Index Of Multiple Deprivation Research Articles

Holistic approach to assess the association between the synergistic effect of physical activity, exposure to greenspace, and fruits and vegetable intake on health and wellbeing: Cross-sectional analysis of UK Biobank.

BackgroundUrban agriculture has been shown to contribute to healthy lifestyle behaviors, such as increased fruit and vegetable intake and greater exposure to greenspaces and there is plenty of evidence linking these lifestyle behaviors to better health and wellbeing. However, most evidence relates to assessing one behavior at a time despite available epidemiological research showing how the combined effects of multiple behaviors are associated with health and wellbeing. This research aims to examine the association of the interactions between various lifestyle behaviors and exposures related to urban agriculture and health and wellbeing.MethodsWe used data from the UK Biobank baseline questionnaire (N~500, 000) to assess the association of two lifestyle behaviors (fruit and vegetable intake and physical activity) and greenspace exposure, with four health and wellbeing markers (blood pressure, BMI, self-health assessment, and self-reported loneliness) independently, and in combination. Associations between lifestyle behaviors, greenspace exposure, and the possible interactions with health and wellbeing were explored using general linear models (GLMs), adjusted for socio-demographic confounders including age, sex, educational qualifications, index of multiple deprivation, and ethnicity, and a lifestyle confounder: smoking status.ResultsAfter removing missing data, as well as participants who did not meet the inclusion criteria, the final study sample was n = 204,478. The results indicate that meeting recommended levels of the World Health Organization (WHO) for fruits and vegetable intake, and the advice from the UK Chief Medical Officer for physical activity, is linked to better health and wellbeing markers. We found that UK Biobank participants who lived in greener areas and were physically active were more likely to feel alone and think their health was poor. Participants who were physically active and met the recommended intake of fruits and vegetables were more likely to have healthy blood pressure, feel less lonely, and rate their health as good. Evidence of three-way interactions was weak, and mostly was not associated with the health and wellbeing markers assessed here.ConclusionTaken in combination, healthy diets, physical activity and exposure to greenspaces are associated with health and wellbeing. In some cases, these effects are synergistic, indicating associations above and beyond the mere additive effect of the behaviors considered independently. Promoting such behaviors together, for example, through urban agriculture, is therefore more likely to generate greater public health changes than if they are promoted through independent policies and programs. Inter-relationships between these pathways and different health and wellbeing markers, however, are complex, and require further investigation to understand optimal environments and conditions for urban health promotion.

Prenatal health behaviours as predictors of human placental lactogen levels.

Placental lactogen (hPL) is a key hormone of pregnancy responsible for inducing maternal adaptations critical for a successful pregnancy. Low levels of placental lactogen have been associated with lower birth weight as well as symptoms of maternal depression and anxiety. Lower placental lactogen has been reported in women with higher body mass index (BMI) but it is unclear whether prenatal health behaviours predict hPL levels or if hPL is associated with infant weight outcomes. This study utilised data from the longitudinal Grown in Wales cohort, based in South Wales. Participants were recruited at the pre-surgical appointment for an elective caesarean section. This study incorporates data from recruitment, post-delivery and a 12 month follow-up. Measures of maternal serum hPL were available for 248 participants. Analysis included unadjusted and adjusted linear and binary regression. Unadjusted, prenatal smoking and a Health Conscious dietary pattern were associated with hPL levels, however this was lost on adjustment for BMI at booking, Welsh Index of Multiple Deprivation (WIMD) score and placental weight. When stratified by maternal BMI at booking, a Health Conscious dietary pattern remained associated with increased hPL levels in women with a healthy BMI (p=.024, B=.59. 95% CI=.08,1.11) following adjustment for WIMD score and placental weight. When adjusted for a wide range of confounders, maternal hPL was also associated with increased custom birthweight centiles (CBWC) (p=.014, B=1.64. 95% CI=.33,2.94) and increased odds of large for gestational age deliveries (p=<.001, Exp(B)=1.42. 95% CI=1.17,1.72). This study identified that consuming a Health Conscious dietary pattern in pregnancy was associated with increased hPL, within women of a healthy BMI. Moreover, higher hPL levels were associated with increased CBWC and increased odds of delivering a large for gestational age infant. This improves the current limited evidence surrounding the nature of hPL in these areas.

Catastrophic health spending among older adults in India: Role of multiple deprivation

BackgroundPrevious studies have assessed catastrophic health spending (CHS) is high among households with older member, but no studies have examined its association with multiple deprivation. The purpose of this study is to compare the incidence and determinants of CHS between multiple deprived and non-deprived households in India. MethodsData for this paper was obtained from the 75th round of the National Sample Survey (NSS), a cross-sectional household survey conducted in 2017-18. The multiple deprivation index was estimated using Alkire and Foster method while CHS was estimated using the capacity to pay approach. Logistic regression analysis was used to identify the determinants of CHS in both types of households. ResultsThe study found 43% of households with an older member were deprived in multiple dimensions. We found the incidence of CHS was 19% among households with an older adults; 22% among multiple deprived and 16% among the multiple non-deprived older adult households. Regression analysis result suggest that the odds ratio of incurring CHS was 1.84 (p < 0.001) for the deprived older adult households than that of non-deprived households. Apart from multiple deprivation, any member being hospitalized or any member suffering from chronic diseases significantly associated with CHS in both type of households. ConclusionThis study established the higher financial catastrophes among the deprived older adult households. Therefore, there is an utmost need for the government and policymakers to focus on multiple aspects of geriatric wellbeing at one hand and improving financial mechanisms to reduce the CHS at other hand.

Socioeconomic deprivation status predicts both the incidence and nature of Achilles tendon rupture.

The aim of this study was to describe the epidemiology of Achilles tendon rupture (ATR) and its relationship with socioeconomic deprivation status (SEDS). The hypothesis was that ATR occurs more frequently in socioeconomically deprived patients. Secondary aims were to determine variations in circumstances of injury between more and less deprived patients. A 6-year retrospective review of consecutive patients presenting with ATR was undertaken. The health-board population was defined using governmental population data and SEDS was defined using the Scottish Index of Multiple Deprivation. The primary outcome was an epidemiological description and comparison of incidence in more and less deprived cohorts. Secondary outcomes included reporting of the relationship between SEDS and patient and injury characteristics with univariate and binary logistic regression analyses. There were 783 patients (567 male; 216 female) with ATR. Mean incidence for adults (≥ 18years) was 18.75/100,000 per year (range 16.56-23.57) and for all ages was 15.26/100,000 per year (range 13.51 to 19.07). Incidence in the least deprived population quintiles (4th and 5th quintiles; 18.07 per 100,000/year) was higher than that in the most deprived quintiles (1st and 2nd; 11.32/100,000 per year; OR 1.60, 95%CI 1.35-1.89; p < 0.001). When adjusting for confounding factors, least deprived patients were more likely to be > 50years old (OR 1.97; 95%CI 1.24-3.12; p = 0.004), to sustain ATR playing sports (OR 1.72, 95%CI 1.11-2.67; p = 0.02) and in the spring (OR 1.65, 95%CI 1.01-2.70; p = 0.045) and to give a history of preceding tendinitis (OR 4.04, 95%CI 1.49-10.95; p = 0.006). They were less likely to sustain low-energy injuries (OR 0.44, 95%CI 0.23-0.87; p = 0.02) and to be obese (OR 0.25-0.41, 95%CI 0.07-0.90; p ≤ 0.03). The incidence of ATR was higher in less socioeconomically deprived populations and the hypothesis was therefore rejected. Significant variations in patient and predisposing factors, mechanisms of injury and seasonality were demonstrated between most and least deprived groups, suggesting that circumstances and nature of ATR may vary with SEDS and these are not a homogenous group of injuries. Prognostic Study Level III.

An investigation of factors affecting changes in health behaviours during the COVID-19 pandemic in a UK population–based cohort study

ObjectivesThe COVID-19 pandemic has led to changes in behaviours, which may have different health effects in population subgroups. We investigated whether within-individual changes in health behaviours from before to during the pandemic differ by socio-economic deprivation, age or sex. Study designProspective cohort study. MethodsParticipants were recruited from the existing UK Fenland cohort study with measurements of health behaviours twice prepandemic (2005 to February 2020) and three times during the pandemic (July 2020 to April 2021). Health behaviours included daily servings of fruit and vegetables, units of alcohol consumed per week, smoking status, sleep duration and total and domain-specific physical activity energy expenditure. Sociodemographic information (English indices of multiple deprivation, education, occupation and ethnicity) and COVID-19 antibody status were also collected. Participants were grouped into three categories based on their English indices of multiple deprivation score: most, middle and least deprived. ResultsParticipants were included if they had completed at least one measurement during the pandemic and one prepandemic (n = 3212). Fruit and vegetable consumption, total physical activity energy expenditure and smoking prevalence decreased during the pandemic compared with prepandemic, whereas average sleep duration increased and alcohol consumption did not change. Decreases in fruit and vegetable intake and physical activity energy expenditure were most pronounced in the most deprived group compared with the least deprived group and were greater in women than men. ConclusionsSocio-economic inequalities in health behaviours have worsened during the pandemic. As the country emerges from the COVID-19 pandemic, strategies to reduce health inequalities need to be put at the forefront of recovery plans.

Differential attainment, socioeconomic factors and surgical training.

Differential attainment (DA) is the gap in levels of achievement between different groups; socioeconomic factors are thought to play a significant role in DA. The aim of this study was to review and assess the evidence for DA in early surgical training and to examine the potential influence of socioeconomic status. Data were obtained from the General Medical Council GMC for those taking Membership of the Royal College of Surgeons (MRCS) examinations between 2016 and 2019 and core surgical training annual review of competency progression (ARCP) outcomes between 2017 and 2019. The index of multiple deprivation (IMD) was used as a measure of socioeconomic background. Trainees were then divided into deprivation quintiles (DQ1=most deprived, DQ5=least deprived). MRCS and ARCP outcomes were compared between DQ groups using 95% confidence intervals and chi-square tests. Those from lower socioeconomic backgrounds had significantly lower overall MRCS pass rates (DQ1=45.5%, DQ2=48.9% vs DQ4=59.6%, DQ5=61.5%, p<0.05) and 1st time pass rates (DQ1&2=46.6% vs DQ4&5=63.5%, p<0.001). Additionally, they had a significantly higher number of attempts required to pass MRCS (DQ 1&2=1.86 vs DQ 4&5=1.54, p<0.01). Those from lower socioeconomic backgrounds had a significantly greater proportion of unsatisfactory ARCP outcomes (DQ1&2=24.4% vs DQ 4&5=14.2%, p<0.05). There is clear evidence of the influence of socioeconomic background on DA in early surgical training. However, the reasons for this are likely complex and more work is required to investigate this relationship.

EP01.06-006 Impact of Low Dose CT Screening on Cause of Death in Different Socio-Economic Groups

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 in cancer screening. The UKLS low-dose-CT (LD-CT) screening trial for lung cancer was consistent with a lung cancer mortality benefit for CT screening [Field, et al. (2021) Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis. Lancet Regional Health Europe, doi.org/10.1016/j.lanepe.2021.100179].

600P Ethnic and socio-economic status in ovarian cancer patients recruited to clinical trials

Ethnicity and deprivation affect cancer outcomes. We sought to determine whether the ovarian cancer (OC) trial population was representative of the general OC population in terms of ethnicity and socio-economic status (SES), across two London tertiary cancer centres. All OC patients treated between 2017 and 2022 were included. Any patients participating in a clinical trial during this period were included in the trial population (TP) and the remainder classified as the non-trial population (NTP). Demographic and treatment data were collected from electronic patient records. Ethnicity was classified using NHS coding, based on the UK 2021 Census. The UK Indices of Multiple Deprivation (IMD) was calculated based upon postcode, grouped into quintiles. Pearson’s chi-square test was used to evaluate differences between TP and NTP. 215 TP and 680 NTP were included. In the TP; 88, 104 and 23 entered phase II, phase III or observational trials, respectively. 11 (5.1%) TP were non-English speaking. There was a statistically significant difference in SES (p=0.0260) and ethnicity (p<0.0001) between TP and NTP cohorts (Table).Table: 600PTP (n=215; %)NTP (n=680; %)P valueSocio-Economic Status: Indices of Multiple Deprivation (Quintiles)Q1 Most Deprived30 (13.9)107 (15.7)P = 0.0260Q250 (23.3)234 (34.4)Q351 (23.7)128 (18.8)Q435 (16.3)106 (15.6)Q5 Least Deprived43 (20.0)104 (15.3)Unclassified6 (2.8)1 (0.2)EthnicityAsian or Asian British14 (6.5)86 (12.6)P <0.0001Black (African, Black British, Black Caribbean, Black Other)11 (5.1)65 (9.6)Other ethnic group11 (5.1)53 (7.8)Mixed/Multiple Ethnic Groups8 (3.7)7 (1.0)White (British, Irish, Other)157 (73.0)381 (56.0)Unclassified14 (6.5)88 (12.9)The odds ratio for clinical trial enrolment was 0.69 (95% confidence interval (CI): 0.50 - 0.94; p=0.018) and 0.51 (95% CI: 0.35 - 0.74; p=0.003) for those more vs less deprived and in non-white vs white patients, respectively. Open table in a new tab The odds ratio for clinical trial enrolment was 0.69 (95% confidence interval (CI): 0.50 - 0.94; p=0.018) and 0.51 (95% CI: 0.35 - 0.74; p=0.003) for those more vs less deprived and in non-white vs white patients, respectively. Patients with higher levels of deprivation and non-white ethnicity were under-represented in clinical trials at our centres, which may worsen health disparities. Further research is required to understand the systematic, clinician-focused and patient-focused barriers to trial recruitment in such groups.

Temporal trends in comorbidity in adult elective hip and knee arthroplasty patients in England : a national population-based cohort study from the National Joint Registry.

Our main aim was to describe the trend in the comorbidities of patients undergoing elective total hip arthroplasties (THAs) and knee arthroplasties (KAs) between 1 January 2005 and 31 December 2018 in England. We combined data from the National Joint Registry (NJR) on primary elective hip and knee arthroplasties performed between 2005 and 2018 with pre-existing conditions recorded at the time of their primary operation from Hospital Episodes Statistics. We described the temporal trend in the number of comorbidities identified using the Charlson Comorbidity Index, and how this varied by age, sex, American Society of Anesthesiologists (ASA) grade, index of multiple deprivation, and type of KA. We included 696,504 and 833,745 elective primary THAs and KAs respectively, performed for any indication. Between 2005 and 2018, the proportion of elective THA and KA patients with one or more comorbidity at the time of their operation increased substantially (THA: 20% to 38%, KA: 22% to 41%). This was driven by increases in four conditions: chronic obstructive pulmonary disease (COPD) (2018: ~17%), diabetes without complications (2018: THA 10%, KA 14%), myocardial infarction (2018: 4%), and renal disease (2018: ~8%). Notably, renal disease prevalence increased from < 1% in 2005 to ~8% in 2018. Between 2005 and 2018 there were significant changes in the number of comorbidities recorded in patients having elective primary THAs and KAs. Renal disease is now one of the most prevalent comorbidities in this patient population. Future research should explore whether this comorbidity trend has increased the burden on other medical specialities to optimize these patients before surgery and to provide additional postoperative care.Cite this article: Bone Joint J2022;104-B(9):1052-1059.

Socio-economic disparities in patients who present to hospital for self-harm: patients' characteristics and problems in the Multicentre Study of Self-harm in England

BackgroundWe examined disparities in sociodemographic and clinical characteristics and in problems preceding self-harm across levels of socio-economic deprivation (SED) in persons who presented to hospital for self-harm. Method108,092 presentations to hospitals (by 57,306 individuals) following self-harm in the Multicentre Study of Self-harm in England (1/1/2000–31/12/2016). Information on area-level SED was based on the English Index of Multiple Deprivation. Information about patients' characteristics and problems was obtained from self-harm monitoring systems in the hospitals. We assessed the association of SED with the characteristics of interest using descriptive statistics. ResultsOverall, 45 % of the presentations were by individuals from areas ranked nationally as most deprived, while 13 % of episodes were by individuals from the least deprived areas. Males and non-white ethnic groups were over-represented in the most deprived SED stratum. Previous self-harm was more prevalent in the two most deprived groups. Relationships difficulties with partners and other family members were reported more commonly by individuals from less socio-economically deprived areas, as were problems pertaining to finances and employment or studies. Problems in relationships with friends were more prevalent in the most deprived group relative to other groups. LimitationsInformation about problems which preceded self-harm was available only for patients who received psychosocial assessment. ConclusionsPatients vary considerably across area-level SED strata in terms of gender, ethnicity, and the problems which preceded their self-harm. These findings emphasise the need to use an individualised approach to patients in understanding the unique circumstances which contribute to their self-harm and their specific care needs.

Investigating the impact on mental wellbeing of an increase in pensions: A longitudinal analysis by area-level deprivation in England, 1998–2002

In 1997 approximately two million people aged 60 years or over were living poverty in the UK. In 1999 the UK Government raised real pension incomes of low-income pensioners by around a third through the introduction of the Minimum Income Guarantee (MIG). This study explores the implications of this change for pensioners’ mental wellbeing with a focus on differences by area level deprivation in England. We explore mental wellbeing outcomes of 205 men (750 person-year observations) and 367 women (1,336 person-year observations) of state pension age from scores on the General Health Questionnaire from the British Household Panel Survey using a panel difference-in-difference estimation procedure. We compare the mental wellbeing of pensioners receiving MIG to that of low-income pensioners not claiming MIG, from 1998 to 2002. To investigate differences by area deprivation we use quintiles of the of the distributions of the 2000 and 2019 local-authority-level English Index of Multiple Deprivation. Models controlled for age, marital status and year. Between 1998 and 2002, 136 (38%) of low-income women and 57 (28%) of low-income men in the sample were claiming MIG at any one time. Income increased by 31% for men and 22% for women. There was no change in mental wellbeing for women but we found an improvement for men overall and for men living in the most deprived areas, in the latter case with a decrease of the GHQ-12 score of 2.43 points (95% CI: −5.49, 0.02). This estimate was similar across all measures of deprivation, and across both years of IMD. This study provides tentative evidence that the increase in pension income in England for low-income pensioners contributed to a reduction of inequalities in mental wellbeing for men. This needs to be considered in terms of future state pension policies.

P03-04 Perceived and objective indicators of neighbourhood safety and physical activity in early adolescence: a national cohort study

BackgroundThe health benefits of regular physical activity in adolescence are well-documented. Currently, young people in the UK are not achieving recommended levels of physical activity. The neighbourhood environment is a key setting for physical activity in adolescence. Due to lack of financial independence and mobility restrictions, adolescents spend a significant amount of time in their neighbourhood. Feeling unsafe in their neighbourhood may be a potential barrier to physical activity.This study aims to examine associations between objective and subjective measures of neighbourhood safety and physical activity.MethodsParticipants (n = 11,726) came from the Millennium Cohort Study; a nationally representative UK longitudinal birth cohort. At age 11 perceived neighbourhood safety was assessed via questionnaire and the Index of Multiple Deprivation (IMD) crime domain was linked to participant postcode data. At age 14, participants self-reported physical activity and a subsample (n = 4,813) also wore GENEActiv wrist-worn activity monitors for one weekday and one weekend day. Associations between perceived safety, IMD crime and self-reported physical activity were quantified using linear regression models. Zero Inflated Poisson (ZIP) models were used to examine associations with accelerometer-measured physical activity. We adjusted for parental education, family income, ethnicity and season of accelerometer wear. An interaction term for sex was tested to assess whether associations between perceived safety and physical activity differed by sex. Models were also stratified by sex.ResultsFeeling not safe compared to very safe was associated with 0.28 (95% CI -0.50, -0.06) fewer days of self-reported physical activity. However, no association was seen between perceived safety and accelerometer physical activity. Those living in the highest IMD crime areas reported on average 0.31 (95% CI -0.47, -0.15) fewer days of physical activity compared to those living in the lowest crime areas. Individuals living in the highest IMD crime areas achieved 5.56 fewer minutes of daily accelerometer-measured exercise than those in least crime areas.ConclusionsThis study demonstrates consistent associations between perceived safety and objective crime with physical activity levels in adolescence.

Linkage of historical GB Census data to present day population registers.

ObjectivesThis research links, for the first time, individual level entire GB population census data for 1851-1911 to present day individual level population registers. Precise georeferencing of individual records using AddressBase Premium and further linkage to Indices of Multiple Deprivation (IMDs) enables family group analysis of inter-generational social mobility outcomes. ApproachPresent-day individual names and addresses taken from Electoral Registers and consumer data are georeferenced and linked to IMD data using AddressBase. This enables calculation of average IMD scores for every family group (surname). Individual level names and addresses from 1851-1911 censuses are assigned to harmonised historical parishes. The present day surname IMD scores are attributed to every resident in the historical censuses. Parish average ‘future IMD’ scores are calculated to show which areas have bequeathed the highest and lowest IMD scores on their residents’ descendants. This is a measure of how ‘north – south divides’ shape inter-generational social mobility. ResultsA linked data website, apps.cdrc.ac.uk/gbnames, profiles social mobility outcomes for 13,000+ family names, according to average neighbourhood quality experienced by family name bearers. There are clear and enduring regional divides in “future deprivation” inherited from ancestors by the present-day GB population. The research traces the origins of a north-south divide in England. Family roots in northern industrial cities are associated with unfavourable outcomes today. In Scotland, an east-west divide identifies eastern areas sharing similarly high levels of hardship to nineteenth-century industrial cities such as Liverpool and Manchester. Migration partially mitigates these inequalities, but most family groups remain concentrated in their ancestral heartlands, and continue to experience the long-term disadvantages bestowed by geographical location. ConclusionSurnames provide an under-exploited way of linking precisely georeferenced geographies of entire historical populations to their descendants today. Additional linkage to areal deprivation measures makes it possible to evaluate how social and spatial inequalities both endure and are promulgated through the generations. Geography is destiny for much of the population.

Are children who do not receive their first Measles Mumps and Rubella (MMR1) vaccination by 24 months more likely to share a household with older non-vaccinated children? Linked household-level analysis of primary care electronic health records (EHRs).

ObjectivesOnly 89.4% of UK children receive MMR1 by age 24 months. We investigated whether children not receiving MMR1 by this age were more likely to share a household with children also not vaccinated by this age, and its variation by sex, ethnic background and area-level deprivation.&#x0D; ApproachWe identified 208,907 children born between 2013-2019 and eligible for MMR1 from the primary care EHRs of 1,192,630 children registered to a general practitioner in North East London between 2001-2021. We estimated the proportion of children and 95% Confidence Interval (CI) receiving MMR1 between 12 and 24 months of age. We calculated prevalence ratios (PR) by sex, ethnicity, and deprivation (Index of Multiple Deprivation (IMD) quintiles). We identified all children with the same pseudonymised Unique Property Reference Numbers (pUPRNs) at the MMR1 date. We are completing analyses to calculate mutually adjusted PRs and examine household-level associations in timeliness of MMR1.&#x0D; ResultsOverall, 172,319 (82.5%) of 208,907 eligible children received an MMR1 between age 12-24 months. Non-receipt of MMR1 by 24 months was less likely in children from South Asian ethnic backgrounds (PR 0.74; 95% CI: 0.68,0.79), and more likely in those from Black ethnic backgrounds (1.43;1.31,1.56) and in those living in the most deprived IMD quintile (1.83;1.49,2.23). We identified 137,919 children with the same pUPRNs at the MMR1 date, comprising 69,892 boys (50.7%) and 41,846 (30.3%), 32,631 (23.7%), 10,793 (7.8%), 12,246 (8.9%) and 40,403 (29.3) from White, South Asian, Black, Mixed/Other and Missing ethnic backgrounds respectively. We are calculating adjusted PRs and will estimate associations between non-receipt of MMR1 in the youngest and oldest children within a household.&#x0D; ConclusionOur findings suggest that non-receipt of MMR1 by 24 months is ethnically patterned and more likely in areas of higher deprivation. Household-level analyses provide actionable insights into the characteristics of measles-susceptible households and opportunities for data-enabled primary care interventions to reduce vaccination inequalities and prevent measles outbreaks.

Who lives in overcrowded households in north-east London? Cross-sectional study of linked electronic health records and Energy Performance Certificate register data.

ObjectivesHousehold overcrowding is associated with adverse health outcomes, including increased risk of infectious diseases, mental health problems, and poor educational attainment. We investigated inequalities in overcrowding in an urban, ethnically diverse, and disadvantaged London population by pseudonymously linking electronic health records (EHR) to Energy Performance Certificates (EPC) data. ApproachWe used pseudonymised Unique Property Reference Numbers to link EHRs for 1,066,156 currently registered patients from 321,318 households in north-east London to EPC data. We measured household occupancy and derived the bedroom standard overcrowding definition (number of rooms relative to occupants’ sex and ages) to estimate overcrowding prevalence. We examined associations with: household composition (adults only, single adult+children, ≥2 working-age adults+children, ≥1 retirement-age adults+children, three-generational household); ethnic background (White, South Asian, Black, Mixed, Other, missing); and Index of Multiple Deprivation (IMD) quintile. We used multivariable logistic regression to estimate the adjusted odds (aOR) and 95% Confidence Intervals (CI) of overcrowding. ResultsOverall, 243,793 (22.9%) people were overcrowded. People living in households with children, or three-generational households were more likely (aOR [95% CI] 3.79 [3.74 - 3.84]; 6.53 [6.41 - 6.66] respectively), and single adults or retirement age adults with children less likely (0.36 [0.35 - 0.38]; 0.36 [0.23 - 0.57] respectively), to be overcrowded. Overcrowding was more likely among people from Asian or Black ethnic backgrounds (1.24 [1.22 - 1.25] and 1.17 [1.15 - 1.19] respectively). There was a dose-response relationship between IMD quintile and overcrowding: OR 0.20 [0.20 - 0.21] in the least deprived compared to most deprived quintile. ConclusionOne in five people in north-east London live in overcrowded households with marked inequalities by ethnicity, household generational composition, and deprivation. Up-to-date estimates of household overcrowding can be derived from linked housing and health records and used to evaluate the impact of economic policies on health and housing inequalities.

Palliative care, unpaid care and deprivation in Scotland: a study using census and vital registration data.

ApproachThe analysis was based on a linkage of the Scottish 2011 census and death registration records where deaths had occurred within 12 months of the decennial census. Areal deprivation used the Scottish Index of Multiple Deprivation, a widely used indicator that uses administrative data to rank areas by degree of deprivation. Palliative care needs were assessed using a validated approach that utilizes ICD10 codes from death registrations. Availability of unpaid care was assessed using place of residence at point of census and indication of other people resident in the same household.&#x0D; ResultsThere were 52,553 death records of which 46,473 were for people aged 18 years or older at census and had matched census records. Deaths with palliative care needs were highest in the least deprived areas, though proportions were high regardless of deprivation ranging from 81.2% of deaths in the least deprived to quintile to 76.0% in the most deprived. Given the higher number of deaths in the most deprived areas, numbers of deaths were spread evenly across quintiles. In contrast, people approaching the end of life at point of census were more likely to live alone if resident in the most deprived quintile at point of census (40.8% vs 26.5%).&#x0D; ConclusionPalliative care needs are high regardless of levels of deprivation. However, it may be that those residing in more deprived areas not only have fewer financial resources to cope but also have lower recourse to support within the household.

Evaluation of the real-world implementation of the Family Nurse Partnership in England: an observational cohort study using linked data from health, education and children’s social care.

ObjectivesThe Family Nurse Partnership (FNP) is an early home visiting service supporting young mothers. A randomised controlled trial of FNP in England found no effect on short-term primary outcomes or maltreatment up to age seven, but positive impacts on educational outcomes by age 7. We report preliminary results of an evaluation of FNP using linked administrative data. ApproachWe constructed a cohort of all mothers aged 13-19 and their firstborn child(ren) giving birth between 2010 and 2017, using linked administrative data from hospital admissions (Hospital Episode Statistics) and education and social care (National Pupil Database). We evaluated differences in a range of policy relevant child and maternal outcomes, comparing mothers who were enrolled in FNP with those who were not using propensity score matching. ResultsOf 110,960 mothers in our linked cohort, 26,290 (24%) were enrolled in FNP. FNP mothers were younger, more deprived, and more likely to have adversity or social care histories than mothers not enrolled. Preliminary results suggest that FNP was not associated with fewer unplanned hospital admissions for injury / maltreatment by age two, improved child development at age 4, persistent school absence or children looked after in out-of-home care by age 7, or improved maternal outcomes. Some adverse outcomes appeared to be increased in the FNP group. We will present findings amongst subgroups of younger maternal age (13-15 years), increased deprivation according to quintile of Index of Multiple Deprivation, and adversity and social care history. We also present sensitivity analyses that aim to minimise confounding. ConclusionOur study supports findings from previous trials of FNP showing little benefit for measured child and maternal outcomes. Interpretation of results needs careful consideration of the impact of residual confounding due to unmeasured or undisclosed factors (e.g. family violence) linked to targeting of FNP to higher risk mothers, and surveillance bias.

Differences in end-of-life health service usage between people who died at home before and during the pandemic in Scotland.

ObjectivesTo compare health service usage of people who died at home in Scotland during the Covid-19 pandemic to the population who died at home prior to the pandemic, as a proxy measure of end-of-life care availability during the pandemic. ApproachRetrospective observational study of linked routine data: death registrations of all adults who died aged 18+ in Scotland during 12-month pandemic period (2020-03-23 to 2021-03-22) and pre-pandemic period (5 years prior), linked to inpatient acute hospital, psychiatric, and cancer registration records, and unscheduled care records (NHS24, A&amp;E, ambulance, and Out-of-hours GP records). Service usage will be summarised for pandemic and pre-pandemic cohorts. ResultsDeaths at home increased by about 35% during the first year of the pandemic in Scotland. Health service usage before and during the pandemic will be compared, in particular, length of stay in hospital in the last year of life, to test the hypothesis that patients were discharged earlier to ease pressures on hospitals. Geographical differences in length of hospital stay will be presented in terms of NHS health boards, Urban-rural status and Scottish Index of Multiple Deprivation (SIMD). ConclusionStudying the effects of the pandemic on end-of-life care has important implications for policy and future pandemic preparedness. These preliminary results are an early step towards understanding the effects of the pandemic and motivate further linkage of social care data as soon as they are made available.

164 The Relationship Between Patient Reported Outcome Measures (PROMs) in Patients Undergoing Hip and Knee Joint Replacement Surgery and Social Deprivation on the Wirral

Abstract Aim This study investigated differences in patient reported outcome measures (PROMs) pre- and post-operatively and socio-economic deprivation in patients on the Wirral. The Wirral is an area s with a diverse socioeconomic spectrum but served by the same Musculoskeletal department. Method This was a retrospective cohort study of 1594 adult patients who underwent a hip or knee replacement between 2012–2019. Socioeconomic deprivation was quantified using the Index of multiple deprivation (IMD) Outcomes pre- and post-operatively (Q1 and Q2) were recorded using the Oxford Hip and Knee scores. Results The mean Q1 and Q2 score for each IMD decile was found to have a strong positive correlation with PROM score across both hip and knee replacements for both genders. The mean difference between Q1/Q2 score was not strongly correlated with IMD decile. Patients from areas of higher socioeconomic deprivation have lower PROMs pre- and post-operatively. Conclusions The Oxford Hip and Knee scores are widely used for assessing health status. The treating unit does not specify a score that triggers discussion regarding arthroplasty but undertakes a holistic assessment. This study supports this approach as it would appear scores are influenced by IMD decile. NHS Digital publishes PROMs scores using change in PROM score pre- and post-operation rather than absolute PROMs scores; this study supports this as both the pre- and post-operative scores appeared to be strongly correlated to IMD decile but change/improvement in score was poorly correlated and therefore is less influenced by catchment area deprivation.

776 Patient Outcomes Vary with Surgeons’ Experience Following Emergency Laparotomy: An Observational Study

Abstract Aim There is some evidence that patient outcomes for surgeons improve with years of experience. We aimed to investigate the relationship between surgeon experience and patient outcomes following an emergency laparotomy in a large sample of the UK National Emergency Laparotomy Audit (NELA) database. Method A 5-year retrospective observational study was undertaken using data extracted from NELA for patients who underwent emergency laparotomies at a large UK multi-site NHS Trust. The association between 30-day mortality and surgeon years of experience was investigated using logistic regression, adjusted for ASA grade, patient age and gender, Index of Multiple Deprivation (IMD) score, and time of surgery. Results There were 3153 patients with a median age of 66 (IQR 51–76), and 49.4% were male. Patients in the group who died within 30 days were more likely to be older, have a higher ASA score, and have an operation during the night. Increasing years of surgeon experience, patient age, and ASA were all significantly associated with increased odds ratio of death within 30-days. Conclusions Increasing years of surgical experience appears to be related to worse patient outcomes for an emergency laparotomy. This is likely due to surgeons taking on more complex and challenging cases as their career progresses. Further explorations of how surgeons’ activity changes over their full career are warranted.