Index Of Multiple Deprivation Quintile Research Articles

The long-term effect of the coronavirus pandemic on parkrun participation: an interrupted time series analysis

BackgroundThe growth of parkrun between 2004 and 2019 has been heralded as a success story for public health as a result of its physical activity and wellbeing benefits for participants. However, parkrun was not immune from the COVID-19 pandemic - with events in mainland England cancelled from March 2020 to July 2021. This study explores the lasting impact of the pandemic on parkrun participation to February 2023, and its implications across the socioeconomic spectrum.MethodsThe study combines aggregated parkrun weekly finisher data from 32,470 Lower Layer Super Output Areas (LSOA) in England from January 2015 to February 2023 with Office of National Statistics (ONS) data on population and deprivation. Interrupted time series analysis using segmented Poisson regression models was used to estimate the immediate change in parkrun participation and the change in the rate of growth following the pandemic. Models were fitted for each Index of Multiple Deprivation (IMD) quintile separately to assess whether this effect differed by socioeconomic deprivation.ResultsVisualisation and interrupted time series analysis showed a significant and long-term decrease in parkrun participation following the reopening of parkrun events. This was consistent across all IMD quintiles, indicating that the inequalities in parkrun participation according to IMD observed prior to the pandemic remained after the pandemic. Between March 2020 and February 2023, almost 13 million fewer parkrun finishes are estimated to have occurred relative to what would have occurred in the absence of the pandemic.ConclusionThe reduction in parkrun participation during the pandemic and following the reopening of events is likely to have negatively impacted wellbeing in would-be participants. Going forwards, policymakers must make the difficult trade-off between the long-term health and social implications of restricting outdoor physical activity events against the benefits associated with a reduction in infectious disease transmission.

Socioeconomic inequalities in patients undergoing abdominal wall reconstruction in the North-West of England, UK: a three-centre retrospective cohort study

PurposePatients from deprived areas are more likely to experience longer waiting times for elective surgery, be multimorbid, and have inferior outcomes from elective and emergency surgery. This study aims to investigate how surgical outcomes vary by deprivation for patients undergoing elective abdominal wall reconstruction.MethodsA three-centre retrospective cohort study was conducted across three hospitals in North-West England, including patients with complex ventral hernias undergoing abdominal wall reconstruction between 2013 and 2021. Demographic data, comorbidities, and index of multiple deprivation quintiles were recorded.Results234 patients (49.6% female), age 57 (SD 13) years, underwent elective abdominal wall reconstruction. Significantly higher unemployment rates were found in the most deprived quintiles (Q1 and Q2). There were more smokers in Q1 and Q2, but no significant deprivation related differences in BMI, diabetes, chronic kidney disease or ischaemic heart disease. There were also higher rates of Clavien-Dindo 1–2 complications in Q1 and Q5, but no difference in the Clavien-Dindo 3–4 outcomes. Patients in Q1 and Q5 had a significantly greater hospital length of stay.ConclusionThe association between deprivation and greater unemployment and smoking rates highlights the potential need for equitable support in patient optimisation. The lack of differences in patient co-morbidities and hernia characteristics could represent the application of standardised operative criteria and thresholds. Further research is needed to better understand the relationship between socioeconomic status, complications, and prolonged hospital length of stay.

Healthcare utilisation and associated costs for methadone versus buprenorphine recipients: Examination of interlinked primary and secondary care electronic health records in England.

More evidence for patterns of healthcare utilisation and associated costs among people receiving opioid agonist therapy (OAT) is needed. We investigated primary and secondary healthcare usage and costs among methadone and buprenorphine recipients in England. We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases of patients who were prescribed OAT between 1 January 2007 and 31 July 2019. The cohort was linked to Hospital Episode Statistics admitted patient care, outpatient and emergency department data, neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records. Negative binomial regression models were applied to estimate weighted rate ratios (wRR) of healthcare utilisation. Total and mean costs were calculated using Unit Costs of Health and Social Care and the National Healthcare Service Payment by Results National Tariffs. Among 12,639 patients observed over 39,016 person-years, we found higher rate of hospital admissions (wRR 1.18; 1.08-1.28) among methadone compared with buprenorphine recipients. The commonest hospital discharge diagnoses among methadone patients were infectious diseases (19.2%), mental and behavioural disorders (17.0%) and drug-related poisoning (16.5%); the three commonest among buprenorphine patients were mental and behavioural diseases (21.5%), endocrine (13.8%) and genitourinary system diseases (13.1%). Methadone patients had similar mean costs compared with buprenorphine patients (cost difference: £539.01; 432.11-1006.69). Differences in healthcare utilisation frequency for methadone versus buprenorphine recipients were observed. The differences in associated costs were mainly driven by hospital admissions. These findings offer valuable insights for optimising care strategies and resource allocation for OAT recipients.

The effect of frailty on mortality and hospital admission in patients with benign pleural disease in Wales: a cohort study

Pleural disease is common, representing 5% of the acute medical workload, and its incidence is rising, partly due to the ageing population. Frailty is an important feature and little is known about disease progression in patients with frailty and pleural disease. We aimed to examine the effect of frailty on mortality and other relevant outcomes in patients diagnosed with pleural disease. In this cohort study in Wales, the national Secure Anonymised Information Linkage databank was used to identify a cohort of individuals diagnosed with non-malignant pleural disease between Jan 1, 2005, and March 1, 2023, who were not known to have left Wales. Frailty was assessed at diagnosis of pleural disease using an electronic Frailty Index. The primary outcome was time from diagnosis to all-cause mortality for all patients. Data were analysed using multilevel mixed-effects Cox proportional hazards regression adjusting for the prespecified covariates of age, sex, Welsh Index of Multiple Deprivation quintile, smoking status, comorbidity, and subtype of pleural disease. 54 566individuals were included in the final sample (median age 66years [IQR 47-77]; 26 477 [48·5%] were female and 28 089 [51·5%] were male). By the end of the study period, 25 698 (47·1%) participants had died, with a median follow-up of 1·0years (IQR 0·2-3·6). There was an association between frailty and all-cause mortality, which increased as frailty worsened. Compared with fit individuals, there was increasing mortality for those with mild frailty (adjusted hazard ratio 1·11 [95% CI 1·08-1·15]; p<0·0001), moderate frailty (1·25 [1·20-1·31]; p<0·0001), and severe frailty (1·36 [1·28-1·44]; p<0·0001). Independent of age and comorbidities, frailty status at diagnosis of pleural disease appeared to be useful as a prognostic indicator. Patients with moderate or severe frailty had a rapid decline in health. Future patients should be assessed for frailty at the time of diagnosis of pleural disease and might benefit from optimised care and advance care planning. Cardiff University's Wellcome Trust iTPA funding award.

Menopause symptom prevalence in three post–COVID-19 syndrome clinics in England: A cross-sectional analysis

ObjectivesThere is an overlap between symptoms of perimenopause/menopause and post-COVID syndrome and there is a concern that some female patients referred to post-COVID syndrome clinics may have undiagnosed perimenopause/menopause. However, the prevalence of such symptoms in this population is unknown. MethodsCross-sectional analysis of 122 women's health questionnaires as part of a service improvement project in three National Health Service post-COVID syndrome clinics in England. The primary outcomes were prevalence of menopause symptoms and association between the total menopause symptom questionnaire (MSQ) score and the key predictors. ResultsAge group 40-54 years showed the highest prevalence of most individual symptoms and the highest mean total MSQ score (36.4; confidence interval [CI] 32.3-40.6), correlating clinically with the onset of perimenopause/menopause. Regression modeling shows a significant positive parabolic relationship between age and total MSQ score. Age group 40-54 years is associated with a 6.60-point higher (CI 1.31-11.9) total MSQ score than the age group 55-79 years; an increase of one index of multiple deprivation quintile is associated with a 2.85-point lower (CI −1.24 to −4.45) total MSQ score; presence of a gynecologic diagnosis is associated with a 6.31-point higher (CI 1.32-11.3) total MSQ score. A total of 51% of patients who menstruate reported menstrual disturbance with COVID-19 infection and 21% with COVID-19 vaccination. ConclusionsSymptoms possibly attributable to perimenopause and menopause were highly prevalent among female patients attending post-COVID syndrome clinics in Greater Manchester, England. Our findings provide key prevalence estimates and significant predictors of MSQ scores that are vital for future research, clinical practice, and policy.

Is Scotland Walking in the Right Direction? A Cross-Sectional Analysis of Trends in Walking by Socioeconomic Status.

Walking is a key target behavior for promoting population health. This paper charts the 30-year history of walking policy in Scotland. We assess whether population walking levels among adults in Scotland have changed in recent years and identify the characteristics of those least likely to report any walking. We pooled 9years (2012-2019 and 2021) of data from adult (≥16y) respondents of the Scottish Health Survey (n = 41,470). The outcomes of interest were the percentage reporting (1)any walking and (2)any walking with an average pace that is of at least moderate intensity. We also investigated the contribution of walking to total nonoccupational moderate to vigorous physical activity. We used linear and logistic regressions to test linear trends over time and to identify inequalities by age, sex, and the Scottish Index of Multiple Deprivation quintile. There was an increase in all measures of walking over the period 2012-2021; for example, the percentage reporting any walking increased by 7 percentage points (81.4%-88.4%). Inequalities still exist by age, sex, and the Scottish Index of Multiple Deprivation but have not grown over time. Inequalities by sex and age are most pronounced in the least affluent Scottish Index of Multiple Deprivation quintiles; less affluent older women are least likely to report any walking. Scotland appears to be walking in the right direction. Surveillance data support a positive trend after decades of policy and promotion efforts. The policies do not appear to be exacerbating existing inequalities, but narrowing them will require more concentrated efforts.

Social determinants of health inequalities in early phase clinical trials in Northern England

BackgroundEarly phase clinical trials in Oncology represent a subspecialised area where UK patient selection is influenced by access to Experimental Cancer Medicine Centres (ECMCs). Equity of access with respect to social determinants of health (SDoH) were explored for two major ECMCs.MethodsA retrospective cohort study including all referrals to Newcastle and Manchester ECMCs in 2021 was completed. Consent to screening or pre-screening was stratified against SDoH characteristics, including: Index of Multiple Deprivation (IMD) decile, ethnicity and distance to centre.Results1243 patients were referred for trials. IMD quintile 1 (most deprived) patients had reduced likelihood of referral compared to expected population models (OR, 0.67; 95% CI: 0.55 to 0.80, p = <0.0001). IMD quintile 5 (least deprived) had increased likelihood of referral (OR, 1.46; 95% CI: 1.17 to 1.82, p = 0.0007). Living beyond median distance from Manchester reduced the likelihood of consenting to trials (OR, 0.72; 95% CI: 0.55 to 0.94, p = 0.015). Ethnicity data represented a White British propensity.ConclusionsInequalities in socioeconomic and geographic factors influence referral and enrolment to early phase clinical trials in Northern England. This has implications for equity of access and generalisability of trial results internationally and warrants further study.

Are local public expenditure reductions associated with increases in inequality in emergency hospitalisation? Time-series analysis of English local authorities from 2010 to 2017

BackgroundReductions in local government funding implemented in 2010 due to austerity policies have been associated with worsening socioeconomic inequalities in mortality. Less is known about the relationship of these reductions...

Paediatric open fractures presenting to a level 1 trauma centre: a 10 year epidemiological study.

The epidemiology of paediatric fractures has been previously described, however there is limited data available on open fractures in this population. The purpose of this study was to investigate trends, mechanism of injury (MOI) and severity of paediatric open fractures and undertake an epidemiological study. All children ≤ 16.0 years presenting with open fractures were identified between 01/04/2013 and 01/04/2023. Those with craniofacial, thoracic and distal phalangeal fractures were excluded. Incidence was calculated based on those presenting within the local geographical region. Social deprivation was measured using the Index of Multiple Deprivation (IMD). There were 208 open fractures with a median age of 11.0(q1 7.4-q3 13.4) years, and 153(74.6%) were in males. The MOIs were road traffic collisions 73(35.1%), sports/play 45(21.6%), fall > 2m 29(13.9%), simple fall 25(12.0%), crush 16(7.7%), bites 8(3.8%), assault 6(2.9%), and other 6(2.9%). Nineteen children (9.1%) presented with polytrauma. Gustilo-Anderson grade for long bone fractures were I-61(29.3%), II-24(11.5%), IIIa-36(17.3%), IIIb-30(14.4%) and IIIc-7(3.4%). There were 129 children presenting within the local geographical region providing an annual incidence of 8.0/100,000. Radius and ulna were the most frequently injured 49(38.0%) followed by tibia and fibula 44(34.1%). There were 69(53.5%) children presenting from an IMD quintile 1 with open fractures. Paediatric open fractures are commonly seen in the adolescent male and affect those who are from a more socially deprived background. These injuries account for 3.2% of fractures admitted to a MTC. Data suggests children principally sustain open fractures through two distinct injury patterns and ten-year trends suggests that there is a gradual decline in the annual incidence.

Impact of single round of low dose CT lung cancer screening on cause of mortality in different socio-economic groups: a post-hoc analysis of long-term follow-up of the UKLS trial

Lower socioeconomic status, as measured by the Index of Multiple Deprivation (IMD), is associated with higher rates of smoking-related disease mortality, and with poor uptake of cancer screening. Here we explore whether socioeconomic status impacts the effectiveness of a single round of low-dose-CT screening, or impacts other causes of death, in the UKLS LDCT screening trial. IMD quintiles were defined according to UK-wide data, with the deprived group defined as the lower two quintiles (Q1-2) and the less deprived as Q3-5. Follow-up data was obtained for lung cancer diagnosis (median follow-up 9.1 years) and cause of death (median follow-up 9.9 years). Outcomes were compared based on IMD group and trial arm (CT or control). More deprived quintiles were less likely to respond to the questionnaire, but this population was more likely to be selected for screening by the LLP risk model. Lower IMD quintiles benefitted from low-dose-CT screening in terms of lung cancer survival (HR 1.89, 95% CI 1.16-3.08) to the same extent as upper quintiles (HR 1.87, 95% CI 1.07-3.26). However, there was a bigger impact on deaths due to COPD and emphysema in more deprived quintiles. Whilst LDCT screening benefit for lung cancer was similar, significant impact on the rates of death from other smoking-related diseases, notably COPD and emphysema, was seen primarily in lower socioeconomic groups. Future research is required to confirm how lung cancer screening benefits other disease outcomes. NIHR Health Technology Assessment Programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.

Socioeconomic inequalities in accumulation of multimorbidity in England from 2019 to 2049: a microsimulation projection study

There are socioeconomic inequalities in the prevalence of multimorbidity and its accumulation across the life course. Estimates of multimorbidity prevalence in English primary care increased by more than two-thirds from 2004 to 2019. We developed a microsimulation model to quantify current and projected multimorbidity inequalities in the English adult population. We used primary care data for adults in England from the Clinical Practice Research Datalink Aurum database between 2004 and 2019, linked to the 2015 English Index of Multiple Deprivation (IMD), to model time individuals spent in four health states (healthy, one chronic condition, basic multimorbidity [two or more chronic conditions], and complex multimorbidity [three or more chronic conditions affecting three or more body systems]) by sex, age, IMD quintile, birth cohort, and region. We applied these transition times in a stochastic dynamic continuous-time microsimulation model to Office for National Statistics population estimates for adults aged 30-90 years. We calculated projected prevalence and cumulative incident cases from 2019 to 2049 by IMD quintile, age group (younger than 65 years vs 65 years and older), and years to be lived without multimorbidity at age 30 years. Under the assumption that all chronic conditions were lifelong, and that once diagnosed there was no recovery, we projected prevalence of multimorbidity (basic or complex) increases by 34% from 53·8% in 2019 to 71·9% (95% uncertainty interval 71·8-72·0) in 2049. This rise equates to an 84% increase in the number of people with multimorbidity: from 19·2 million in 2019 to 35·3 million in 2049 (35·3 million to 35·4 million). This projected increase is greatest in the most deprived quintile, with an excess 1·07 million (1·04 million to 1·10 million) cumulative incident basic multimorbidity cases and 0·70 million (0·67 million to 0·74 million) complex multimorbidity cases over and above the projected cases for the least deprived quintile, largely driven by inequalities in those younger than 65 years. The median expected number of years to be lived without multimorbidity at age 30 years in 2019 is 15·12 years (14·62-16·01) in the least deprived IMD quintile and 12·15 years (11·61-12·60) in the most deprived IMD quintile. The number of people living with multimorbidity will probably increase substantially in the next 30 years, a continuation of past observed increases partly driven by changing population size and age structure. Inequalities in the multimorbidity burden increase at each stage of disease accumulation, and are projected to widen, particularly among the working-age population. Substantial action is needed now to address population health and to prepare health-care and social-care systems for coming decades. University of Liverpool and National Institute for Health and Care Research School for Public Health Research.

Neighborhood Deprivation and Changes in Oral Health in Older Age: A Longitudinal Population-Based Study

The aim of this study was to examine the extent to which neighborhood-level socioeconomic factors (objective and perceived) are associated with poor oral health in older adults over time, independent of individual socioeconomic position. Data for this cross-sectional and longitudinal observation study came from a socially and geographically representative cohort of men aged 71 to 92 y in 2010–12 (n = 1,622), drawn from British general practices, which was followed up in 2018–19 (aged 78–98 y; N = 667). Dental measures at both times included number of teeth, periodontal pocket depth, self-rated oral health, and dry mouth. Neighborhood deprivation was based on Index of Multiple Deprivation (IMD) and a cumulative index measuring perceptions about local environment. Individual-level socioeconomic position was based on longest-held occupation. Multilevel and multivariate logistic regressions, adjusted for relevant sociodemographic, behavioral, and health-related factors, were performed to examine the relationships of dental measures with IMD and perceived neighborhood quality index, respectively. Cross-sectionally, risks of tooth loss, periodontal pockets, and dry mouth increased from IMD quintiles 1 to 5 (least to most deprived); odds ratios (ORs) for quintile 5 were 2.22 (95% confidence interval [CI], 1.41–3.51), 2.82 (95% CI, 1.72–4.64), and 1.51 (95% CI, 1.08–2.09), respectively, after adjusting for sociodemographic, behavioral, and health-related factors. Risks of increased pocket depth and dry mouth were significantly greater in quintile 5 (highest problems) of perceived neighborhood quality index compared to quintile 1. Over the 8-y follow-up, deterioration of dentition (tooth loss) was significantly higher in the most deprived IMD quintiles after full adjustment (OR for quintile 5 = 2.32; 95% CI, 1.09–4.89). Deterioration of dentition and dry mouth were significantly greater in quintile 5 of perceived neighborhood quality index. Neighborhood-level factors were associated with poor oral health in older age, both cross-sectionally and longitudinally, particularly with tooth loss, and dry mouth, independent of individual-level socioeconomic position.

A Service Evaluation of More Than 27 000 Adults Referred to a Community Weight Management Program: 24-Month Outcomes.

Obesity has a significant impact on healthcare resources with limited accessible support available through the NHS. This service evaluation determines 24-month efficacy of referral to an open-group behavioral program by BMI category and socioeconomic status. This retrospective, longitudinal study examined weight outcomes of adults living in England referred by healthcare professionals to Slimming World during 2016 who recorded at least 1 weight change. Primary outcome was % weight change at 3, 6, 12, and 24 months. Socioeconomic status was measured using the Index of Multiple Deprivation (IMD). Data from a post-referral questionnaire investigated self-reported changes in dietary and activity behaviors. Twenty-seven thousand five hundred sixty (15.6% male) records were analyzed. Mean (SD) age and BMI on joining were 48.6 (14.80) years and 37.1 (6.31) kg/m2; 91.7% had a BMI > 30 kg/m2. Mean (SD) % weight change was -5.6 (3.79), -7.1 (5.71), -7.5 (6.88), and -7.3 (6.88) at 3, 6, 12, and 24-months, respectively. At 24- months, differences in weight loss between BMI category were significant, ranging from 0.29% (35-<40 vs 40+) to 1.33% (25-<30 vs 40+). For IMD quintile only comparisons against Q1 and Q2 were significant, ranging between 0.36% (Q2 vs Q3) to 0.94% (Q1 vs Q5). Five thousand eight hundred sixty-two (21.2%) completed the post-referral questionnaire. There were no BMI category effects on dietary behaviors but changes in physical activity behaviors were lower within the higher categories albeit effect sizes were small (all ges < 0.001). IMD quintile influenced changes for sugary drinks, watching TV and avoiding moderate activity although effect sizes were small (all ges < 0.01). Following 12-week referral to a commercial weight management organization, a mean weight loss of over 7% was reported at 24-months. Adults with higher BMIs and a greater level of deprivation can benefit from the practical support offered as part of the referral, supporting weight loss and weight loss maintenance albeit with some inequality.

Factors associated with bacterial sexually transmitted infections among people of South Asian ethnicity in England

ObjectivesDespite being the largest ethnic minority group in England, South Asians have historically had low levels of utilisation of sexual health services (SHS) and sexually transmitted infection (STI) diagnoses, although...

The role of the multiple Index of deprivation in predicting mental health outcomes after the COVID-19 pandemic in adolescents: a cross-sectional study

BackgroundThe number of children and young people (CYP) diagnosed with mental health problems has increased over the past decade. The COVID-19 pandemic also has accelerated this increase, raising significant concerns about adolescent emotional wellbeing. Research suggests that adolescents who live in more deprived areas are more likely to experience poor emotional wellbeing. Children in the northwest of England are among those with the poorest outcomes in the UK. We aimed to investigate the association between deprivation and mental health outcomes from 2019 to 2022. The aim was to support local authorities with targeted provision of public health services as well as predicting service need for 2022 onwards. MethodsIn this cross-sectional study, we analysed routinely collected Schools Health Needs Assessment (SHNA) data. The School Health Needs Assessment dataset contained 32 676 responses from Year 6 (ages 10–11 years) and Year 9 (ages 13–14 years) who completed the annual survey in 2019–22. The questionnaire was offered to all mainstream schools, delivered by the public health school nursing service. Index of multiple deprivation (IMD) data were provided for household postcodes. Data were analysed using IBM SPSS. Factor analysis created a composite emotional wellbeing scale (EWS) and estimates generated by school year (Years 6 and 9) and three academic years (2019–22). We calculated correlations between IMD and EWS overall and within school and academic year samples. FindingsThe final total sample across the three consecutive survey years and the two school years was 32 659. The sample consisted of 15 932 (49%) female students and 5066 (16%) students who registered at school as from an ethnic minority. Of the total sample, 9209 (28%) lived in a postcode in the most deprived IMD quintile in England. There was an overall decrease in EWS from Year 6 to Year 9 and from 2019 to 2022. The Year 6 students in 2022 reported mean levels of EWS equivalent to Year 9 students in 2019 indicating a shift toward poorer mental health in younger children. The correlational analyses showed no significant associations between IMD and EWS scores within the school or academic year cohorts. A follow-up analysis of children in receipt or not in receipt of free school meals also showed no significant association with EWS scores. InterpretationFindings showed that the emotional wellbeing of children and young people in the northwest of England has deteriorated since 2019, with greatest changes observed in the younger cohort of children in Year 6. This was not explained by postcode-based indices of multiple deprivation. Although it is recognised that deprivation is both a cause and a result of poor mental health, policy decisions on service provision for children and young people should not be based solely on IMD or receipt of free school meals. A rapid response is required to address the decline in emotional wellbeing currently observed in younger children of the northwest of England. FundingNone.

Assessment of the association between ambient air pollution and stillbirth in the UK: Results from a secondary analysis of the MiNESS case-control study.

We examined whether the risk of stillbirth was related to ambient air pollution in a UK population. Prospective case-control study. Forty-one maternity units in the UK. Women who had a stillbirth ≥28 weeks' gestation (n = 238) and women with an ongoing pregnancy at the time of interview (n = 597). Secondary analysis of data from the Midlands and North of England Stillbirth case-control study only including participants domiciled within 20 km of fixed air pollution monitoring stations. Pollution exposure was calculated using pollution climate modelling data for NO2 , NOx and PM2.5 . The association between air pollution exposure and stillbirth risk was assessed using multivariable logistic regression adjusting for household income, maternal body mass index (BMI), maternal smoking, Index of Multiple Deprivation quintile and household smoking and parity. Stillbirth. There was no association with whole pregnancy ambient air pollution exposure and stillbirth risk, but there was an association with preconceptual NO2 exposure (adjusted odds ratio [aOR] 1.06, 95% CI 1.01-1.08 per microg/m3 ). Risk of stillbirth was associated with maternal smoking (aOR 2.54, 95% CI 1.38-4.71), nulliparity (aOR 2.16, 95% CI 1.55-3.00), maternal BMI (aOR 1.05, 95% CI 1.01-1.08) and placental abnormalities (aOR 4.07, 95% CI 2.57-6.43). Levels of ambient air pollution exposure during pregnancy in the UK, all of were beneath recommended thresholds, are not associated with an increased risk of stillbirth. Periconceptual exposure to NO2 may be associated with increased risk but further work is required to investigate this association.

Influence of neighborhood-level socioeconomic deprivation and individual socioeconomic position on risk of developing type 2 diabetes in older men: a longitudinal analysis in the British Regional Heart Study cohort

IntroductionEvidence from longitudinal studies on the influence of neighborhood socioeconomic deprivation in older age on the development of type 2 diabetes mellitus (T2DM) is limited. This study investigates the prospective...

Validation of a dynamic method of measuring households and populations from primary care Electronic Health Records: Cross-sectional comparison with Office for National Statistics Census 2021 estimates

ObjectivesWe have developed a dynamic method for identifying household members from Electronic Health Records (EHR). We compared the 2021 Census estimates of household number and demography with similar estimates derived from primary care EHRs on the Census date using primary care EHRs for the population of north east London (NEL).&#x0D; MethodWe included 2,115,017 patients registered with a general practitioner on the 2021 Census date in NEL and assigned households from encrypted Unique Property Reference Numbers. We compared household number and size by Local Authority (LA), Middle Layer Super Output Area (MSOA) and area’s Index of Multiple Deprivation quintiles (IMDq) to Office for National Statistics (ONS) 2021 Census estimates and by LA to ONS Admin Based Housing Stock (ABHS) 2020 estimates. We assessed differences in EHR and Census 2021 populations by sex, age, LA, MSOA and IMDq. Sensitivity analyses will exclude those without a recent recorded clinical encounter.&#x0D; ResultsEHR population estimates (2,115,017) were 116,346 (5.8%) higher than Census estimates (1,998,671), higher among men (9.2%) than women (2.5%) in almost all age groups, especially men aged 30-50 years and higher in the most (8.7%), than in the least (2.5%) deprived IMDq. EHR household estimates (660,789) were 68,047 (9.3%) lower than Census estimates (728,836), and 19,719 (3.1%) higher than ABHS occupied addresses (641,070). EHR household size estimates were 15.6%, 29.2%,12.5% and 8.4% lower for household sizes 1,2 3 and 4, and 13.3%, 42.1%, 82.1% and 195.8% higher for household sizes 5, 6,7 and 8 respectively when compared to Census estimates. EHR population and household estimates were respectively 5-10% higher and 5-11% lower for almost all NEL local authorities.&#x0D; ConclusionEHR- and Census-derived population and household estimates differ, mainly in the prevalence of larger households. While data were extracted on the same date, person-level validation was not possible. Differences may reflect deregistration delay in EHR when changing residence. Analyses based on clinical encounters recency may identify registered patients who are no longer residents.

Colorectal cancer incidence trends by tumour location among adults of screening-age in England: a population-based study.

Proximal and distal colorectal cancers (CRCs) exhibit different clinical, molecular and biological patterns. The aim of this study was to determine temporal trends in the age-standardized incidence rates (ASIRs) of proximal and distal CRC following the introduction of the English Bowel Cancer Screening Programme (BCSP) in 2006. The National Cancer Registration and Analysis Service database was used to identify incident cases of CRC among adults of screening age (60-74 years) between 2001 and 2017. ASIRs were calculated using the European Standard Population 2013 and incidence trends analysed by anatomical subsite (proximal, caecum to descending colon; distal, sigmoid to rectum), sex and Index of Multiple Deprivation (IMD) quintile using Joinpoint regression software. Between 2001 and 2017, 541 515 incident cases of CRC were diagnosed [236 167 proximal (43.6%) and 305 348 distal (56.4%)]. A marginal reduction in the proximal ASIR was noted from 2008 [annual percentage change (APC) -1.4% (95% CI -2.0% to -0.9%)] compared with a greater reduction in distal ASIR from 2011 to 2014 [APC -6.6% (95% CI -11.5% to -1.5%)] which plateaued thereafter [APC -0.5% (95% CI -3.2% to 2.2%)]. Incidence rates decreased more rapidly in men than women. Adults in IMD quintiles 4-5 experienced the greatest reduction in distal tumours [APC -3.5% (95% CI -4.3% to -2.7%)]. Following the introduction of the English BCSP, the incidence of CRC has subsequently reduced among adults of screening age, with this trend being most pronounced in distal tumours and in men. There is also evidence of a reduction in the deprivation gap for distal tumour incidence. Strategies to improve the detection of proximal tumours are warranted.

Non-fatal overdose risk associated with prescribing opioid agonists concurrently with other medication: Cohort study conducted using linked primary care, secondary care and mortality records.

An apparently protective effect of opioid agonist treatment (OAT) on all-cause and cause-specific mortality risk has been widely reported. Non-fatal overdose (NFO) often precedes subsequent drug-poisoning deaths. We hypothesized that benzodiazepines, gabapentinoids, antipsychotics, antidepressants, Z-drugs or opioids increase the NFO risk when co-prescribed with OAT. We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases. The cohort was linked to Hospital Episode Statistics admitted patient care data (HES-APC), neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records from the Office for National Statistics. Primary care in England. We studied patients with opioid use disorder, aged 18-64 years, who were prescribed OAT (15155 methadone and 5743 buprenorphine recipients) between Jan 1, 1998, and Dec 31, 2017. The main outcome examined was NFO risk during co-prescription of OAT with benzodiazepines, antipsychotics, gabapentinoids, antidepressants, Z-drugs or opioids. Overdose was defined according to International Classification of Diseases codes from the HES-APC data set. Negative binomial regression models were used to estimate weighted rate ratios (wRR) for NFO during co-prescription of OAT and benzodiazepines, antipsychotics, gabapentinoids, antidepressants, Z-drugs or opioids with periods of exclusive OAT usage. Among 20 898 patients observed over 83 856 person-years, we found an elevated overdose risk that resulted in hospital admission during co-prescription of OAT with benzodiazepines [wRR: 1.45; 95% confidence interval (CI) = 1.26-1.67], gabapentinoids (wRR = 2.22; 95% CI = 1.77-2.79), Z-drugs (wRR = 1.60; 95% CI = 1.31-1.96), antipsychotics (wRR = 1.85; 95% CI = 1.53-2.25) and opioids (wRR = 1.28; 95% CI = 1.02-1.60). The risk ratio for antidepressant co-prescriptions was below unity (wRR = 0.90; 95% CI = 0.79-1.02) but this result was not statistically significant. Elevated risk of non-fatal overdose among opioid agonist treatment recipients is associated with concurrent use of medication prescribed for other reasons.