health and social care and there is a demand for developing new models of working.AimTo improve connections between patients, local services and their communities to reduce unscheduled admissions.Design and settingA primary care cluster with areas of high deprivation, consisting of 11 general practices serving over 74,000 people.MethodA multi-disciplinary team with representatives from healthcare, local council and the third sector was formed to provide support for people with complex or social needs. A discharge liaison hub contacted patients following hospital discharge offering support, while cluster pharmacists led medicine reviews. Wellbeing Connectors were commissioned to act as a link to local wellbeing and social resources. Advance Care Planning was implemented to support personalised decision making.ResultsUnscheduled admissions in the over 75 age group decreased following the changes, equating to over 800 avoided monthly referrals to assessment units for the cluster. Over 2,500 patients have been reviewed by the MDT since its inception with referrals to social prescribing groups, physiotherapy and mental health teams; these patients are 20% less likely to contact their GP after their case is discussed. An improved sense of wellbeing was reported by 80% of patients supported by wellbeing connectors. Staff feel better able to meet patient needs and reported an increased joy in working.ConclusionImproved integration between health, social care and third sector has led to a reduction in admissions, improved patient wellbeing and has improved job satisfaction amongst staff.

‘It depends on where you were born…here in the North East, there’s not really many job opportunities compared to in the South’: young people’s perspectives on a North-South health divide and its drivers in England, UK

BackgroundImproving the public’s understanding of how regional and socioeconomic inequalities create and perpetuate inequalities in health, is argued to be necessary for building support for policies geared towards creating a more equal society. However, research exploring public perceptions of health inequalities, and how they are generated, is limited. This is particularly so for young people. Our study sought to explore young people’s lived experiences and understandings of health inequalities.MethodsWe carried out focus group discussions (n = 18) with 42 young people, aged 13–21, recruited from six youth organisations in England in 2021. The organisations were located in areas of high deprivation in South Yorkshire, the North East and London. Young people from each organisation took part in three interlinked focus group discussions designed to explore their (i) perceptions of factors impacting their health in their local area, (ii) understandings of health inequalities and (iii) priorities for change. Due to the Covid-19 pandemic, most discussions took place online (n = 15). However, with one group in the North East, we carried out discussions face-to-face (n = 3). Data were analysed thematically and we used NVivo-12 software to facilitate data management.ResultsYoung people from all groups demonstrated an awareness of a North-South divide in England, UK. They described how disparities in local economies and employment landscapes between the North and the South led to tangible differences in everyday living and working conditions. They clearly articulated how these differences ultimately led to inequalities in people’s health and wellbeing, such as linking poverty and employment precarity to chronic stress. Young people did not believe these inequalities were inevitable. They described the Conservative government as prioritising the South and thus perpetuating inequalities through uneven investment.ConclusionsOur study affords important insights into young people’s perceptions of how wider determinants can help explain the North-South health divide in England. It demonstrates young people’s contextualised understandings of the interplay between spatial, social and health inequalities. Our findings support calls for pro-equity policies to address the structural causes of regional divides in health. Further research, engaging young people in deliberative policy analysis, could build on this work.

Socio-Ecologic Influences on Weight Trajectories Among Children with Obesity Living in Rural and Urban Settings.

Background: Childhood obesity is a risk factor for poor cardiovascular, metabolic, and respiratory health. The studies examining influences of socio-ecologic factors on weight trajectories using longitudinal data are limited, often examine single measures (e.g., proximity to parks), and have not examined the specific trajectories of children with obesity. Methods: We examined influences on weight among 1518 children, 6-12 years of age, who had obesity using body mass index (BMI) criteria. BMI slope trajectories were categorized as decreasing, flat, or increasing, with a median of 2.1 years of follow-up. We examined socio-ecologic exposures, stratified by rural and urban settings, using census tracts to map indices, including food access, proximity to parks, normalized difference vegetation index, and area deprivation index (ADI). We used ordinal logistic regression to examine the associations between the socio-ecologic factors and BMI trajectories. Results: Among the 1518 children, 360 (24%) had a decreasing BMI trajectory with the remainder having flat (23%) or increasing (53%) trajectories. Children in rural areas were more likely to live in high disadvantage areas, 85%, compared with urban children, 46%. In the multivariable ordinal model, living in a lower ADI census tract had a 0.78 (95% CI 0.61-0.99) lower odds of being in an increasing BMI slope group, and no other socio-ecologic factor was associated. Conclusions: The area deprivation index captures a range of resources and social context compared with the built environment indicators, which had no association with BMI trajectory. Further work examining how to develop effective interventions in high deprivation areas is warranted.

Post-discharge surgical site infection surveillance using patient smartphones: a single-centre experience in cardiac surgery

Background/Aims Surgical site infections following cardiac surgery pose significant risks and financial burdens to both patients and healthcare systems. This study aimed to explore the implementation and outcomes of a novel surgical wound monitoring system using patient smartphones for post-discharge surveillance. Methods The study was conducted at a London-based cardiothoracic tertiary referral centre, where 1358 patients undergoing cardiac surgery between January 2021 and March 2023 were enrolled onto the surgical wound monitoring system. Data were collected from the National Cardiac Audit Programme dataset, the monitoring syste and Hospital Episode Statistics data. Comparisons between patients who did or did not respond to surveillance requests were performed. A nested confirmatory analysis assessed antibiotics reported by patients through the digital route compared with antibiotics given by GPs or in outpatients. Results The overall response rate for surgical wound monitoring using patient smartphones was 86.6%. Patients who were female, from areas of higher deprivation and lived closer to the hospital were less likely to engage with surgical wound monitoring. Although not statistically significant, the current study suggests that patients with surgical site infections who used smartphones for surgical wound monitoring were less likely to be re-admitted or have further surgery and had shorter readmission stays. The accuracy of antibiotic use for surgical site infections using the surgical wound monitoring system was 96.5%. Conclusions This study underscores the potential of digital technologies, particularly smartphones, in efficient and accurate post-surgical monitoring. The findings suggest that the use of digital monitoring systems may improve patient outcomes, with potential for wider system-level benefits.