Disease In England Research Articles

The impact of COVID-19 vaccination on patients with congenital heart disease in England: a case-control study

BackgroundStudies predating widespread COVID-19 vaccination identified patients with congenital heart disease (CHD) as a group at increased risk of severe outcomes from COVID-19. Here we evaluate the impact of vaccination...

The effectiveness, cost-effectiveness and policy processes of regulatory, voluntary and partnership policies to improve food environments: an evidence synthesis.

Dietary factors are among the largest and costliest drivers of chronic diseases in England. As a response, the government implements a range of population interventions to promote healthy diets by targeting food environments. This study aimed to conduct a systematic review of the effectiveness, cost-effectiveness and policy process of real-world evaluations of national and state policies on improving food environments, with a focus on whether they were regulatory, voluntary or partnership approaches. Fourteen relevant English-language databases were searched in November 2020 for studies published between 2010 and 2020. Six separate evidence reviews were conducted to assess the evidence of effectiveness, cost-effectiveness and policy processes of policies to improve food environments. A total of 483 primary research evaluations and 14 evidence syntheses were included. The study reveals considerable geographic, methodological and other imbalances across the literature, with, for example, 81% of publications focusing only on 12 countries. The systematic reviews also reveal the effectiveness and cost-effectiveness of reviewed regulatory approaches designed to improve health, consumer behaviour and food environment outcomes while public-private partnerships and voluntary approaches to improve diets via reformulation, advertising and promotion restrictions or other changes to the environment were limited in their effectiveness and cost-effectiveness. The study also revealed key enabling and impeding factors across regulatory, voluntary and public-private partnership approaches. From the available evidence reviewed, this study finds that regulatory approaches appear most effective at improving the food environment, and voluntary agreements and partnerships have limited effectiveness. These findings should be carefully considered in future public health policy development, as should the findings of geographic imbalance in the evidence and inadequate representation of equity dimensions across the policy evaluations. We find that food policies are at times driven by factors other than the evidence and shaped by compromise and pragmatism. Food policy should be first and foremost designed and driven by the evidence of greatest effectiveness to improve food environments for healthier diets. This was a complex evidence synthesis due to its scope and some policy evaluations may have been missed as the literature searches did not include specific policy names. The literature was limited to studies published in English from 2010 to 2020, potentially missing studies of interest. Priorities include the need for guidance for appraising risk of bias and quality of non-clinical studies, for reporting policy characteristics in evaluations, for supporting evaluations of real-world policies equitably across geographic regions, for capturing equity dimensions in policy evaluations, and for guideline development for quality and risk of bias of policy evaluations. This study is registered as PROSPERO CRD42020170963. This awardproject was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128607)and is published in full in Public Health Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further awardinformation.

Clinical Management of Hospitalized Patients With High-Consequence Infectious Diseases in England.

Infectious disease physicians in England have been diagnosing and managing occasional cases of viral hemorrhagic fever since 1971, including the United Kingdom's first case of Ebola virus disease in 1976. Specialist isolation facilities to provide safe and effective care have been present since that time. Following the emergence of Middle East respiratory syndrome (MERS) in 2012, and the avian influenza A (H7N9) outbreak in 2013, and the 2014-2016 Ebola virus disease outbreak in West Africa, clinical and public health preparedness and response pathways in England have been strengthened for these types of diseases, now called high-consequence infectious diseases (HCIDs). The HCID program, led by NHS England and Public Health England between 2016 and 2018, helped to deliver these enhancements, which have since been used on multiple occasions for new UK cases and outbreaks of MERS, mpox, avian influenza, and Lassa fever. Additionally, HCID pathways were activated for COVID-19 during the first 3 months of 2020, before the pandemic had been declared and little was known about COVID-19 but HCID status had been assigned temporarily to COVID-19 as a precaution. The HCID program also led to the commissioning of a network of new airborne HCID treatment centers in England, to supplement the existing network of contact HCID treatment centers, which includes the United Kingdom's only 2 high-level isolation units. In this case study, the authors describe the airborne and contact HCID treatment center networks in England, including their formation and structures, their approach to safe and effective clinical management of patients with HCIDs in the United Kingdom, and challenges they may face going forward.

Patient pathways for four major chronic respiratory diseases in England between 2008 and 2021

BackgroundNot all chronic diseases have clear pathways and time targets for diagnosis. We explored pathways and timings for four major chronic respiratory diseases in England.MethodsUsing deidentified electronic healthcare records from...

Trends in invasive Haemophilus influenzae serotype b (Hib) disease in England: 2012/13 to 2022/23

Haemophilus influenzae serotype b (Hib) conjugate vaccines have been highly successful in reducing the Hib disease worldwide. Recently, several European countries have reported an increase in invasive Hib disease. We aimed to describe the epidemiology, clinical characteristics, genomic trends, and outcomes of invasive Hib disease over the past 11 years in England. The UK Health Security Agency (UKHSA) conducts national surveillance of invasive H influenzae disease and hosts a national reference laboratory for confirmation and serotyping. General practitioners are contacted to complete a surveillance questionnaire for confirmed Hib cases. Invasive Hib isolates routinely undergo whole genome sequencing. During 2012/13-2022/23, there were 6,881 invasive H. influenzae infections, of which 5,852 (85%) were serotyped; most isolates (4,881, 83%) were non-typeable H. influenzae, followed by Hif (591, 10%), Hie (189, 3%), Hib (118, 2%) and Hia (54, 1.0%). The median age for invasive Hib disease was 51 years and most cases (84%, 99/118) were in adults. Children accounted for 19 cases (16%), including 13 (11%) in <1 year-olds and 6 (5%) in 1-5-year-olds. Bacteraemic pneumonia was the most common diagnosis (66/118, 56%). Hib case-fatality rate was 5.9% (7/118), with the last fatality reported in 2016. Among 64 sequenced strains during 2016/17-2022/2023, most (56/64, 88%) belonged to the CC6 lineage (representing ST6 and single locus variants of ST6). In England, invasive Hib disease remains rare with no evidence of any increase in incidence and is rarely fatal, affecting mainly adults with underlying conditions, who typically develop pneumonia.

Health Care Costs After Genome-Wide Sequencing for Children With Rare Diseases in England and Canada

Etiologic diagnoses for rare diseases can involve a diagnostic odyssey, with repeated health care interactions and inconclusive diagnostics. Prior studies reported cost savings associated with genome-wide sequencing (GWS) compared with cytogenetic or molecular testing through rapid genetic diagnosis, but there is limited evidence on whether diagnosis from GWS is associated with reduced health care costs. To measure changes in health care costs after diagnosis from GWS for Canadian and English children with suspected rare diseases. This cohort study was a quasiexperimental retrospective analysis across 3 distinct English and Canadian cohorts, completed in 2023. Mixed-effects generalized linear regression was used to estimate associations between GWS and costs in the 2 years before and after GWS. Difference-in-differences regression was used to estimate associations of genetic diagnosis and costs. Costs are in 2019 US dollars. GWS was conducted in a research setting (Genomics England 100 000 Genomes Project [100KGP] and Clinical Assessment of the Utility of Sequencing and Evaluation as a Service [CAUSES] Research Clinic) or clinical outpatient setting (publicly reimbursed GWS in British Columbia [BC], Canada). Participants were children with developmental disorders, seizure disorders, or both undergoing GWS between 2014 and 2019. Data were analyzed from April 2021 to September 2023. GWS and genetic diagnosis. Annual health care costs and diagnostic costs per child. Study cohorts included 7775 patients in 100KGP, among whom 788 children had epilepsy (mean [SD] age at GWS, 11.6 [11.1] years; 400 female [50.8%]) and 6987 children had an intellectual disability (mean [SD] age at GWS, 8.2 [8.4] years; 2750 female [39.4%]); 77 patients in CAUSES (mean [SD] age at GWS, 8.5 [4.4] years; 33 female [42.9%]); and 118 publicly reimbursed GWS recipients from BC (mean [SD] age at GWS, 5.5 [5.2] years; 58 female [49.2%]). GWS diagnostic yield was 143 children (18.1%) for those with epilepsy and 1323 children (18.9%) for those with an intellectual disability in 100KGP, 47 children (39.8%) in the BC publicly reimbursed setting, and 42 children (54.5%) in CAUSES. Mean annual per-patient spending over the study period was $5283 (95% CI, $5121-$5427) for epilepsy and $3373 (95% CI, $3322-$3424) for intellectual disability in the 100KGP, $724 (95% CI, $563-$886) in CAUSES, and $1573 (95% CI, $1372-$1773) in the BC reimbursed setting. Receiving a genetic diagnosis from GWS was not associated with changed costs in any cohort. In this study, receiving a genetic diagnosis was not associated with cost savings. This finding suggests that patient benefit and cost-effectiveness should instead drive GWS implementation.

#772 Causes of non-elective hospitalisations among adult patients with chronic kidney disease in England: Clinical Practice Research Datalink 2010-2019

Abstract Background and Aims Patients with chronic kidney disease (CKD) are at higher risk of non-elective hospitalisation compared to the general population, which is associated with an increased risk of death and accounts for disproportionate resource utilisation. There are limited population-level estimates of the causes of non-elective hospitalisation for patients with CKD in England. Therefore, a population-based study was implemented to start to address this shortfall. Method This non-interventional, observational study utilised data from primary care electronic health records from the Clinical Practice Research Datalink (CPRD) AURUM and Hospital Episode Statistics (HES) admitted patient care (APC). Patients aged ≥18 years registered in CPRD with eligible linkage to HES between January 1, 2010-December 31, 2019 with at least two eGFR measurements during that period were identified. CKD was defined by an eGFR &amp;lt;60 ml/min/1.73 m2 and/or presence of a uACR measurement ≥3 mg/mmol, both confirmed by a second measurement 90-365 days later. Start of follow-up (index) was set to the earliest date during the study period where CKD was confirmed. Non-elective admissions were defined as hospitalisations not planned in advance. Follow-up for hospitalisations ended at the earliest of death, administrative censoring, or December 31, 2019. Patients with end stage kidney disease at index were excluded. Causes of hospitalisation during follow-up were based on three character-level ICD codes in the primary position. Where the same ICD-10 code was coded more than once within a hospitalisation, it was only counted once. Results From a total population of 6.1 million adult patients meeting study inclusion criteria, 743.945 adults with CKD were identified (12.2%) with a median follow-up of 3.62 years. The mean age (SD) was 76.1 (11.5) years, 55.2% were female, and 89.8% were White. The majority (60.9%) of patients had stage 3a CKD (eGFR 45-59 ml/min/1.732 m2) and 34.3% and 17.1% had a history of type 2 diabetes and heart failure at time of CKD confirmation, respectively. There were 1.45 million non-elective hospitalisations observed, with 449.128 (60%) of patients experiencing ≥1 non-elective hospitalisation during follow-up. The most frequent ICD-10 chapter indicated as primary cause of all non-elective hospitalisation was diseases of the circulatory system (19.4%), including heart failure (4.9%), ischaemic heart disease (myocardial infarction and angina) (3.5%), stroke (2.2%) and atrial fibrillation/flutter (1.9%). Infection was also a frequent cause of non-elective hospitalisation, including pneumonia of unspecified organism (7.8%), unspecified acute lower respiratory tract (2.5%), and other sepsis (2.7%). Frequent hospitalisation also occurred in patients with CKD due to fractures (3.5%) and injuries to the head (1.7%). Conclusion Non-elective hospitalisations are frequent among patients with CKD. Diseases of the circulatory and respiratory systems are overall most common causes, with pneumonia, ischaemic heart disease, and heart failure the most frequent modifiable reasons for admission. Ensuring that current shortfalls in primary and secondary prevention for patients with CKD through optimization of strategies such as vaccination and evidence based cardiovascular disease management will reduce rates of non-elective hospitalisation and other clinical outcomes and ensure best use of health care resources for patients with CKD.

#1244 Rates of eGFR and UACR testing in patients with chronic kidney disease in England: Clinical Practice Research Datalink 2010-2019

Abstract Background and Aims The NICE chronic kidney disease (CKD) treatment guidelines recommend regular laboratory measurements of both kidney function (eGFR) and damage (proteinuria) to appropriately inform efforts to prevent and treat progression of CKD. Recommendations also indicate frequency of such testing should increase with CKD progression. There are few data on rates of testing in patients with confirmed CKD with particularly paucity in patients with various stages of CKD. Method This non-interventional, observational study utilised data from primary care electronic health records from Clinical Practice Research Datalink (CPRD) AURUM. Patients aged ≥18 years with CKD registered in CPRD with at least one year of follow-up (FU) between January 1, 2010 and December 31, 2019 were identified. CKD was defined by an eGFR &amp;lt;60 ml/min/1.73 m2 and/or presence of a uACR measurement ≥3 mg/mmol, both confirmed by a second measurement 90-365 days later (index). Patients with eGFR &amp;lt;9 ml/min/1.73 m2 at index were excluded. Frequency of renal testing (eGFR and UACR) for each complete year of FU was quantified starting the day after index and patients were censored the last day of the final complete calendar year of FU after index. Frequency of renal testing per FU year was calculated overall and by CKD stage and level of albuminuria at index. Results In the 650 565 patients with CKD identified, mean age (SD) was 76.1 (11.3) years, 55.4% were female, and 88.5% White. Most (62.0%) patients had stage 3a CKD (eGFR 45-&amp;lt;59 ml/min/1.73 m2) at index. Among patients with UACR measurements within 1 year prior to index (54.1%), 49.3% were A1 (&amp;lt;3 mg/mmol), 43.4% A2 (3-30 mg/mmol) and 7.3% A3 (&amp;gt;30 mg/mmol) at index. During the first year of FU, 81.45% of patients had 1+ eGFR test whereas 39.2% had 1+ UACR test. Patients more frequently received 1+ eGFR per year over subsequent years of FU but the low proportion with 1+ UACR test per year remained stable for UACR. The mean (SD) number of eGFR and UACR tests performed per patient in the first year of FU was 2.09 (2.39) and 0.49 (0.70), respectively. More frequent eGFR testing was observed with lower eGFR at index and across subsequent years of FU. Frequency of UACR testing was lower at more advanced stages of CKD at index in all FU years, however, no trends in UACR testing frequency were observed by level of albuminuria at index. Conclusion This evidence from a population-based sample of patients with confirmed CKD in England, indicates that eGFR is being monitored in the majority of patients, yet UACR testing is suboptimal according to NICE guidelines regardless of level of kidney function or level of albuminuria. Although eGFR testing is more frequent at more advanced stages of CKD, UACR testing seems to become less frequent with more advanced stages of CKD. With emergence of new therapies to prevent progression of CKD, efforts to increase frequency of UACR testing are needed (particularly in earlier CKD stages) to ensure that patients who are at risk of worsening CKD and albuminuria receive appropriate management.

Inequalities in emergency care use across transition from paediatric to adult care: a retrospective cohort study of young people with chronic kidney disease in England.

Sociodemographic inequalities in emergency secondary care usage were evident in this cohort across the transition period, independent of age, with some variation between admissions and A&E use, and evidence of effect modification by transfer. Such inequalities likely have multifactorial origin, but importantly, could represent differential meetings of care needs. • In chronic kidney disease (CKD), transfer from paediatric to adult healthcare is associated with declining health outcomes. • Known differences in CKD outcomes by sociodemographic factors have limited prior exploration in the context of transfer. • Population-level data was used to examine the impacts of transfer and sociodemographic factors on unplanned secondary care utilisation in CKD. • Healthcare utilisation trends may not reflect known CKD pathophysiology and there may be unexplored sociodemographic inequalities in the experiences of young people across transfer.

The tales of contradiction: A thematic analysis of British sheep farmers’ perceptions of managing sheep scab in their flocks

Sheep scab is endemic in Great Britain with an estimated national herd-level prevalence of 10.9% from a surveyed population of sheep farms. Previous studies have investigated how sheep farmers manage sheep scab on their farms in Great Britain, but there have not been any qualitative studies investigating sheep farmers perceptions on the roles different stakeholders have in the management of sheep scab. This qualitative study aims to explore how sheep farmers perceive their role and the different stakeholders’ roles in the management of sheep scab, and how they would like sheep scab to be managed going forward. Semi-structured interviews were conducted with 43 sheep farmers from England, Scotland, and Wales. The data were analysed using reflexive thematic analysis, through the theoretical lens of Foucault’s notion of ‘biopower’. Two themes were generated: ‘The feeling of powerlessness leads to a need of rules and regulations’, with sub-themes: ‘The need for governmental rules and regulations’ and ‘The need for rules and regulation at livestock markets’, and ‘An apparent lack of sheep scab surveillance’, with sub-themes: ‘The farmers perceive that the veterinarians have control over surveillance’ and ‘The farmers have control over surveillance on their farms’. In the first theme, the respondents suggested that more rules and regulations to control the management of sheep scab was required. This included reinstating of sheep scab as a notifiable disease in England and Wales, as well as more regulations at livestock markets to prevent the trading of infested sheep; both of which would subject the farmers to regulatory power mechanisms. The second theme centred around who has the control of surveillance on the farms. Most of the respondents perceived that the veterinarians had knowledge and expertise of the local area on sheep scab, which they were able to relay to the farmers. Thus, veterinarians exerted disciplinary power by creating ‘docile’ bodies. However, it also appeared that veterinarians were not regularly called onto farms. Although disciplinary power flows through the interactions between the farmer and veterinarian, the techniques currently used are not always having their desired effect. The study demonstrated that how sheep farmers want sheep scab to be managed is, at times, conflicting and contradictory, which highlights the complexity of sheep scab as a disease to manage.

Population-Based Study of Alcohol-Related Liver Disease in England in 2001-2018: Influence of Socioeconomic Position.

England has seen an increase in deaths due to alcohol-related liver disease (ALD) since 2001. We studied the influence of socioeconomic position on the incidence of ALD and the mortality after ALD diagnosis in England in 2001-2018. This was an observational cohort study based on health records contained within the UK Clinical Practice Research Datalink covering primary care, secondary care, cause of death registration, and deprivation of neighborhood areas in 18.8 million residents. We estimated incidence rate and incidence rate ratios of ALD and hazard ratios of mortality. ALD was diagnosed in 57,784 individuals with a median age of 54 years and of whom 43% had cirrhosis. The ALD incidence rate increased by 65% between 2001 and 2018 in England to reach 56.1 per 100,000 person-years in 2018. The ALD incidence was 3-fold higher in those from the most deprived quintile vs those from the least deprived quintile (incidence rate ratio 3.30, 95% confidence interval 3.21-3.38), with reducing inequality at older than at younger ages. For 55- to 74-year-olds, there was a notable increase in the incidence rate between 2001 and 2018, from 96.1 to 158 per 100,000 person-years in the most deprived quintile and from 32.5 to 70.0 in the least deprived quintile. After ALD diagnosis, the mortality risk was higher for patients from the most deprived quintile vs those from the least deprived quintile (hazard ratio 1.22, 95% confidence interval 1.18-1.27), and this ratio did not change during 2001-2018. The increasing ALD incidence in England is a greater burden on individuals of low economic position compared with that on those of high socioeconomic position. This finding highlights ALD as a contributor to inequality in health.

Real world outcomes, healthcare utilisation and costs of Alzheimer's disease in England

BackgroundEvidence on health and social care resource utilisation and associated costs, and how this varies across people with Alzheimer's disease (AD) dementia is limited. MethodsRetrospective cohort, using the Discover dataset, which includes linked health and social care records for approximately 2.5 million people in North-West London. Individuals were followed up from the latter of 2010 or from diagnosis of AD dementia (index) up to 2019. Outcomes were overall survival, care home admission, health and social care utilisation and associated costs, and cardiovascular outcomes. Variation was explored in subpopulations and by stratifying by cost quintile. Generalised linear modelling was used to estimate the association between clinical and demographic characteristics and healthcare costs. ResultsThe cohort included 18,116 people diagnosed with AD dementia whose mean age at index was 81 years, 62 % were female and 65 % were of white ethnicity. Median survival from index was 4.9 years (95 %CI: 4.8–5.0). Mean healthcare costs were £4,548(£4,491–£4,604) per person year(ppy). Healthcare costs for the 48 % who used social care were £5,433ppy(£5,353–£5,514) and social care costs were £24,374ppy(£24,372–£24,376). In the overall cohort costs in the highest cost quintile were £13,665ppy(£13,420–£13,911), of which 70 % was from inpatient hospitalisation. Subpopulations admitted to care home (£7,535 £7,362–£7,709), with cardiovascular disease (£6,106;£5,990–£6,222) and with type 2 diabetes (£6,049;£5,901–£6,198) accrued the highest healthcare costs. Factors most strongly associated with cost were dying during follow up (+£2,224;£2,010–£2,493), being frail (+£1,246;£1,051–£1,440) and prior stroke (+£1,207;£908–£1,507). ConclusionCharacteristics of individuals with high healthcare costs include requirement for social care and cardiometabolic comorbidities. Identifying individuals early in their disease course may improve health outcomes and reduce the cost of AD dementia in later life.

Time trends and geographical variation in major lower limb amputation related to peripheral arterial disease in England.

Above and below knee amputation (AKA, BKA) are treatments of last resort for peripheral arterial disease (PAD). The aim was to examine amputation rates, AKA:BKA ratios, previous revascularization and minor amputation, lengths of stay in hospital, mortality following amputation, and regional variation in people with and without diabetes in England. The study used population-based ecological and cohort study designs, 31 672 census areas, hospital admissions from 2006 to 2018 and Poisson, logistic and Cox regression. There were 47 249 major lower limb amputations (50.7% AKA; 48% had diabetes), giving an annual PAD-related amputation rate of 11 per 100 000 in the population aged 25+ years. Amputation rates were higher in men and substantially higher in people with diabetes. The AKA:BKA ratio was 0.63 in patients with diabetes (n = 22 702) and 1.62 in patients without diabetes (n = 24 547). Of patients having AKA, 25.3% died within 90 days of amputation compared with 11.9% for BKA. Median survival following amputation ranged from only 1.68 years following AKA in patients with diabetes to 5.72 years following BKA in patients without diabetes. Amputation rates decreased over time mainly in the population with diabetes. Short-term mortality and lengths of stay in hospital also decreased over time, while the percentage with previous revascularization generally increased. Amputation rates and AKA:BKA ratios were highest in the North. Adjustment for age, sex and deprivation did not substantially alter geographical patterns. Adjusted 90-day mortality was generally higher in the North and the Midlands but also high in London. There were also regional variations in adjusted duration from admission to amputation, duration from amputation to discharge or death in hospital, previous revascularization and previous minor amputation. There were large variations in amputation rates and survival following amputation in relation to diabetes status and amputation level, and regional variations which remained after adjustment for deprivation.

Outcomes of first emergency admissions for alcohol-related liver disease in England over a 10-year period: retrospective observational cohort study using linked electronic databases

ObjectivesTo examine time trends in patient characteristics, care processes and case fatality of first emergency admission for alcohol-related liver disease (ARLD) in England.DesignNational population-based, retrospective observational cohort study.SettingClinical Practice Research...

Hepatitis A Vaccination Coverage Among People With Chronic Liver Disease in England (HEALD): Protocol for a Retrospective Cohort Study.

Hepatitis A outbreaks in the United Kingdom are uncommon. Most people develop mild to moderate symptoms that resolve, without sequelae, within months. However, in high-risk groups, including those with underlying chronic liver disease (CLD), hepatitis A infection can be severe, with a higher risk of mortality and morbidity. The Health Security Agency and the National Institute of Health and Care Excellence recommend preexposure hepatitis A vaccination given in 2 doses to people with CLD, regardless of its cause. There are currently no published reports of vaccination coverage for people with CLD in England or internationally. This study aims to describe hepatitis A vaccination coverage in adults with CLD in a UK primary care setting and compare liver disease etiology, sociodemographic characteristics, and comorbidities in people who are and are not exposed to the hepatitis A vaccine. We will conduct a retrospective cohort study with data from the Primary Care Sentinel Cohort of the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub database, which is nationally representative of the English population. We will include people aged 18 years and older who have been registered in general practices in the Research and Surveillance Centre network and have a record of CLD between January 1, 2012, and December 31, 2022, including those with alcohol-related liver disease, chronic hepatitis B, chronic hepatitis C, nonalcohol fatty liver disease, Wilson disease, hemochromatosis, and autoimmune hepatitis. We will carefully curate variables using the Systematized Nomenclature of Medicine Clinical Terms. We will report the sociodemographic characteristics of those who are vaccinated. These include age, gender, ethnicity, population density, region, socioeconomic status (measured using the index of multiple deprivation), obesity, alcohol consumption, and smoking. Hepatitis A vaccination coverage for 1 and 2 doses will be calculated using an estimate of the CLD population as the denominator. We will analyze the baseline characteristics using descriptive statistics, including measures of dispersion. Pairwise comparisons of case-mix characteristics, comorbidities, and complications will be reported according to vaccination status. A multistate survival model will be fitted to estimate the transition probabilities among four states: (1) diagnosed with CLD, (2) first dose of hepatitis A vaccination, (3) second dose of hepatitis A vaccination, and (4) death. This will identify any potential disparities in how people with CLD get vaccinated. The Research and Surveillance Centre population comprises over 8 million people. The reported incidence of CLD is 20.7 cases per 100,000. International estimates of hepatitis A vaccine coverage vary between 10% and 50% in this group. This study will describe the uptake of the hepatitis A vaccine in people with CLD and report any disparities or differences in the characteristics of the vaccinated population. PRR1-10.2196/51861.

Prepayment meters strongly associated with multiple types of deprivation and emergency respiratory hospital admissions: an observational, cross-sectional study

BackgroundPrepayment meters (PPMs) require energy to be paid in advance. Action groups and media contend that PPMs are concentrated in the most vulnerable groups, prone to run out of credit...

Estimating the prevalence of diagnosed Alzheimer disease in England across deprivation groups using electronic health records: a clinical practice research datalink study

ObjectiveEstimate the prevalence of diagnosed Alzheimer’s disease (AD) and early Alzheimer’s disease (eAD) overall and stratified by age, sex and deprivation and combinations thereof in England on 1 January 2020.DesignCross-sectional.SettingPrimary...

Epidemiological and strain characteristics of invasive meningococcal disease prior to, during and after COVID-19 pandemic restrictions in England

In 2020, COVID-19 pandemic restrictions led to a major suppression of meningococcal disease in England. Here we describe the epidemiology of invasive meningococcal disease in the three years prior to the COVID-19 pandemic, and the three years immediately after the introduction of restrictions. The UK Health Security Agency conducts national meningococcal disease surveillance in England consisting of laboratory-based case confirmation with strain characterisation by culture and/or molecular detection, as well as clinical follow-up of all cases. In the pre-pandemic period, 554-742 IMD cases were laboratory-confirmed per year. MenB caused 57.2% of cases, followed by MenW (22.7%), MenY (10.6%) and MenC (7.7%). The introduction of restrictions in late March 2020 led to a 73% reduction in IMD. After the removal of restrictions in 2021, a resurgence in MenB was observed, primarily in teenagers and young adults. During the following winter period (2022/23), MenB disease increased to the highest level since 2012 with cases rising across multiple age groups, however, cases in young children eligible for MenB vaccination remained lower than prior to the pandemic. MenACWY cases remained very low throughout the pandemic period. Once pandemic restrictions in England were removed, MenB quickly rebounded- initially driven by a resurgence in teenagers/young adults, but later among other age groups. MenACWY cases remain very low due to the protection afforded by the adolescent MenACWY conjugate vaccine programme.

Inequity in end-of-life care for patients with chronic liver disease in England.

The World Health Assembly recommends integration of palliative care into treatment of patients with any life-limiting condition, yet patients with non-malignant disease are less likely to receive specialist palliative care (SPC). This study compares SPC offered to patients with hepatocellular carcinoma (HCC) versus patients with chronic liver disease without HCC (CLD without HCC). Patients who died from CLD or HCC over 5 years (2013-2017) in England were identified using a dataset linking national data on all hospital admissions (Hospital Episode Statistics - HES) with national mortality data from the Office for National Statistics (HES - ONS). The primary outcome was the proportion of patients who received inpatient SPC in their last year of life (LYOL). Secondary outcomes were (1) early inpatient SPC input and (2) the proportion dying in a hospice. The outcomes were compared between patients with HCC and CLD without HCC. 29 669 patients were identified, 8143 of whom had HCC. Patients with HCC were significantly more likely to receive inpatient SPC input-adjusted OR 3.74 (95% CI 3.52-3.97) and early inpatient SPC input-adjusted OR 7.26 (95% CI 6.38-8.25) and die in a hospice OR 8.23 (95% CI 7.33-9.24) than patients with CLD without HCC. These data highlight the stark inequity in access to SPC services between patients with HCC and patients with CLD without HCC in England. Addressing these inequities will improve end-of-life care for patients with CLD.

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.