Districts Of England Research Articles

Rainfall Enhancement Downwind of Hills Due to Stationary Waves on the Melting Level and the Extreme Rainfall of December 2015 in the Lake District of Northwest England

This paper investigates how stationary gravity waves generated by flow over orography enhance rainfall, with particular attention to the role of induced waves in the melting level. The findings reveal a new mechanism by which gravity wave flow focuses precipitation, amplifying rainfall intensity downwind of hills. This mechanism, which depends on the differential velocities of rain and snow, offers fresh insights into how orographic effects can intensify rainfall. A two-dimensional diagnostic model based on linear gravity wave theory is used to investigate the record-breaking rainfall of December 2015 in the Lake District of northwest England. The pattern of ascent is shown to have a qualitatively good fit to that of the Met Office’s operational high-resolution UKV model averaged over 24 h, suggesting that orographically excited stationary waves were the principal cause of the rain. Precipitation trajectories imply that a persistent downstream elevated wave caused by the Isle of Man supported a spray of seeding ice particles directed towards the Lake District, and that these grew whilst suspended in strong upslope flow before being focused by the undulating melting-level into intense shafts of rain.

The health legacy of coal mining: Analysis of mortality rates over time in England and Wales (1981–2019)

Background– Coal mining areas in the UK continue to suffer worse health outcomes despite the industry disappearing by the early 1990s. Unemployment and deprivation are cited as key explanations. However, as the health effects of hazardous working environments continue after the industry's closure, it is unclear to what extent this ongoing health deficit is due to the legacy health effect of coal mining versus socioeconomic factors, including unemployment and deprivation. Methods– I isolate the legacy health effect of coal mining using a matching research design. Coal mining areas are paired with non-mining areas using propensity score matching. This creates a sample of socioeconomically similar local authority districts in England and Wales. I estimate the effect of coal mining on male and female age-standardised period mortality rates for 1981–2019, analysing temporal dynamics and testing for convergence. Results– I find an initial coal mining effect in 1981 on male (female) mortality rates of 122.6 (66.5) deaths per 100,000. This effect decreases by 91% (70%) during this period, indicating convergence in mortality rates. The timing of this convergence is consistent with that of the industry's closure, with higher convergence rates observed during the 1990s. Conclusions– These results provide evidence for a legacy health effect on mortality from coal mining and convergence in mortality rates between 1981 and 2019. This effect is important when explaining the health deficit experienced by coal mining areas. Furthermore, as coal mining areas tend to be more deprived, these results also shed light on relevant mechanisms driving recent health inequality in the UK.

Mortality from leading cancers in districts of England from 2002 to 2019: a population-based, spatiotemporal study

Cancers are the leading cause of death in England. We aimed to estimate trends in mortality from leading cancers from 2002 to 2019 for the 314 districts in England. We did a high-resolution spatiotemporal analysis of vital registration data from the UK Office for National Statistics using data on all deaths from the ten leading cancers in England from 2002 to 2019. We used a Bayesian hierarchical model to obtain robust estimates of age-specific and cause-specific death rates. We used life table methods to calculate the primary outcome, the unconditional probability of dying between birth and age 80 years by sex, cancer cause of death, local district, and year. We reported Spearman rank correlations between the probability of dying from a cancer and district-level poverty in 2019. In 2019, the probability of dying from a cancer before age 80 years ranged from 0·10 (95% credible interval [CrI] 0·10-0·11) to 0·17 (0·16-0·18) for women and from 0·12 (0·12-0·13) to 0·22 (0·21-0·23) for men. Variation in the probability of dying was largest for lung cancer among women, being 3·7 times (95% CrI 3·2-4·4) higher in the district with the highest probability than in the district with the lowest probability; and for stomach cancer for men, being 3·2 times (2·6-4·1) higher in the district with the highest probability than in the one with the lowest probability. The variation in the probability of dying was smallest across districts for lymphoma and multiple myeloma (95% CrI 1·2 times [1·1-1·4] higher in the district with the highest probability than the lowest probability for women and 1·2 times [1·0-1·4] for men), and leukaemia (1·1 times [1·0-1·4] for women and 1·2 times [1·0-1·5] for men). The Spearman rank correlation between probability of dying from a cancer and district poverty was 0·74 (95% CrI 0·72-0·76) for women and 0·79 (0·78-0·81) for men. From 2002 to 2019, the overall probability of dying from a cancer declined in all districts: the reductions ranged from 6·6% (95% CrI 0·3-13·1) to 30·1% (25·6-34·5) for women and from 12·8% (7·1-18·8) to 36·7% (32·2-41·2) for men. However, there were increases in mortality for liver cancer among men, lung cancer and corpus uteri cancer among women, and pancreatic cancer in both sexes in some or all districts with posterior probability greater than 0·80. Cancers with modifiable risk factors and potential for screening for precancerous lesions had heterogeneous trends and the greatest geographical inequality. To reduce these inequalities, factors affecting both incidence and survival need to be addressed at the local level. Wellcome Trust, Imperial College London, UK Medical Research Council, and the National Institute of Health Research.

Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland

Recent studies have established the key individual-level risk factors of COVID-19 mortality such as age, gender, ethnicity, and socio-economic status. However, the spread of infectious diseases is a spatial and temporal process implying that COVID-19 mortality and its determinants may vary sub-nationally and over time. We investigate the spatial patterns of age-standardised death rates due to COVID-19 and their correlates across local authority districts in England, Wales, and Scotland across three waves of infection. Using a Spatial Durbin model, we explore within- and between-country variation and account for spatial dependency. Areas with a higher share of ethnic minorities and higher levels of deprivation had higher rates of COVID-19 mortality. However, the share of ethnic minorities and population density in an area were more important predictors of COVID-19 mortality in earlier waves of the pandemic than in later waves, whereas area-level deprivation has become a more important predictor over time. Second, during the first wave of the pandemic, population density had a significant spillover effect on COVID-19 mortality, indicating that the pandemic spread from big cities to neighbouring areas. Third, after accounting for differences in ethnic composition, deprivation, and population density, initial cross-country differences in COVID-19 mortality almost disappeared. COVID-19 mortality remained higher in Scotland than in England and Wales in the third wave when COVID-19 mortality was relatively low in all three countries. Interpreting these results in the context of higher overall (long-term) non-COVID-19 mortality in Scotland suggests that Scotland may have performed better than expected during the first two waves. Our study highlights that accounting for both spatial and temporal factors is essential for understanding social and demographic risk factors of mortality during pandemics.

Memories of a fishing landscape: Making sense of flow and decline

Drawing on life history interviews conducted with former fishers and other older residents in Great Yarmouth – one of the 20% most deprived districts in England – this article explores how memories of a once flourishing fishing industry are used to make sense of the decline that followed the end of the industry in the 1960s. Focusing on the material and affective constituents of people’s memories, embodied in three categories of fishing-related objects (boats and quay, nets and fish) through which their stories are told, I explore how those formerly involved in fishing-related activities understand and experience the past and their world in the present. Using biographical and historical memories to reclaim their role in the making of a town that they consider to ‘have missed the boat’, they are able to make sense of the transformations that occurred and to reclaim their role as place makers.

COVID-19 spatio-temporal forecast in England

The 2019 novel coronavirus disease (COVID-19, SARS-CoV-2) being contagious illness with allegedly high potential for global transmission, low potential for morbidity and fatality, and certain impact on global public health.This study describes a novel bio-system reliability spatio-temporal approach, that is especially appropriate for multi-regional environmental, biological and health systems and that, when observed for a sufficient amount of time, produces a reliable long-term forecast of the likelihood of an outbreak of a highly pathogenic virus. Conventional statistical approaches do not have the benefit of effectively handling large regional dimensionality and cross-correlation between various regional observations. These methods deal with temporal observations of multi-regional phenomena. The most afflicted districts of England's COVID-19 daily counts of reported patients were used for this investigation. In order to extract the essential data from dynamically observed patient numbers while taking into consideration pertinent geographical mapping, this study utilized recently developed bio-reliability methodology. With the use of the spatio-temporal approach described in this study, future epidemic outbreak risks for multi-regional public health systems may be predicted with sufficient accuracy.

Phthalates, adipates, BPA, and pesticides in school meals

BackgroundExposure to phthalates, adipates, bisphenol-A (BPA), and pesticides may have important health consequences for children, but little is known regarding their presence in school meals, a major food source for children. The aims of this study were to determine the presence of phthalates, adipates, BPA, and pesticides in school meals. MethodsUsing a cross-sectional design, n = 50 school meal components were collected from four school districts in New England (n = 8 elementary/K-8 schools) differing preparation methods (on-site scratch cooking and pre-packaged heat and serve meals with plastic films) between 2019 and 2021. Meal components were tested for the presence of phthalates, adipates, BPA, and pesticides by an independent laboratory. ResultsOne adipate, DEHA, was detected in 42% of samples (range 0.08 mg/kg - 50.39 mg/kg). Among the prepackaged foods, DEHA was detected in 86% of samples, which also contained the highest average concentrations among all the samples tested. The phthalate Diisononyl phthalate (DINP) was detected in only one sample, and BPA was not detected in any of the samples tested. Pesticides were detected in 64% of produce and 27% of entrées, but most had levels that were lower than the average levels detected by the USDA's Pesticide Data Program and only one sample had levels that exceeded those detected by the USDA (Cyfluthrin levels in one sample of apples were 0.038 mg/kg compared with an USDA average range of 0.004–0.032 mg/kg). ConclusionsOverall pesticides and phthalate levels in school meals are low and BPA was not detected. However, this study suggests that manufacturers may be changing to less studied plasticizers such as DEHA. More studies should examine the impact of DEHA on human health, particularly among children. As schools transition back from the COVID-19 pandemic, foods packaged in plastic should be minimized where possible. Overall, school meals remain one of the healthiest options for children and policies that support on site cooking can further strengthen the quality of school meals.

Differences in public's perception of air quality and acceptability of a clean air zone: A mixed-methods cross sectional study

BackgroundAir pollution is a major cause of morbidity and mortality. Clean Air Zones (CAZs) which restrict the entry of polluting vehicles in targeted areas have been identified as potentially effective in improving health and reducing air pollution; however, their implementation can be controversial. MethodsA cross-sectional survey was completed by 1949 respondents who lived or worked in Bradford, a multi-cultural deprived city in England, between April and December 2021. Of these, 1137 were recruited from the longitudinal Born in Bradford (BiB) family cohort (families with children born in the city during 2007–2011) and 812 were from the general public. Bradford is the seventh largest metropolitan district in England and Wales with a population of over half a million mainly white British and Pakistani origin. The BiB families cohort and the general public respondents were used for descriptive analysis of perception of air quality and acceptability of CAZ, then the relationship between participants responses with demographic characteristics were investigated using the BiB families cohort. Outcomes included perceptions of air quality and acceptability of the CAZ supplemented by free-text questions. Thematic analysis was used to code free-text data. Descriptive analyses were performed on the entire sample. Latent class analysis was used to characterise participants was performed in the BiB dataset for whom detailed existing socio-demographic data were available. ResultsThe majority of participants (67%) considered improving air quality in Bradford as extremely important; 70% supported implementation of the CAZ. Three latent classes were identified within the BiB sample: deprived white British families (25%), more affluent white British families (32%) and deprived Pakistani-origin families (43%). Deprived white British (OR = 0.54, 95% CI: 0.34 to 0.84) and more affluent white British families (OR = 0.53, 95% CI: 0.36 to 0.79) were less likely to say the air quality was good/excellent when compared with deprived Pakistani-origin families. Affluent White British families were more likely to support the CAZ compared with deprived white British families (OR = 2.24; 95% CI: 1.55. to 3.25) and deprived Pakistani-origin families (OR = 2.06, 95% CI: 1.50 to 2.85). Qualitative analysis suggested that a perceived lack of cohesion in the policy and concerns about financial impacts drove negative attitudes. ConclusionFamilies in Bradford were generally supportive of the planned CAZ and efforts to reduce pollution; however, support was weaker in more deprived communities. Pakistani-origin communities living in deprived areas perceived air quality as better than other groups. Tailored approaches to communicate about the proposed benefits of policies such as CAZ prior to implementation may be an important way to increase acceptability amongst vulnerable groups.

Micromotives and macromoves: political preferences and internal migration in England and Wales

Abstract When people migrate internally, do they tend to move to locations that reflect their political preferences? To address this question, we combine evidence from a unique panel dataset on population movements across local authority districts in England and Wales (2002–2015) with evidence stemming from individual survey-based data. Our results suggest that political similarity between two districts exerts an important positive effect on their bilateral migration flows. Our results also indicate that political alignment to the district of residence contributes to individuals’ sense of belonging and ‘fitting in’, consistent with the existence of a homophily mechanism.

Caring through Crisis: Supporting African Immigrant Students and Educators during the COVID-19 Pandemic

All human beings need care, including professional caregivers such as educators. What happens when a global crisis places care providers; own care needs in conflict with their duty and desire to provide care? In this article, we apply care ethics to a school district's decisions regarding newcomer English learners (ELs) and their educators during the 2020-2021 academic year. Drawing on qualitative case study data from a larger multi-district, multi-state study, we examine how educators and administrators in a small urban school district in New England make sense of students' and educators' sometimes conflicting care needs during the COVID-19 pandemic. We argue that even school districts with clear commitments to equity and justice have their efforts severely limited by state and federal leadership's neglect of care/essential workers, youth, and marginalized groups. To end the ongoing pandemic and prevent future harm, we recommend that educational and political leaders prioritize human needs and relationships through a move towards "universal care" (Chatzidakis et al., 2020).

“I Dreamed of an Alliance between the Authority of Dogma and Political Liberty”: Mormonism and Socialism in France in the Nineteenth Century

“I Dreamed of an Alliance between the Authority of Dogma and Political Liberty”: Mormonism and Socialism in France in the Nineteenth Century

National lockdowns in England: The same restrictions for all, but do the impacts on COVID-19 mortality risks vary geographically?

Quantifying the impact of lockdowns on COVID-19 mortality risks is an important priority in the public health fight against the virus, but almost all of the existing research has only conducted macro country-wide assessments or limited multi-country comparisons. In contrast, the extent of within-country variation in the impacts of a nation-wide lockdown is yet to be thoroughly investigated, which is the gap in the knowledge base that this paper fills. Our study focuses on England, which was subject to 3 national lockdowns between March 2020 and March 2021. We model weekly COVID-19 mortality counts for the 312 Local Authority Districts in mainland England, and our aim is to understand the impact that lockdowns had at both a national and a regional level. Specifically, we aim to quantify how long after the implementation of a lockdown do mortality risks reduce at a national level, the extent to which these impacts vary regionally within a country, and which parts of England exhibit similar impacts. As the spatially aggregated weekly COVID-19 mortality counts are small in size we estimate the spatio-temporal trends in mortality risks with a Poisson log-linear smoothing model that borrows strength in the estimation between neighbouring data points. Inference is based in a Bayesian paradigm, using Markov chain Monte Carlo simulation. Our main findings are that mortality risks typically begin to reduce between 3 and 4 weeks after lockdown, and that there appears to be an urban–rural divide in lockdown impacts.

Women, homelessness and multiple disadvantage in Stoke-on-Trent: The need for safe places in the context of wider health and social inequalities

This article is based on two qualitative studies related to women’s experiences of homelessness and multiple disadvantage in Stoke-on-Trent (one of the 20% most ‘deprived’ districts in England, with higher than average rates of statutory homelessness). This research utilised a participatory approach, with collaboration between researchers from Staffordshire University’s Centre for Health and Development (CHAD) and Expert Citizens C.I.C. Qualitative data collection occurred with 10 women with lived experiences of homelessness and local services (conducted by Expert Citizens) and 20 frontline workers/wider stakeholders (conducted by CHAD). For this article, we conducted thematic analysis to identify patterns across both studies. Three themes are discussed: ‘So much unmet need’ and revolving doors for women; the lack of safe accommodation for women and ‘risky’ alternatives; creating safe spaces for women and the need for longer-term investment and opportunities. There was surprise at how many women came forward for accommodation during ‘Everyone In’ and evolving recognition of gendered experiences of homelessness combined with other experiences. Next steps for action are discussed, highlighting the importance of partnerships and collaboration with people with lived experience. We have strong foundations to build on, and far more to be done, to improve women’s experiences within Stoke-on-Trent.

Contributions of event rates, pre-hospital deaths, and deaths following hospitalisation to variations in myocardial infarction mortality in 326 districts in England: a spatial analysis of linked hospitalisation and mortality data

Myocardial infarction mortality varies substantially within high-income countries. There is limited guidance on what interventions-including primary and secondary prevention, or improvement of care pathways and quality-can reduce myocardial infarction mortality. Our aim was to understand the contributions of incidence (event rate), pre-hospital deaths, and hospital case fatality to the variations in myocardial infarction mortality within England. We used linked data from national databases on hospitalisations and deaths with acute myocardial infarction (ICD-10 codes I21 and I22) as a primary hospital diagnosis or underlying cause of death, from Jan 1, 2015, to Dec 31, 2018. We used geographical identifiers to estimate myocardial infarction event rate (number of events per 100 000 population), death rate (number of deaths per 100 000 population), total case fatality (proportion of events that resulted in death), pre-hospital fatality (proportion of events that resulted in pre-hospital death), and hospital case fatality (proportion of admissions due to myocardial infarction that resulted in death within 28 days of admission) for men and women aged 45 years and older across 326 districts in England. Data were analysed in a Bayesian spatial model that accounted for similarities and differences in spatial patterns of fatal and non-fatal myocardial infarction. Age-standardised rates were calculated by weighting age-specific rates by the corresponding national share of the appropriate denominator for each measure. From 2015 to 2018, national age-standardised death rates were 63 per 100 000 population in women and 126 per 100 000 in men, and event rates were 233 per 100 000 in women and 512 per 100 000 in men. After age-standardisation, 15·0% of events in women and 16·9% in men resulted in death before hospitalisation, and hospital case fatality was 10·8% in women and 10·6% in men. Across districts, the 99th-to-1st percentile ratio of age-standardised myocardial infarction death rates was 2·63 (95% credible interval 2·45-2·83) in women and 2·56 (2·37-2·76) in men, with death rates highest in parts of northern England. The main contributor to this variation was myocardial infarction event rate, with a 99th-to-1st percentile ratio of 2·55 (2·39-2·72) in women and 2·17 (2·08-2·27) in men across districts. Pre-hospital fatality was greater than hospital case fatality in every district. Pre-hospital fatality had a 99th-to-1st percentile ratio of 1·60 (1·50-1·70) in women and 1·75 (1·66-1·86) in men across districts, and made a greater contribution to variation in total case fatality than did hospital case fatality (99th-to-1st percentile ratio 1·39 [1·29-1·49] and 1·49 [1·39-1·60]). The contribution of case fatality to variation in deaths across districts was largest in women aged 55-64 and 65-74 years and in men aged 55-64, 65-74, and 75-84 years. Pre-hospital fatality was slightly higher in men than in women in most districts and age groups, whereas hospital case fatality was higher in women in virtually all districts at ages up to and including 65-74 years. Most of the variation in myocardial infarction mortality in England is due to variation in myocardial infarction event rate, with a smaller role for case fatality. Most variation in case fatality occurs before rather than after hospital admission. Reducing subnational variations in myocardial infarction mortality requires interventions that reduce event rate and pre-hospital deaths. Wellcome Trust, British Heart Foundation, Medical Research Council (UK Research and Innovation), and National Institute for Health Research (UK).

Examining Student Plate Waste Following a Conversion From Pre-packaged to Lunches Prepared On-Site: A Longitudinal Cohort Study

ObjectivesSubsidized meals provided through the National School Breakfast and Lunch programs are an important source of daily nutrition for millions of students across the United States. Aging school infrastructure has led some districts to rely on pre-packaged meals to feed students over the past few decades. It is unclear how investments in infrastructure upgrades that would enable on-site scratch cooking in schools might influence student selection and consumption of school meals. The aim of this study was to assess changes in student selection and consumption of school lunches following a conversion from pre-packaged meals to lunches prepared on-site, the introduction of salad bars on the lunch line, and removal of flavored milk offerings. MethodsQuasi-experimental difference-in-difference analysis of pre/post direct observation weighed plate waste measurements collected in Fall 2018 and Spring 2019 from 595 3rd-5th graders at eight elementary schools (four intervention, four controls) in a large urban school district in New England. Descriptive statistics and mixed-model linear regressions controlling for grade, sex, intervention, and observations nested within individual were used to examine changes in meal component selection and consumption. ResultsStudent selection and consumption of vegetables increased by 31 grams (95%CI 18g – 43g) (equivalent to ∼3.25 carrot sticks or grape tomatoes) in intervention schools relative to controls, while student selection and consumption of milk decreased by 46g (95%CI 18g – 43g) (∼1/5 of an 8 ounce milk carton). Entrée and fruit selection and consumption did not change significantly. ConclusionsRemoval of flavored milk may lead to an initial decline in milk selection and consumption. Increased offerings of fresh unpackaged vegetables can increase student acceptance and consumption. Funding SourcesT32 HL098048/HL/NHLBI NIH HHS/United States.

The impact of adverse childhood experiences and recent life events on anxiety and quality of life in university students.

Adverse childhood experiences (ACEs) have been repeatedly associated with a wide range of physical and mental health issues. Research has indicated high levels of anxiety and depression among university students, and a few studies have documented the relationship between ACEs and anxiety in the university student population. This study surveyed first year students at a university located in the most ethnically diverse district in England, with the second highest poverty rate. Eight hundred and fifty-eight responded; a response rate of 12%. The survey included questions about adverse childhood events, recent life stressors, current deprivation, quality of life, positive physical health and positive mental health, and used the Generalized Anxiety Disorder Scale, a standardised measure. Thirty-seven percent of the responding students met the diagnosis for generalised anxiety disorder. In a multivariate multiple regression model, life stressors and childhood adversities were significantly associated with higher levels of anxiety and lower levels of physical and mental health. Only childhood adversities significantly predicted lower levels of quality of life. The findings highlight the importance of considering adverse childhood experiences in enhancing the wellbeing of the student population. Given the demographics of the student population at the University of East London, the high rates of ACEs and anxiety are likely to partially reflect poverty and racism. The implications of the findings for trauma-informed policies and practices in universities are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10734-021-00774-9.

Childhood adversities among students at an English University: A latent class analysis

ABSTRACT University students routinely participate in research, including research on trauma and adversity, but the unique implications of trauma and adversity for educational and developmental outcomes for this group have received less attention. This study surveyed first year undergraduate students at an urban university located in the most ethnically diverse district in England, with the second highest poverty rate. Of 7,110 students, 858 responded; a response rate of 12%. The survey included thirteen questions about adverse events and circumstances before age 18. Four in five students (79%) reported at least one adversity, 51% reported three or more, and 20% reported at least six. Female students reported a higher mean number of adversities than men, but men were significantly more likely to report having been “attacked, stabbed, shot or robbed by threat.” Where comparisons were possible, rates were higher than for the general population or for the only other UK university survey. A Latent Class Analysis produced four groupings. Besides the ’No adversity’ (36%) and “Intermediate” (46%) classes, there were two “High adversity” groups, differentiated by high (12%) or moderate (6%) adversities related to cohabitation (parental separation, lived with depressed person, lived with alcohol/drug user, and lived with incarcerated person). Higher rates of adversities, and latent class membership, were related to predictions that one would not complete one’s degree. Implications and next steps are discussed.

The Context of Crisis: Teacher social network effects during crisis-based organizational change

This exploratory study examines the ways in which teacher social networks vary by organizational context. The study draws on data collected in a large urban adjacent public school district in New England after start the start of the global COVID-19 pandemic and the subsequent switch to remote instruction. In so doing, the study compares changes in teacher’s informal advice networks in the same schools during both a “Status Quo” context relative to a context of “Crisis-based Organizational Change.” Results indicate that central traits of teacher advice networks – out-degree centrality, tie strength, and network composition – vary with organizational context. Further, these network traits are associated with variation in network mechanisms supporting more positive perceptions of innovative climate in each context. Findings of this study suggest that organizational context may drive variation in the ways that networks support the same organization outcome, furthering the notion that how networks ‘work’ is not the same in all instances. Implications for future research of teacher social networks and implications for school managerial staff involved in organizational change efforts are discussed.

An Extended Bayesian Hierarchical Model Predicted SARS-CoV-2 Cases and Reproductions After Vaccination in England

In the UK, one of the worst affected countries by the SARS-CoV-2 global pandemic, the UK government has released a comprehensive vaccination plan for SARS-CoV-2 and will set up more vaccination sites in the coming months to expand the service to more people. We built an extended Bayesian hierarchical prediction model to predict the number of cases and breeding situation after vaccination in the nine districts of England. Based on the population of each region, the number of deaths and the IFR (the infection mortality ratio) for each region were predicted. We found that EAST, NORTHWEST and SOUTHEAST had the largest IFR, and the corresponding death numbers were 29,079, 28,734 and 25,201, respectively. Reproduction number ( ) is expected to drop below 1 in all regions on January 7, January 12, January 16, January 13, January 10, January 17, January 10, January 18 and January 14, respectively. Major vaccine interventions have been effective in reducing transmission in the nine areas of England given the mortality rate of the infected people and epidemiological characteristics of SARS-CoV-2. We also found that vaccination among people aged 70 to 80 had made a significant contribution to reducing transmission of the virus. The model can be extended to forecast the effects of certain interventions in public health emergencies, the effect of preventing the spread of disease, and the effect of different interventions in different age groups to find the best way to control the spread of disease. It can also be extended to drug and non-drug interventions to find the best combination of solutions.

Socioeconomic inequalities in food outlet access through an online food delivery service in England: A cross-sectional descriptive analysis

Online food delivery services facilitate ‘online’ access to food outlets selling food prepared away-from-home. Online food outlet access has not previously been investigated in England or across an entire country. Systematic differences in online food outlet access could exacerbate existing health inequalities, which is a public health concern. However, this is not known. Across postcode districts in England (n = 2118), we identified and described the number of food outlets and unique cuisine types accessible online from the market leader (Just Eat). We investigated associations with area-level deprivation using adjusted negative binomial regression models. We also compared the number of food outlets accessible online with the number physically accessible in the neighbourhood (1600m Euclidean buffers of postcode district geographic centroids) and investigated associations with deprivation using an adjusted general linear model. For each outcome, we predicted means and 95% confidence intervals. In November 2019, 29,232 food outlets were registered to accept orders online. Overall, the median number of food outlets accessible online per postcode district was 63.5 (IQR; 16.0–156.0). For the number of food outlets accessible online as a percentage of the number accessible within the neighbourhood, the median was 63.4% (IQR; 35.6–96.5). Analysis using negative binomial regression showed that online food outlet access was highest in the most deprived postcode districts (n = 106.1; 95% CI: 91.9, 120.3). The number of food outlets accessible online as a percentage of those accessible within the neighbourhood was highest in the least deprived postcode districts (n = 86.2%; 95% CI: 78.6, 93.7). In England, online food outlet access is socioeconomically patterned. Further research is required to understand how online food outlet access is related to using online food delivery services.