Index Of Multiple Deprivation Quintile Research Articles

Persistent variations in national asthma mortality, hospital admissions and prevalence by socioeconomic status and region in England

BackgroundThe UK-wide National Review of Asthma Deaths sought to identify avoidable factors from the high numbers of deaths, but did not examine variation by socioeconomic status (SES) or region.MethodsWe used...

NHS health checks: a cross- sectional observational study on equity of uptake and outcomes

BackgroundThe National Health Checks programme aims to reduce the incidence of cardiovascular diseases and health inequalities in England. We assessed equity of uptake and outcomes from NHS Health Checks in general practices in Bristol, UK.MethodsA cross-sectional study using patient-level data, from 38 general practices. We descriptively analysed the socioeconomic status (SES) of patients invited and the SES and ethnicity of those attending. Logistic regression was used to test associations between invitation and attendance, with population characteristics.ResultsBetween June 2010 to October 2014, 31,881 patients were invited, and 13,733 NHS Health Checks completed. 47% of patients invited from the three least and 39% from the two most-deprived index of multiple deprivation quintiles, completed a Check. Proportions of invited patients, by ethnicity were 64% non-black and Asian and 31% black and Asian. Men were less likely to attend than women (OR 0.73, 95% confidence interval 0.67 to 0.80), as were patients ≤ 49 compared to ≥ 70 years (OR 0.40, 95% confidence interval 0.65 to 0.83).After controlling for SES and population characteristics, compared to patients with low CVD risk, high risk patients were more likely to be prescribed cardiovascular drugs (OR 6.2, 95% confidence interval 4.51 to 8.40). Compared to men, women (OR 01.18, 95% confidence interval 1.03 to 1.35) were more likely to be prescribed cardiovascular drugs, as were those ≤ 49 years (50–59 years, OR 1.42, 95% confidence intervals 1.13–1.79, 60–69 years, OR 1.60, 95% confidence intervals, 1.22–2.10, ≥ 70 years, OR 1.64, 95% confidence intervals, 1.14 to 2.35).Controlling for population characteristics, the following groups were most likely to be referred to lifestyle services: younger women (OR 2.22, 95% CI 1.69 to 2.94), those in the most deprived IMD quintile (OR 3.22, 95% CI 1.63 to 6.36) and those at highest risk of CVD (OR, 2.77, 95% CI 1.91 to 4.02).ConclusionsWe found no statistically significant evidence of inequity in attendance for an NHS Health Check by SES. Being older or a woman were associated with better attendance. Targeting men, younger patients and ethnic minority groups may improve equity in uptake for NHS Health Checks.

Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis

ObjectivesOnline services for self-sampling at home could improve access to STI testing; however, little is known about those using this new modality of care. This study describes the characteristics of...

Cirrhosis with ascites in the last year of life: a nationwide analysis of factors shaping costs, health-care use, and place of death in England

Liver disease mortality increased by 400% in the UK between 1970 and 2010, resulting in rising pressures on acute hospital services, and an increasing need for end-of-life care. We aimed to assess the effect of demographic, clinical, and health-care factors on costs, patterns of health-care use, and place of death in a national cohort of patients with cirrhosis and ascites in their last year of life. We did a retrospective, nationwide analysis of all patients who died from cirrhosis in England between 2013 and 2015, who required large-volume paracentesis in their last year of life. The outcomes measured were health-care costs accrued in the last year of life, number of inpatient days in last year of life, 30-day readmission rate, and occurrence of unplanned hospital death (probability of dying in hospital after unplanned admission). Using generalised linear and logistic regression models, we examined the effect of 12 independent variables on each outcome: sex, ethnicity, age at death, index of multiple deprivation quintile, year of death, liver disease causing death, place of death, time from index presentation in last year of life to death, whether enrolled in a day-case paracentesis service (care group), paracentesis ratio (number of day-case large-volume paracentesis procedures as a proportion of the total number of procedures in the last year of life), number of hospital episodes in the last year of life (not involving large-volume paracentesis), and number of large-volume paracentesis procedures in the last year of life. Between Jan 1, 2013, and Dec 31, 2015, 13 818 people in England died from liver disease and had large-volume paracentesis within their last year of life. For all patients, mean cost of the last year of life was £21 113 (SD 16 881), 17 888 (52·5%) of 34 068 readmissions occurred within 30 days of discharge, and 10 341 (74·8%) of 13 818 deaths occurred in hospital, of which 10 045 (97·1%) followed an emergency hospital admission. Patients who attended a day-case large-volume paracentesis service within their last year of life had significant reductions in cost (-£4240, 95% CI -4829 to -3651; p<0·0001), number of inpatient bed days (-16·98 days, -18·45 to -15·51; p<0·0001), probability of early readmission (odds ratio [OR] 0·35, 95% CI 0·31 to 0·40; p<0·0001), and probability of dying in hospital after unplanned admission (0·31, 0·27 to 0·34; p<0·0001), compared with patients who had unplanned care. For patients enrolled in day-case services, improvements in outcomes correlated with the proportion of large-volume paracentesis procedures done in a day-case (vs unplanned) setting. The use of day-case large-volume paracentesis services in the last year of life was associated with lower costs, reduced pressure on acute hospital services, and a lower probability of dying in hospital, compared with patients who received exclusively unplanned care in their last year of life. Wider adoption of day-case models of care could reduce costs and improve outcomes in the last year of life. David Telling Charitable Trust.

Association between area-based deprivation and change in body-mass index over time in primary schoolchildren: a population-based cohort study in Hampshire, UK

BackgroundChildhood obesity is a serious health challenge. Cross-sectional evidence indicates that the burden of obesity impacts most on more deprived children, yet longitudinal research is lacking. We aimed to assess the association of home-based and school-based deprivation indices with change in childhood body-mass index (BMI) z-score and BMI status over 6 years. MethodsThis cohort study linked the National Child Measurement Programme data for Hampshire children from age 4–5 years (2007–08 to 2009–10) to 10–11 years. The dataset was analysed in two groups: 18 733 children for whom home deprivation quintiles, according to the Index of Multiple Deprivation (IMD), remained constant, and 6153 children who moved home to more deprived quintiles over time. The associations between IMD quintiles and change in BMI z-score and status, defined using the British 1990 growth reference, were analysed with multiple linear regression and multinomial logistic regression, respectively, and adjusted for age, sex, ethnicity, and school Ofsted status. Ethics approval was granted by the University of Southampton. Findings11 924 children (63·7%) remained a healthy weight, 585 (3·1%) remained overweight, 990 (5·3%) remained obese, 1560 (8·3%) became overweight, and 1921 (10·3%) became obese. Children living in the most deprived quintile increased their BMI z-score by 0·13 units more than those in the least deprived quintile (95% CI 0·08–0·19). There was no significant difference for school-based quintiles. Children attending school in the most deprived quintile were significantly more likely to remain obese (relative risk 1·93, 95% CI 1·53–2·44) and become obese (1·90, 1·55–2·32). Home-based deprivation quintiles displayed stronger associations with change in BMI status than did school-based quintiles (relative risk for remaining obese 2·23, 95% CI 1·78–2·79; becoming overweight 1·36, 1·16–1·60; and becoming obese 2·42, 2·08–2·81). Moving home to a more deprived quintile was only associated with becoming obese (1·22, 1·04–1·43). InterpretationIn Hampshire, UK, home-based deprivation level is more strongly associated with negative change in childhood adiposity than school-based deprivation level. Although schools provide ample opportunities to deliver interventions, focus should not be lost on the obesogenic home environment. This study used robust measures, and a large sample size was analysed. However, consideration of familial influences of obesity is paramount. Further research of the obesogenic environment is required, combining individual and area-based measures. FundingMSc Public Health funded by Health Education England Wessex. The funding source had no role in writing the abstract or in the decision to submit it for publication.

Socioeconomic deprivation and inequalities in asthma care in Wales

BackgroundArea-based deprivation indices are widely used to study health inequalities. We explored whether inequality exists for asthma care across socioeconomic deprivation levels in Wales. MethodsUsing the Wales-wide Secure Anonymised Information Linkage databank, we accessed anonymised data on patients with a general practitioner (GP) diagnosis of asthma in or before 2009 and continuous GP registration between 2009 and 2014, and linked these data to the 2011 Welsh Index of Multiple Deprivation quintiles. The primary outcome variables were numbers of asthma-related GP visits, annual reviews, emergency department visits, and hospital admissions between 2010 and 2014. Statistical analysis included zero-inflated negative binomial regression adjusted for age and sex. No ethics approval was needed for use of anonymised data. FindingsWe analysed data from 209 887 patients with asthma. Over 5 years, there were 8·2% more asthma-related GP visits per patient in the most deprived areas than in the least deprived areas (4·0 vs 3·7; incidence rate ratio 1·082, 95% CI 1·071–1·094), 3·7% more asthma annual reviews (2·35 vs 2·26; 1·037, 1·026–1·049), 31·1% more asthma emergency department visits (0·021 vs 0·016; 1·311, 1·151–1·494), and 123·3% more asthma inpatient admissions (0·074 vs 0·033; 2·233, 1·983–2·515) (all p<0·0001). InterpretationHigher health-care utilisation in the most deprived group indicates worse asthma control. Despite an 8·2% excess of primary care contacts in this group, outcomes are poorer in terms of much higher emergency department visits and hospital admissions. Disease severity, quality of primary care, self-management, or wider non-health-care-related determinants may be contributing factors, indicating further potential to reduce inequality in the impact of disease. FundingHealth and Care Research Wales, Abertawe Bro Morgannwg University Health Board, Asthma UK Centre for Applied Research (AUK-AC-2012-01), Farr Institute of Health Informatics Research (CIPHER MR/K006525/1, Scotland MR/K007017/1).

Risk factors for childhood obesity: a data analysis of the Welsh Health Survey.

Background The prevalence of childhood obesity in Wales is 12%. It has been estimated that obesity will cost the NHS £10 billion a year by 2050 ( Government Office for Science 2007 ). Aim To determine important risk factors associated with childhood obesity from the data in the Welsh Health Survey 2008 to 2012. Method The analysis used survey data from 11,279 children aged 4-15 years. The lifestyle variables considered as potential risk factors for obesity included: intake of sugar-sweetened drinks; unhealthy food consumption; physical activity; and currently-treated illnesses. The sociodemographic and socioeconomic factors included: sex; age; Welsh Index of Multiple Deprivation quintile; National Statistics Socio-economic Classification; and housing tenure. Results A total of 1,582 (20%) children were obese. A significant association was found between obesity and having one illness - odds ratio (OR) 1.20 (95% confidence interval (CI): 1.05 to 1.38, P=0.008) and having two or more illnesses - OR 1.50 (95% CI: 1.22 to 1.85, P<0.001), and not meeting the physical activity recommendation - OR 1.33 (95% CI: 1.17 to 1.52, P<0.001). Conclusion Every child should meet the physical activity recommendation and those with an illness should receive a care plan to prevent or manage obesity, although this is difficult in the time available for children in clinics and consultations.

Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001-2013: a Clinical Practice Research Datalink study.

ObjectiveTrends in recorded diagnoses of chronic fatigue syndrome (CFS, also known as ‘myalgic encephalomyelitis’ (ME)) and fibromyalgia (FM) in the UK were last reported more than ten years ago, for the period 1990–2001. Our aim was to analyse trends in incident diagnoses of CFS/ME and FM for the period 2001–2013, and to investigate whether incidence might vary by index of multiple deprivation (IMD) score.DesignElectronic health records cohort study.SettingNHS primary care practices in the UK.ParticipantsParticipants: Patients registered with general practices linked to the Clinical Practice Research Datalink (CPRD) primary care database from January 2001 to December 2013.Main outcome measureIncidence of CFS/ME, FM, post-viral fatigue syndrome (PVFS), and asthenia/debility.ResultsThe overall annual incidence of recorded cases of CFS/ME was 14.8 (95% CI 14.5, 15.1) per 100,000 people. Overall annual incidence per 100,000 people for FM was 33.3 (32.8–33.8), for PVFS 12.2 (11.9, 12.5), and for asthenia/debility 7.0 (6.8, 7.2). Annual incidence rates for CFS/ME diagnoses decreased from 17.5 (16.1, 18.9) in 2001 to 12.6 (11.5, 13.8) in 2013 (annual percent change −2.8% (−3.6%, −2.0%)). Annual incidence rates for FM diagnoses decreased from 32.3 (30.4, 34.3) to 27.1 (25.5, 28.6) in 2007, then increased to 38.2 (36.3, 40.1) per 100,000 people in 2013. Overall annual incidence of recorded fatigue symptoms was 2246 (2242, 2250) per 100,000 people. Compared with the least deprived IMD quintile, incidence of CFS/ME in the most deprived quintile was 39% lower (incidence rate ratio (IRR) 0.61 (0.50, 0.75)), whereas rates of FM were 40% higher (IRR 1.40 (0.95, 2.06)).ConclusionThese analyses suggest a gradual decline in recorded diagnoses of CFS/ME since 2001, and an increase in diagnoses of fibromyalgia, with opposing socioeconomic patterns of lower rates of CFS/ME diagnoses in the poorest areas compared with higher rates of FM diagnoses.

Sociodemographic predictors of variation in coverage of the national shingles vaccination programme in England, 2014/15

IntroductionIn September 2013, England introduced a shingles vaccination programme to reduce incidence and severity of shingles in the elderly. This study aims to assess variation in vaccine coverage with regards to selected sociodemographic factors to inform activities for improving equity of the programme. MethodsEligible 70year-olds were identified from a national vaccine coverage dataset in 2014/15 that includes 95% of GPs in England. NHS England Local Team (LT) and index of multiple deprivation (IMD) scores were assigned to patients based on GP-postcode. Vaccine coverage (%) with 95% confidence intervals (CIs), were calculated overall and by LT, ethnicity and IMD, using binomial regression. ResultsOf 502,058 eligible adults, 178,808 (35.6%) had ethnicity recorded. Crude vaccine coverage was 59.5% (95%CI: 59.3–59.7). Coverage was lowest in London (49.6% coverage, 95%CI: 49.0–50.2), and compared to this coverage was significantly higher in all other LTs (+6.3 to +10.4, p<0.001) after adjusting for ethnicity and IMD. Coverage decreased with increasing deprivation and was 8.2% lower in the most deprived (95%CI: 7.3–9.1) compared with the least deprived IMD quintile (64.1% coverage, 95%CI: 63.6–64.6), after adjustment for ethnicity and LT. Compared with White-British (60.7% coverage, 95%CI: 60.5–61.0), other ethnic groups had between 4.0% (Indian) and 21.8% (Mixed: White and Black African) lower coverage. After adjusting for IMD and LT, significantly lower coverage by ethnicity persisted in all groups, except in Mixed: Other, Indian and Bangladeshi compared with White-British. ConclusionsAfter taking geography and deprivation into account, shingles vaccine coverage varied by ethnicity. White-British, Indian and Bangladeshi groups had highest coverage; Mixed: White and Black African, and Black-other ethnicities had the lowest. Patients' ethnicity and IMD are predictors of coverage which contribute to, but do not wholly account for, geographical variation coverage. Interventions to address service-related, sociodemographic and ethnic inequalities in shingles vaccine coverage are required.

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

BackgroundBowel cancer screening reduces cancer-specific mortality. There is a socioeconomic gradient in the uptake of the English NHS Bowel Cancer Screening Programme (BCSP), which may lead to inequalities in cancer outcomes.ObjectiveTo reduce socioeconomic inequalities in uptake of the NHS BCSP’s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group.DesignWorkstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘gist’ information, (2) a ‘narrative’ leaflet, (3) ‘general practice endorsement’ (GPE) and (4) an ‘enhanced reminder’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention.MethodsInterventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘usual care’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘gist’ leaflet (n = 163,525), (2) ‘narrative’ leaflet (n = 150,417), (3) GPE on the invitation letter (n = 265,434) and (4) ER (n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual’s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘definitive’ test result of either ‘normal’ (i.e. no further investigation required) or ‘abnormal’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome.ResultsThe gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; allp-values &gt; 0.05). GPE showed no effect on the gradient (p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10;p &lt; 0.0001]. ER showed a significant interaction with SECs (p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20;p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06;p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11;p = 0.001). All interventions were inexpensive to provide.LimitationsIn line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect.ConclusionsEnhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results highlight the challenge of achieving equitable delivery of the screening offer when all communication is written; the format is universal and informed decision-making mandates extensive medical information.Future workSocioculturally tailored research to promote communication about screening with family and friends should be developed and evaluated.Trial registrationCurrent Controlled Trials ISRCTN74121020.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information.

Patterns of referral and waiting times for specialist Child and Adolescent Mental Health Services.

During 12-month period (2012/13) around 21,480 children and young people (CYP) were referred to Child and Adolescent Mental Health Service (CAMHS) in Scotland (NHS Scotland, 2013, Child and Adolescent Mental Health Services waiting times in Scotland). At the end of September 2012, there were 3,602 CYP still waiting for 'start of treatment' or 'removal from the waiting list', 375 (10%) CYP had waited over 26weeks and 1,204 (33%) CYP had waited over 18weeks (NHS Scotland, 2013, Child and Adolescent Mental Health Services waiting times in Scotland). Referral source, referral reason and the sociodemographic characteristics of CYP are not routinely collected, and therefore, associations between these factors and wait times for 'start of treatment' or 'removal from the waiting list' (i.e. the referral outcome) are unknown. In this exploratory study, a retrospective analysis of referral data was conducted in one CAMHS. Data for 476 referrals between 1st May 2013 and 31st May 2014 were initially analysed to define categories for each of the following key variables: referral source, referral reason and referral outcome. Data on CYP sociodemographic characteristics were extracted from referral records, including age, gender and postcode, from which Scottish Index of Multiple Deprivation quintile of residence was derived. Descriptive statistics were calculated for referral source, referral reason and CYP sociodemographic characteristics. Regression models were then built to determine predictors of a referral being rejected by CAMHS and waiting time for referrals accepted by CAMHS. Data were analysed in SPSS (Version 20). Of the 476 referrals, 72% (n=342) were accepted and 12% (n=59) were rejected. Most referrals were made by general practitioners. Just under a third of referrals to CAMHS (31%) were for CYP with emotional and behavioural difficulties. The odds of being rejected by CAMHS were significantly higher if referred by teachers and for CYP with emotional and behavioural difficulties. Age and referral reason were significant independent predictors of waiting time after referral to CAMHS, with CYP referred for hyperactivity/inattention waiting significantly longer. Policymakers should consider ways to foster dialogue and collaboration between different groups of professionals making and accepting referrals to CAMHS in order to improve timely access to appropriate mental health support services for CYP. Research is urgently needed to investigate the experiences of CYP who are either rejected by CAMHS or wait lengthy periods of time before starting their treatment with CAMHS.

Access to chlamydia testing in remote and rural Scotland

The aim of this study was to assess access to sexual health care in remote and rural settings using <i>Chlamydia</i> testing as a focus by measuring the extent of Chlamydia testing and positivity across the Scottish Highlands in relation to the Scottish Index of Multiple Deprivation Quintile (SIMD) and Urban Rural 8-fold index (UR8). Tests processed through Raigmore Hospital in Inverness, the main testing laboratory for microbiology tests in North and West and South and Mid Highlands, were studied. Where people are tested in relation to where they live was assessed, as well as the type of test they opt for. Also assessed was the rate of positivity in male and female patients in rural compared with urban settings using the Scottish Government UR8 and in relation to the SIMD. 9644 results were analysed. 77.2% of the results were for females and 22.4% for males. 8.1% of the results were positive and 84.4% were negative. There were proportionately more positive tests from the sexual health sources than from general practice. The proportion of men who had positive tests was almost double that for women (12.7% vs 6.6%) although men made up only 27.9% of the total number of tests. There was no significant difference in positivity when compared with UR8 index or SIMD. 37.7% of people living in the most rural areas (UR8 7-8) had their test performed in a more urban setting (UR8 1-6), and 20.4% people had their test performed in a very urban setting (UR8 1-2). Of these tests, there was a tendency for UR8 7-8 patients to be more likely to have a positive test if tested in an urban setting. These results are similar to previous results in other countries that suggest that Chlamydia positivity is similar in rural and urban settings. A large proportion of people living in more rurally classified areas, and perhaps those with a higher risk, have their test in a central setting, suggesting that they may be bypassing local resources to get a test. The reason for this is not clear. The results also show that men are more likely to have their test in a genitourinary setting as well as have proportionately more positive results. These results support the case for customising sexual health services to the most rural areas and suggest that providing an anonymous testing service in these areas might be beneficial, especially for men.

Future trends and inequalities in premature coronary deaths in England: Modelling study

BackgroundCoronary heart disease (CHD) is a major cause of premature mortality, particularly in deprived groups. Might recent declines in overall mortality obscure different rates of decline among social strata, creating potentially misleading views on inequalities? MethodsWe used a Bayesian analysis of an age–period–cohort model for the English population. We projected age-specific premature CHD mortality (ages 35–74) by gender and area-based deprivation status for the period 2007–2035, using 1982–2006 as the input. Deprivation status was measured by Index of Multiple Deprivation quintiles, which aggregate seven types of deprivation, including health and income.We analysed inequality in premature CHD mortality. We investigated the annual changes in inequality and the contributions of changes in each IMDQ to the overall annual changes, using both absolute (probability) and relative (logit) scales. We quantified inequality using the statistical variance in the probability of premature death among deprivation quintiles. ResultsThe overall premature CHD mortality trends conceal marked heterogeneities. Our models predict more rapid declines in premature CHD mortality for the most affluent quintiles than for the most deprived (annualized rate of decline 2006–2025, 7.5% [95% Credible Interval 4.3–10.5%] versus 5.4% [2.2–8.7%] for men, and 6.3% [3.0–9.9%] versus 5.9% [1.5–10.8%] for women). For men, the posterior probability that the rate of decline is greater for the most affluent was 82%.Variance in premature CHD mortality across deprivation quintiles was projected to decrease by approximately 81% [28–95%] among men and by 89% [30–99%] among women. This decrease was particularly driven by the most deprived groups due to their higher premature death rates. However, relative inequality was projected to rise by 93% among men [81–125%] and rise by 13% [−25–58%] among women. These increases are also mostly influenced by the most deprived, reflecting their slower declines in premature deaths. ConclusionsOverall, premature coronary death rates in England continue to decline steeply. Absolute inequalities are decreasing, reflecting declines in the high premature mortality in deprived groups. However, relative inequalities are projected to widen further, reflecting slower mortality declines in the most deprived groups. More aggressive and progressive prevention policies are urgently needed.

Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity

ObjectivesPotential strategies to address alcohol misuse remain contentious. We aim to characterise the drink purchases of one population group: heavy drinkers in contact with Scottish health services. We contrast our findings with national sales data and explore the impact of socio-economic status on purchasing behaviour. Study designCross-sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012. Methods639 patients with serious health problems linked to alcohol (recruited within NHS hospital clinics (in- and out-patient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last week's or a ‘typical’ weekly consumption (type, brand, volume, price, place of purchase). Scottish Index of Multiple Deprivation quintile was derived as proxy of sociodemographic status. ResultsMedian consumption was 184.8 (IQR = 162.2) UK units/week paying a mean of 39.7 pence per alcohol unit (£0.397). Off-sales accounted for 95% of purchases with 85% of those <50 pence (£0.5 UK) per alcohol unit. Corresponding figures for the Scottish population are 69% and 60%. The most popular low-priced drinks were white cider, beer and vodka with the most common off-sales outlet being the corner shop, despite supermarkets offering cheaper options. Consumption levels of the cheapest drink (white cider) were similar across all quintiles apart from the least deprived. ConclusionsHeavy drinkers from all quintiles purchase the majority of their drinks from off-sale settings seeking the cheapest drinks, often favouring local suppliers. While beer was popular, recent legislation impacting on the sale of multibuys may prevent the heaviest drinkers benefiting from the lower beer prices available in supermarkets. Non-etheless, drinkers were able to offset higher unit prices with cheaper drink types and maintain high levels of consumption. Whilst price is key, heavy drinkers are influenced by other factors and adapt their purchasing as necessary.

The influence of neighbourhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men

BackgroundEvidence from longitudinal studies on the influence of neighbourhood socioeconomic factors in older age on cardiovascular disease (CVD) mortality is limited. We aimed to investigate the prospective association of neighbourhood-level...

Exploring equity in uptake of the NHS Health Check and a nested physical activity intervention trial.

BackgroundSocio-demographic factors characterizing disadvantage may influence uptake of preventative health interventions such as the NHS Health Check and research trials informing their content.MethodsA cross-sectional study examining socio-demographic characteristics of participants and non-participants to the NHS Health Check and a nested trial of very brief physical activity interventions within this context. Age, gender, Index of Multiple Deprivation (IMD) and ethnicity were extracted from patient records of four General Practices (GP) in England.ResultsIn multivariate analyses controlling for GP surgery, the odds of participation in the Health Check were higher for older patients (OR 1.05, 95% CI 1.04–1.07) and lower from areas of greater deprivation (IMD Quintiles 4 versus 1, OR 0.37, 95% CI 0.18–0.76, 5 versus 1 OR 0.42, 95% CI 0.20–0.88). Older patients were more likely to participate in the physical activity trial (OR 1.04, 95% CI 1.02–1.06).ConclusionsYounger patients and those living in areas of greater deprivation may be at risk of non-participation in the NHS Health Check, while younger age also predicted non-participation in a nested research trial. The role that GP-surgery-specific factors play in influencing participation across different socio-demographic groups requires further exploration.

Abstract P079: Disparities in Heart Failure in Older Age: Do Individual or Neighbourhood Measures of Deprivation Affect Incidence Over a 10-Year Follow-up?

Background: Few studies have examined the prospective associations between socioeconomic measures and incident heart failure, and in particular effects of neighbourhood deprivation. The aim of this study was to investigate the association of socioeconomic measures (individual and neighbourhood-level) with incident heart failure in older adults and to examine possible underlying pathways. Methods: A socially and geographically representative cohort of men aged 60-79 years in 1998-2000 from 24 British towns was followed for 10 years for incident heart failure (fatal and non-fatal based on death certificates and doctor-diagnosis). Individual-level socioeconomic measures included longest-held occupational social class, education, pension (state only or state with private), and amenities (car and house ownership, access to central heating) - a cumulative score of adverse socioeconomic measures from 0 to ≥4 was used. Index of multiple deprivation (IMD) was the small area-level socioeconomic measure (based on income, employment, health, housing, education, access to services and crime) grouped into quintiles of increasing deprivation. Prevalent myocardial infarctions and heart failures were excluded.Results: Among 3839 men, 232 incident cases of heart failure occurred over 10 years. Heart failure risk increased with increasing cumulative score of adverse (individual-level) socioeconomic measures (p for trend=0.0006). Compared to men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.19 (95%CI 1.34-3.55) which weakened to 1.99 (95%CI 1.16-3.45), but remained significant after adjusting for neighbourhood deprivation (IMD), systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor and plasma vitamin C slightly weakened the hazard ratio to 1.78 (95%CI 1.01-3.13). Hazard ratio per IMD quintile (neighbourhood deprivation) was 1.04 (95%CI 0.95-1.14). Conclusions: Disparities in heart failure in older populations need to be addressed - the risk of heart failure in older age was greater in the lowest socioeconomic groups, which was only partly explained by established and novel risk factors for heart failure. This increased risk of heart failure according to individual-level socioeconomic measures was independent of neighbourhood-level deprivation. Neighbourhood level deprivation does not in itself appear to influence risk of heart failure.

Long-term outcomes of isolated stable radial head fractures.

There is evidence to support primary nonoperative management of isolated stable fractures of the radial head, although minimal data exist regarding long-term outcomes. The aim of this study was to report subjective long-term outcomes of isolated stable fractures of the radial head and neck following primary nonoperative management. From a prospective database of proximal radial fractures, we identified all skeletally mature patients who sustained an isolated stable Mason type-1 or type-2 fracture of the radial head or neck during an eighteen-month period. Inclusion criteria were a confirmed isolated stable fracture of the proximal aspect of the radius, primarily managed nonoperatively. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. The study cohort comprised 100 patients with a mean age of forty-six years (range, seventeen to seventy-nine years). A fall from a standing height accounted for 69% of all injuries. Thirty-five percent of the patients had one or more comorbidities. There were fifty-seven Mason type-1 fractures and forty-three Mason type-2 fractures. At a mean of ten years post injury (range, 8.8 to 10.2 years), the mean DASH score was 5.8 (range, 0 to 67.2) and the mean Oxford Elbow Score (OES) was 46 (range, 14 to 48). Fourteen (14%) of the patients reported stiffness and twenty-four (24%) reported some degree of pain. A worse DASH score was associated with older age (p = 0.002), one or more comorbidities (p = 0.008), increasing socioeconomic deprivation by Index of Multiple Deprivation quintile (p = 0.026), increasing amount of fracture displacement (p = 0.041), and involvement in compensation proceedings (p = 0.006). Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. We suggest that routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients in our study requiring further intervention for persisting complaints. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Variations in statin prescribing for primary cardiovascular disease prevention: cross-sectional analysis.

BackgroundStatins are an important intervention for primary and secondary cardiovascular disease (CVD) prevention. We aimed to establish the variation in primary preventive treatment for CVD with statins in the English population.MethodsCross sectional analyses of 6155 English primary care practices with 40,017,963 patients in 2006/7. Linear regression was used to model prescribing rates of statins for primary CVD prevention as a function of IMD (index of multiple deprivation) quintile, proportion of population from an ethnic minority, and age over 65 years. Defined Daily Doses (DDD) were used to calculate the numbers of patients receiving a statin. Statin prescriptions were allocated to primary and secondary prevention based on the prevalence of CVD and stroke.ResultsWe estimated that 10.5% (s.d.3.7%) of the registered population were dispensed a statin for any indication and that 6.3% (s.d. 3.0%) received a statin for primary CVD prevention. The regression model explained 21.2% of the variation in estimates of prescribing for primary prevention. Practices with higher prevalence of hypertension (β co-efficient 0.299 p <0.001) and diabetes (β co-efficient 0.566 p < 0.001) prescribed more statins for primary prevention. Practices with higher levels of ethnicity (β co-efficient-0.026 p <0.001), greater deprivation (β co-efficient −0.152 p < 0.001) older patients (β co-efficient −0.032 p 0.002), larger lists (β co-efficient −0.085, p < 0.001) and were more rural (β co-efficient −0.121, p0.026) prescribed fewer statins. In a small proportion of practices (0.5%) estimated prescribing rates for statins were so low that insufficient prescriptions were issued to meet the predicted secondary prevention requirements of their registered population.ConclusionsAbsolute estimated prescribing rates for primary prevention of CVD were 6.3% of the population. There was evidence of social inequalities in statin prescribing for primary prevention. These findings support the recent introduction of a financial incentive for primary prevention of CVD in England.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-414) contains supplementary material, which is available to authorized users.

Experiences, utilisation and outcomes of maternity care in England among women from different socio-economic groups: findings from the 2010 National Maternity Survey.

The objective of this analysis was to explore the healthcare-seeking behaviours and experiences of maternity care among women from different socio-economic groups in order to improve understanding of why socially disadvantaged women have poorer maternal health outcomes in the UK. Secondary analysis of a national survey of women conducted 3 months after they had given birth. England. A total of 5332 women. Logistic regression analysis to investigate differences in outcomes among different socio-economic groups, classified by the Index of Multiple Deprivation (IMD). Healthcare-seeking behaviours, outcomes and experiences of maternity care. With each increase in IMD quintile (decrease in socio-economic position), women were shown to be 25% (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.63-0.90) less likely to have had any antenatal care and 15% (aOR 0.85; 95% CI 0.80-0.90) less likely to have had a routine postnatal check-up. They were 4% (aOR 1.04; 95% CI 0.99-1.10) more likely to have had an antenatal hospital admission, 7% (aOR 1.07; 95% CI 0.99-1.16) more likely to have been transferred during labour and 4% (aOR 1.04; 95% CI 0.99-1.09) more likely to have had a caesarean birth, although these results were not statistically significant. With decreasing socio-economic position women were more likely to report that they were not treated respectfully or spoken to in a way they could understand by doctors and midwives. This analysis suggests the need for a focusing of professionals and services towards pregnant women from lower socio-economic groups and more targeted maternal public health education towards socially disadvantaged women.