Deprived Areas Of England Research Articles

Socio-economic inequalities in second primary cancer incidence: A competing risks analysis of women with breast cancer in England between 2000 and 2018.

We aimed to investigate socio-economic inequalities in second primary cancer (SPC) incidence among breast cancer survivors. Using Data from cancer registries in England, we included all women diagnosed with a first primary breast cancer (PBC) between 2000 and 2018 and aged between 18 and 99 years and followed them up from 6 months after the PBC diagnosis until a SPC event, death, or right censoring, whichever came first. We used flexible parametric survival models adjusting for age and year of PBC diagnosis, ethnicity, PBC tumour stage, comorbidity, and PBC treatments to model the cause-specific hazards of SPC incidence and death according to income deprivation, and then estimated standardised cumulative incidences of SPC by deprivation, taking death as the competing event. Multiple imputation was performed to account for missing data. Among 649,905 included women, 47,399 SPCs and 171,223 deaths occurred during 4,269,042 person-years of follow-up. Income deprivation was consistently associated with an increased rate of SPC incidence (cause-specific hazard ratio for the most vs. least deprived quintile: 1.29; 95% CI: 1.25, 1.33) and of death (1.36; 1.34, 1.38), translating into an absolute risk difference (the most vs. least deprived quintile) of 1.3% (95% CI: 1.0, 1.5) for SPC incidence and 4.9% (95% CI: 4.6, 5.1) for death at 10 years. Women with PBC from deprived areas in England faced a substantially higher risk of SPC than their counterparts. Future research is warranted to understand mechanisms for observed inequalities to inform strategies to monitor, prevent, and identify SPC in women with PBC.

JUE Insight: The labor market effects of place-based policies: Evidence from England’s Neighbourhood Renewal Fund

JUE Insight: The labor market effects of place-based policies: Evidence from England’s Neighbourhood Renewal Fund

Patient and caregiver characteristics associated with differential use of primary care for children and young people in the UK: a scoping review

ObjectiveTo systematically map evidence to answer the research question: What is the relationship between the characteristics of children and young people (CYP) or their caregivers and primary care service use...

P161 Self-reported barriers to exercise from a national United Kingdom systemic lupus erythematosus cohort

Abstract Background/Aims Patients with systemic lupus erythematosus (SLE) are more inactive than the general population. Regular physical activity (PA) positively impacts many health parameters, including cardiovascular health. To better understand patient barriers to leisure time PA we conducted a national survey of patients with SLE in the UK. Methods An online survey was disseminated via LUPUS UK social media platforms between 5/05/2023 and 28/10/2023. Participants self-reported demographic data including postcodes. Indices of Multiple Deprivation (IMD) were used to define socioeconomic deprivation and were split into quantiles, where quartile 5 represents participants living in 20% least deprived areas in England. Categorical and continuous data were analysed using Fisher’s exact test and Mann-Whitney U test respectively. Results There were 249 individual responses. Table 1 describes the cohort demographics alongside response data. On a 0-10 scale (very unsatisfied to very satisfied), 171/244 (70%) of participants rated their satisfaction with their amounts of leisure time PA as ≤ 4. The most commonly reported barriers to PA were fatigue (221/249, 88.8%), pain (155/249, 62.2%) and lupus-related symptoms/flares (145/249, 58.2%). Dislike of exercise was reported by < 10% of cohort (22/249, 8.8%). When asked to identify the primary barrier to PA, 119/244 (48.8%) reported fatigue. Lack of motivation (40/244, 16.4%) and knowledge about exercise (18/244, 7.4%) were other predominant barriers. Concern around injury differed between ethnic groups (p = 0.016). Other barriers did not differ by sex, ethnic group or socioeconomic deprivation. Participants reporting lack of time were younger with a median age of 45 (35-53) versus 54 (43-63) years, p = <0.001. Patients reporting fatigue, pain and self-consciousness had higher BMI in kg/m2 (27.7 [23.6-32.3] vs 23.4 [20.8-28.2]; 28.7 [23.8-33.1] vs 25.4 [22.6-28.8]; 31.4 [27.9-38.4] vs 25.8 [23.1-30.2]), p = <0.001. Lupus-related symptoms/flares and concern that PA may worsen lupus were reported by participants with a shorter disease duration in years (8 [3-17] vs 12 [4.5-24] p = 0.002, and 7 [2-15] vs 10 [4.5-23] p = <0.001 respectively). Conclusion 70% of patients were dissatisfied with their level of leisure time PA. Fatigue and pain were the most commonly reported barriers to PA. Reported barriers differ between patients highlighting the need for personalised exercise programmes for patients with SLE. Disclosure A. Baranskaya: None. A.J. Wadley: None. J. Reynolds: None.

Assessing PM2.5 exposure bias towards deprived areas in England using a new indicator

Assessing PM2.5 exposure bias towards deprived areas in England using a new indicator

Association between distance to nearest automated external defibrillator and socioeconomic deprivation in Great Britain

Abstract Background Disparities in socioeconomic status manifest in death from out of hospital cardiac arrest (OHCA). Inequalities in access to automated external defibrillators (AED) due to socioeconomically determined location of AEDs may be associated with OHCA survival. Purpose To investigate distances between nearest AED location and postcode by socioeconomic deprivation for the population of Great Britain (GB). Methods AED location data for 2022 were drawn from the British Heart Foundation The Circuit registry. All 1,677,466 unit postcodes in Great Britain were linked to the Index of Deprivation for the corresponding Lower Layer Super Output Area using the 2019 Ministry of Housing Communities and Local Government tool. The median distance by road from the centre of each postcode to the nearest AED was calculated using geographic information systems. The proportion available 24/7 was also reported. Multilevel linear mixed regression models fit by country and adjusted for urban/rural status and clustering to calculate predicted marginal mean distances to the nearest active AED, and nearest AED accessible 24/7 by deprivation decile. Results 78,425 unique AED locations were included in the analysis (Table 1). The median distance to nearest AED was 762.1m (IQR 410.8 - 1221.0) in GB; 742.7m (407.2 - 1340.7) in Scotland, 738.8m (422.6 - 1223.5) in England, and 511.5m (282.9 - 937.3) in Wales. For 24/7 access AEDs, median distances were greater: 964.0m (524.7 - 1667.5), 994.1m (538.5 – 1832.3), 990.8m (544.9 - 1683.3), and 569.7m (316.8 - 1033.4), respectively. Overall, there was little evidence of a trend in nearest AED distance by deprivation (fig 1). In Scotland the nearest AED was, on average, 108m further away in the most compared with the least deprived areas. In England, the nearest AED was closer to postcodes in the least deprived areas of England (predicted mean 20m) and Wales (predicted mean 95m). In England, AEDs with 24/7 access were further from postcodes with increasing deprivation (predicted mean 99m further than least deprived areas). In Scotland, nearest 24/7 access AEDs were 317m further away in the most deprived areas, and 62m closer in Wales, but with no evidence of a linear trend. At a typical walking speed (1.31m/sec), on average in GB it would take 17 minutes to retrieve an AED and 21 minutes out of hours. In England and Scotland out of hours, those in the most deprived areas would be delayed access to an AED by 2.5 and 8 minutes respectively compared the least deprived. Conclusions Overall, the median distance to nearest AED across postcodes in GB is at odds with the likelihood of successful resuscitation. Graded social inequalities were not observed in AED access across GB. However, substantive differences were observed in 24/7 AED access between most and least deprived areas of England and Scotland. Greater and more equitable access to AEDs has the potential to save lives and improve outcomes for people with OHCA.

Maternal predictors of timeliness & uptake of Measles, Mumps & Rubella vaccine: A birth cohort study

Abstract Background In the United Kingdom (UK) measles, mumps & rubella (MMR) vaccine uptake is below national recommendations. We aimed to identify maternal predictors for missed or late vaccination, including the association with pregnancy pertussis vaccination, added to the UK schedule in 2012. Methods We used electronic primary care records from the Clinical Practice Research Datalink to create a UK birth cohort following babies born between 01.01.2000 to 12.12.2020 and linked to their mother's record from birth. We estimated the proportion who received their 1st MMR vaccine by 2 years and 1st & 2nd MMR vaccines by 5 years and examined associated maternal predictors using survival analysis and Cox proportional hazard models. We examined a sub-cohort of babies born from 01.01.2013 to estimate the impact of pregnancy pertussis vaccination on children's subsequent MMR uptake. Results Overall, 92.6% (736,495/795,497) children had 1st MMR by 5 years with 89.4% (710,797) by 2 years. Among children still in the cohort when eligible for 2nd MMR, 85.9% had two MMRs by 5 years (478,480/557,050). Lower 1st & 2nd MMR uptake was associated with living in more deprived areas of England, being Black or Black British ethnicity or having mothers aged <20 years (1st MMR by 5 years, adjusted Hazard Ratios (HR):0.86 (CI:0.85-0.87), HR:0.87 (CI:0.85-0.88) & HR:0.89 (CI:0.88-0.90) respectively). Children of mothers vaccinated in pregnancy were more likely to have 1st & 2nd MMRs after adjusting for ethnicity, deprivation and maternal age (1st & 2nd MMRs by 5 years adjusted HRs:1.43 (CI:1.41-1.45), 1.49 (CI:1.45-1.53). Conclusions There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics. Mothers vaccinated against pertussis in pregnancy are more likely to have a child vaccinated with MMR. Health professionals should promote pregnancy and childhood vaccinations during pregnancy and consider how families can be supported to access childhood vaccines. Key messages • There are inequalities in UK childhood MMR vaccine uptake based on maternal characteristics with MMR uptake lower among children living in more deprived areas. • Maternal vaccination and subsequent childhood vaccination uptake are related; pregnancy offers an opportunity to promote childhood vaccines and ensure families can access childhood vaccine services.

Deprivation, essential and non-essential activities and SARS-CoV-2 infection following the lifting of national public health restrictions in England and Wales.

Individuals living in deprived areas in England and Wales undertook essential activities more frequently and experienced higher rates of SARS-CoV-2 infection than less deprived communities during periods of restrictions aimed at controlling the Alpha (B.1.1.7) variant. We aimed to understand whether these deprivation-related differences changed once restrictions were lifted. Among 11,231 adult Virus Watch Community Cohort Study participants multivariable logistic regressions were used to estimate the relationships between deprivation and self-reported activities and deprivation and infection (self-reported lateral flow or PCR tests and linkage to National Testing data and Second Generation Surveillance System (SGSS)) between August - December 2021, following the lifting of national public health restrictions. Those living in areas of greatest deprivation were more likely to undertake essential activities (leaving home for work (aOR 1.56 (1.33 - 1.83)), using public transport (aOR 1.33 (1.13 - 1.57)) but less likely to undertake non-essential activities (indoor hospitality (aOR 0.82 (0.70 - 0.96)), outdoor hospitality (aOR 0.56 (0.48 - 0.66)), indoor leisure (aOR 0.63 (0.54 - 0.74)), outdoor leisure (aOR 0.64 (0.46 - 0.88)), or visit a hairdresser (aOR 0.72 (0.61 - 0.85))). No statistical association was observed between deprivation and infection (P=0.5745), with those living in areas of greatest deprivation no more likely to become infected with SARS-CoV-2 (aOR 1.25 (0.87 - 1.79). The lack of association between deprivation and infection is likely due to the increased engagement in non-essential activities among the least deprived balancing the increased work-related exposure among the most deprived. The differences in activities highlight stark disparities in an individuals' ability to choose how to limit infection exposure.

What can transactional data reveal about the prevalence of menstrual pain in England?

Introduction & BackgroundIt has been reported that up to 91% of those who menstruate experience associated pain. Despite its ubiquity, the prevalence of menstrual pain has been under researched due to stigma, disregard from medical professionals and a lack of data. It has also been reported that different demographics experience menstrual pain differently yet the impact of socio-demographic factors on menstrual pain remains to be explored on a national scale due to data scarcity.
 Objectives & ApproachIn this study, we propose one way to overcome this data barrier, using a novel measure of menstrual pain extracted from supermarket shopping data. We use these national datasets to identify individual customer behaviour patterns. Specifically, we use transactions involving both a pain and menstrual item as a proxy measure for menstrual pain. We investigate national menstrual pain sales and whether there are significant differences between deprived and less deprived areas of England.
 Relevance to Digital FootprintsThis paper brings together data from multiple sources, to provide a population level analysis of the prevalence of menstrual pain England. We use transactional data from a pharmaceutical retailer to develop a novel proxy measure for menstrual pain. We use various machine learning algorithms to explore the relationship between transactional data and various data sources pertaining to social deprivation.
 ResultsOur findings indicate that there is a high prevalence of menstrual pain with at least 26.7% of customers who purchase menstrual items also purchasing pain relief simultaneously. These customers are nearly four times more likely to purchase pain relief with a menstrual item than they are without. In addition, our results indicate a significant geographical disparity between menstrual pain transactions. We examine the relationship between a variety of deprivation factors and regional menstrual pain transactions and find average regional income has the highest predictive impact on menstrual pain sales. Contrary to what would expected from previous research, customers from the region with the lowest regional income were a third less likely (32%) to make a menstrual pain transaction than those from the highest income region.
 Conclusions & ImplicationsThis work motivates further research into the national prevalence of menstrual pain to understand why this regional disparity exists and whether it is a consequence of "period poverty". A better understanding of the sociodemographic factors associated with menstrual pain will help healthcare professionals stratify patients by risk, and could inform strategies to predict and prevent menstrual pain and its adverse impacts.

Data First: Family courts data - An exploratory analysis of the nature and extent of repeat use of the family courts from 2011 to 2020 in England and Wales

ObjectivesAs people move through the courts and other justice services a wealth of administrative data is created which can provide critical new insights on justice system users, their pathways, and outcomes. Data linkage and widening access can maximise its value for research in the public good and to inform policy.
 MethodData linkage has, for the first time, matched parties involved in family and civil law to criminal justice, enabling cross-cutting research opportunities. This data is available to researchers via Trusted Research Environments and these partnerships can build our capacity to derive policy-relevant findings. The administrative data from the family courts in England and Wales provides a joined-up picture of people involved in family law cases such as public law, private law, adoption, Family Law Act, and divorce. The team have published research showcasing the potential of this data and the presentation will primarily focus on this work.
 ResultsThe family court dataset has enabled, for the first time, the extent and nature of repeat users to be explored at scale for research. This analysis provides better understanding of the stability of outcomes for children where courts make decisions about their care. We have conducted exploratory analysis of which parties in family law cases in 2011 returned over the following decade. The research investigates the frequency of return to court following involvement in different case types and roles, and transitions between case types. Locality-based analysis highlights important insights into varied patterns across England and Wales, which highlights an over-representation of family court users in some case types and roles residing in the most deprived areas in England and Wales compared to the general population.
 ConclusionLinked administrative data can drive new insights into justice system use. Initial exploration has delivered new evidence on family justice that advances our understanding of real-world patterns, but also raises more questions. Collaboration across sectors can ensure this rich resource informs the evidence base for government policy and practice.

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.

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

Bystanders' 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. The 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. We 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. ISRCTN90350842. Registration date 28.03.2023. The study was registered after its start date.

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.

Investigating changes in mental health services utilisation in England and their impact on health outcomes and wellbeing during the COVID-19 pandemic: Protocol for a health data-linkage study.

Linking routinely collected health care system data records for the same individual across different services and over time has enormous potential for the NHS and its patients. The aims of this data linkage study are to quantify the changes to mental health services utilisation in responses to the COVID-19 pandemic and determine whether these changes were associated with health-related outcomes and wellbeing among people living in the most deprived communities in North East and North Cumbria, England. We will assemble a retrospective cohort of people having referred or self-referred to NHS-funded mental health services or Improving Access to Psychological Therapies (IAPT) services between 23rd March 2019 and 22nd March 2020 in the most deprived areas in England. We will link together data from retrospective routinely collected healthcare data including local general practitioner (GP) practice data, Hospital Episode Statistics admitted patient care outpatients, and A&E, Community Services Data Set, Mental Health Services Data Set, and Improving Access to Psychological Therapies Data Set. We will use these linked patient-level data to 1) describe the characteristics of the cohort prior to the lockdown; 2) investigate changes to mental health services utilised between multiple time periods of the COVID-19 lockdown including out of lockdown; 3) explore the relationship between these changes and health outcomes/wellbeing and factors that confound and mediate this relationship among this cohort. This study comprises a deprived population-based cohort of people having referred or self-referred to NHS-funded secondary mental health services or Improving Access to Psychological Therapies (IAPT) services over an extended period of the lockdown in England (2019-2022).This study will utilise a new longitudinal data resource that will link together detailed data from a cohort of individual participants and retrospective administrative data relating to the use of primary, secondary, and community care services.The study period covers pre-lockdown, different lockdown and post-lockdown, and out of lockdown periods up to March 2022.Routinely collected administrative data contain limited contextual information and represent an underestimate of total health outcomes for these individuals.Routinely collected datasets can often been incomplete or contain missing data, which can make it difficult to accurately analyse the data and draw meaningful conclusions.Intervention and treatment for mental health conditions are not wholly captured across these data sources and may impact health outcomes.

Socioeconomic gradient in mortality of working age and older adults with multiple long-term conditions in England and Ontario, Canada

BackgroundThere is currently mixed evidence on the influence of long-term conditions and deprivation on mortality. We aimed to explore whether number of long-term conditions contribute to socioeconomic inequalities in mortality, whether the influence of number of conditions on mortality is consistent across socioeconomic groups and whether these associations vary by working age (18–64 years) and older adults (65 + years). We provide a cross-jurisdiction comparison between England and Ontario, by replicating the analysis using comparable representative datasets.MethodsParticipants were randomly selected from Clinical Practice Research Datalink in England and health administrative data in Ontario. They were followed from 1 January 2015 to 31 December 2019 or death or deregistration. Number of conditions was counted at baseline. Deprivation was measured according to the participant’s area of residence. Cox regression models were used to estimate hazards of mortality by number of conditions, deprivation and their interaction, with adjustment for age and sex and stratified between working age and older adults in England (N = 599,487) and Ontario (N = 594,546).FindingsThere is a deprivation gradient in mortality between those living in the most deprived areas compared to the least deprived areas in England and Ontario. Number of conditions at baseline was associated with increasing mortality. The association was stronger in working age compared with older adults respectively in England (HR = 1.60, 95% CI 1.56,1.64 and HR = 1.26, 95% CI 1.25,1.27) and Ontario (HR = 1.69, 95% CI 1.66,1.72 and HR = 1.39, 95% CI 1.38,1.40). Number of conditions moderated the socioeconomic gradient in mortality: a shallower gradient was seen for persons with more long-term conditions.ConclusionsNumber of conditions contributes to higher mortality rate and socioeconomic inequalities in mortality in England and Ontario. Current health care systems are fragmented and do not compensate for socioeconomic disadvantages, contributing to poor outcomes particularly for those managing multiple long-term conditions. Further work should identify how health systems can better support patients and clinicians who are working to prevent the development and improve the management of multiple long-term conditions, especially for individuals living in socioeconomically deprived areas.

Rapid rise in COVID-19 among young people in England – learning for the future

We determined the age and sociodemographic distribution of COVID-19 cases between January and September 2020 to identify the group with the highest incidence rates at the beginning of the second wave in England. We undertook a retrospective cohort study design. SARS-CoV-2 cases in England were linked with area-level socio-economic status indicators using quintiles of the Index of Multiple Deprivation (IMD). Age-specific incidence rates were stratified by IMD quintile to further assess rates by area-level socio-economic status. Between July and September 2020, SARS-CoV-2 incidence rates were highest amongst those aged 18-21 years, reaching rates of 213.9 (18-19 years) and 143.2 (20-21 years) per 100,000 population by week ending 21 September 2022. Stratification of incidence rates by IMD quintile evidenced that despite high rates observed in the most deprived areas of England amongst the very young and older age groups, the highest rates were observed in the most affluent areas of England amongst the 18- to 21-year-olds. The reversal of sociodemographic trend in COVID-19 cases in England for those aged 18-21 years at the end of the summer of 2020 and beginning of the second wave showed a novel pattern of COVID-19 risk. For other age groups, the rates remained highest for those from more deprived areas, which highlighted persisting inequalities. Combined, this demonstrates the need to reinforce awareness of COVID-19 risk for young people, particularly given the late inclusion of the 16-17 years age group for vaccination administration, as well as continued efforts to reduce the impact of COVID-19 on vulnerable populations.

Pharmacies in England's most deprived areas provide 50% more NHS services to their local populations

Community pharmacies in the most deprived areas of England are more likely to close compared to other areas, despite being a vital lifeline for patients, an investigation by The Pharmaceutical Journal has revealed. The investigation has quantified, for the first time, the positive impact of community pharmacy in deprived areas, showing that they provide 50% […]

Putting nutrition education on the table: development of a curriculum to meet future doctors' needs.

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between the most and least deprived areas of England. Poor diets and obesity are established major risk factors for chronic cardiometabolic diseases and cancer, as well as severe COVID-19. For doctors to provide the best care to their patients, there is an urgent need to improve nutrition education in undergraduate medical school training.With this imperative, the Association for Nutrition established an Interprofessional Working Group on Medical Education (AfN IPG) to develop a new, modern undergraduate nutrition curriculum for medical doctors. The AfN IPG brought together expertise from nutrition, dietetic and medical professionals, representing the National Health Service (NHS), royal colleges, medical schools and universities, government public health departments, learned societies, medical students, and nutrition educators. The curriculum was developed with the key objective of being implementable through integration with the current undergraduate training of medical doctors.Through an iterative and transparent consultative process, thirteen key nutritional competencies, to be achieved through mastery of eleven graduation fundamentals, were established. The curriculum to facilitate the achievement of these key competencies is divided into eight topic areas, each underpinned by a learning objective statement and teaching points detailing the knowledge and skills development required. The teaching points can be achieved through clinical teaching and a combination of facilitated learning activities and practical skill acquisition. Therefore, the nutrition curriculum enables mastery of these nutritional competencies in a way that will complement and strengthen medical students' achievement of the General Medical Council (GMC) Outcome for Graduates.As nutrition is an integrative science, the AfN IPG recommends that the curriculum is incorporated into initial undergraduate medical studies before specialist training. This will enable our future doctors to recognise how nutrition is related to multiple aspects of their training, from physiological systems to patient-centred care, and acquire a broad, inclusive understanding of health and disease. In addition, it will facilitate medical schools to embed nutrition learning opportunities within the core medical training, without the need to add in a large number of new components to an already crowded programme or with additional burden for teaching staff.The undergraduate nutrition curriculum for medical doctors is designed to support medical schools to create future doctors who will understand and recognise the role of nutrition in health. Moreover, it will equip frontline staff to feel empowered to raise nutrition-related issues with their patients as a fundamental part of enhanced care and to appropriately refer on for nutrition support with a registered associate nutritionist/registered nutritionist (ANutr/RNutr) or registered dietitian (RD) where this is likely to be beneficial.

Putting nutrition education on the table: development of a curriculum to meet future doctors’ needs

COVID-19 has further exacerbated trends of widening health inequalities in the UK. Shockingly, the number of years of life lived in general good health differs by over 18 years between...

Data First: Criminal Courts Linked Data research report.

ObjectivesThe Ministry of Justice’s pioneering data linking programme Data First, funded by Administrative Data Research UK, links administrative datasets across the justice system and with other government departments to enable research providing critical new insights on justice system users, their pathways, and outcomes across a range of public services. ApproachThe first two datasets shared under the Data First project are magistrates’ courts and Crown Court data which have been deidentified, deduplicated and linked to provide a joined-up picture of criminal court defendant and case journeys. Accredited researchers can access this data using the ONS Secure Research Service to conduct research. Administrative Data Research UK has funded four Research Fellows to conduct analysis using this linked data. Additionally, analysts within the Ministry of Justice Data First team have published a research report showcasing the potential of the linked criminal courts data. The presentation will primarily focus on this work. ResultsThe Data First criminal courts datasets have enabled, for the first time, the extent and nature of repeat users to be explored at scale for research. In March 2022, the Ministry of Justice published exploratory analysis of returning defendants and the potential of linked criminal courts data. The key findings of this report will be covered in the presentation. The research demonstrates more than half of defendants returned to the courts within the data period, but this was highest for specific offence groups, including theft, robbery and drug offences. Locality-based analysis on Crown Court defendants highlights important insights on the backgrounds of justice system users, showing an over-representation of defendants residing in the most deprived areas in England and Wales compared to the general population. ConclusionThe presentation will demonstrate how linked administrative data available through the ground-breaking Data First programme can be effectively used for research. This insight improves our understanding of individuals in the justice system as well as providing a rich resource to develop the evidence base for government policy and practice.