Index Of Multiple Deprivation Score Research Articles

Impact of frailty in older people on health care demand: simulation modelling of population dynamics to inform service planning.

As populations age, frailty and the associated demand for health care increase. Evidence needed to inform planning and commissioning of services for older people living with frailty is scarce. Accurate information on incidence and prevalence of different levels of frailty and the consequences for health outcomes, service use and costs at population level is needed. To explore the incidence, prevalence, progression and impact of frailty within an ageing general practice population and model the dynamics of frailty-related healthcare demand, outcomes and costs, to inform the development of guidelines and tools to facilitate commissioning and service development. A retrospective observational study with statistical modelling to inform simulation (system dynamics) modelling using routine data from primary and secondary health care in England and Wales. Modelling was informed by stakeholder engagement events conducted in Hampshire, England. Data sources included the Royal College of General Practitioners Research and Surveillance Centre databank, and the Secure Anonymised Information Linkage Databank. Population prevalence, incidence and progression of frailty within an ageing cohort were estimated using the electronic Frailty Index tool, and associated service use and costs were calculated. Association of frailty with outcomes, service use and costs was explored with multistate and generalised linear models. Results informed development of a prototype system dynamics simulation model, exploring population impact of frailty and future scenarios over a 10-year time frame. Simulation model population projections were externally validated against retrospective data from Secure Anonymised Information Linkage. The Royal College of General Practitioners Research and Surveillance Centre sample comprised an open cohort of the primary care population aged 50 + between 2006 and 2017 (approx. 2.1 million people). Data were linked to Hospital Episode Statistics data and Office for National Statistics death data. A comparable validation data set from Secure Anonymised Information Linkage was generated. Electronic Frailty Index score calculated annually and stratified into Fit, Mild, Moderate and Severe frailty categories. Other variables included age, sex, Index of Multiple Deprivation score, ethnicity and Urban/rural. Frailty transitions, mortality, hospitalisations, emergency department attendances, general practitioner visits and costs. Frailty is already present in people aged 50-64. Frailty incidence was 47 cases per 1000 person-years. Frailty prevalence increased from 26.5% (2006) to 38.9% (2017). Older age, higher deprivation, female sex, Asian ethnicity and urban location independently predict frailty onset and progression; 4.8% of 'fit' people aged 50-64 years experienced a transition to a higher frailty state in a year, compared to 21.4% aged 75-84. Individual healthcare use rises with frailty severity, but Mild and Moderate frailty groups have higher overall costs due to larger population numbers. Simulation projections indicate frailty will increase by 7.1%, from 41.5% to 48.7% between 2017 and 2027, and associated costs will rise by £5.8 billion (in England) over an 11-year period. Simulation modelling indicates that frailty prevalence and associated service use and costs will continue to rise in the future. Scenario analysis indicates reduction of incidence and slowing of progression, particularly before the age of 65, has potential to substantially reduce future service use and costs, but reducing unplanned admissions in frail older people has a more modest impact. Study outputs will be collated into a commissioning toolkit, comprising guidance on drivers of frailty-related demand and simulation model outputs. This study is registered as NCT04139278 www.clinicaltrials.gov. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/116/43) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 44. See the NIHR Funding and Awards website for further award information.

Socioeconomic inequalities, genetic susceptibility, and risks of depression and anxiety: A large-observational study

ObjectivesThis study aimed to investigate the interplay between genetic susceptibility and socioeconomic disparities on psychiatric disorders. MethodsIn this study, we utilized data from the UK Biobank to analyze the Generalized Anxiety Disorder (GAD)-7 scale (N = 74,425) and the Patient Health Questionnaire (PHQ)-9 (N = 74,101), along with the Index of Multiple Deprivation (IMD). The polygenic risk score (PRS) was calculated to assess the genetic risk associated with GAD-7/PHQ-9 scores, and the individuals were classified into low, medium, and high genetic risk groups according to tertiles of PRSs related to the GAD-7/PHQ-9. Linear regression models were used to explore the relationships between GAD-7/PHQ-9 scores and IMD scores in patients with different genetic susceptibilities. ResultsDisadvantaged socioeconomic status was associated with the risk of anxiety and depression across all strata of genetic risk, and stronger associations were shown for individuals with greater genetic susceptibility. From low to high genetic risk, the risk of psychiatric disorders increased for the GAD-7 (β = 0.002 to 0.032) and PHQ-9 (β = 0.003 to 0.045) scores. In addition, strong associations of high genetic risk with anxiety (β = 0.875) and depression (β = 1.152) were detected in the IMD quartile 4 group compared with the least deprivation quartile group. Furthermore, income and employment were estimated to contribute strongly to anxiety (βemployment = 7.331, βincome = 4.492) and depression (βemployment = 9.951, βincome = 6.453) in the high genetic risk group. ConclusionThe results suggest that we should pay more attention to psychiatric disorders with high genetic susceptibility and try to improve their socioeconomic status to prevent the development of psychiatric disorders.

Adjusting primary-care funding by deprivation: a cross-sectional study of lower-super-output-areas in England.

Previous research has called for General Practice (GP) funding to be adjusted by deprivation data. However, there is no evidence that this would better meet clinical need. We assessed 1. how accurately the capitation formula (Carr Hill), and total GP funding predicts clinical need and 2. whether adjusting by the Index of Multiple Deprivation score (IMD), improves accuracy. Cross-sectional analysis of 32 844 Lower-Super-Output-Areas in England in 2021-2022. Sensitivity analysis used data from 2015-2019. Weighted average Carr-Hill Index (CHI), total GP funding and five measures of clinical need were calculated for each LSOA. For both CHI and total funding, four sets of generalised linear models were calculated for each outcome measure: unadjusted; Age-adjusted; IMD-adjusted; and age and IMD adjusted. Adjusted R2 assessed model accuracy. In unadjusted models, CHI was a better predictor than total-funding of Combined Morbidity Index (CMI) (R2=49.81%,29.31% respectively), combined diagnosed and undiagnosed morbidity (R2=43.52%,21.9%), emergency admissions (R2=32.75%,16.95%). Total-funding was a better predictor than capitation of GP appointments per patient (R2=28.5%, 22.5% respectively) and age and sex standardised mortality rates (R2=0.42%,0.37%).. Adjusting for age and IMD improved all ten models (R2=62.2%,53.2%,48.6%,38.5%,40.5%, 32.8%, 29.1%,34.6%, 25.2%,25.2% respectively). All age and IMD adjusted models significantly outperformed age-adjusted models (p<0.001). Sensitivity analysis confirmed findings. Adjusting capitation or total-funding by IMD would increase funding efficiency, especially for long term outcomes, such as mortality. However, adjusting for IMD without age could have unwanted consequences.

Availability of Alcohol on an Online Third-Party Delivery Platform Across London Boroughs, England: Exploratory Cross-Sectional Study.

Higher availability of alcohol is associated with higher levels of alcohol consumption and harm. Alcohol is increasingly accessible online, with rapid delivery often offered by a third-party driver. Remote delivery and online availability are important from a public health perspective, but to date, relatively little research has explored the availability of alcohol offered by online platforms. This cross-sectional exploratory study describes the availability of alcohol on the third-party platform Deliveroo within London, England. We extracted the number of outlets offering alcohol on Deliveroo for each London borough and converted these into crude rates per 1000 population (18-64 years). Outlets were grouped as outlets exclusively selling alcohol, off-licenses, and premium. We calculated Pearson correlation coefficients to explore the association between borough's crude rate of outlets per 1000 population and average Indices of Multiple Deprivation (IMD) 2019 scores. We extracted the number of outlets also selling tobacco or e-cigarettes and used non-Deliveroo drivers. We searched addresses of the top 20 outlets delivering to the most boroughs by outlet type (60 total) to determine their associated premise. We identified 4277 total Deliveroo-based outlets offering alcohol across London, including outlets delivering in multiple boroughs. The crude rate of outlets per 1000 population aged 18-64 years was 0.73 and ranged from 0.22 to 2.29 per borough. Most outlets exclusively sold alcohol (3086/4277, 72.2%), followed by off-licenses (770/4277, 18.0%) and premium (421/4277, 9.8%). The majority of outlets exclusively selling alcohol sold tobacco or e-cigarettes (2951/3086, 95.6%) as did off-licenses to a lesser extent (588/770, 76.4%). Most outlets exclusively offering alcohol used drivers not employed by Deliveroo (2887/3086, 93.6%), and the inverse was true for premium outlets (50/421, 11.9%) and off-licenses (73/770, 9.5%). There were 1049 unique outlets, of which 396 (37.8%) were exclusively offering alcohol-these outlets tended to deliver across multiple boroughs unlike off-licenses and premium outlets. Of outlets with confirmed addresses, self-storage units were listed as the associated premise for 85% (17/20) of outlets exclusively offering alcohol, 11% (2/19) of off-licenses, and 12% (2/17) of premium outlets. We found no significant relationship between borough IMD scores and crude rate of outlets per 1000 population overall (P=.87) or by any outlet type: exclusively alcohol (P=.41), off-license (P=.58), and premium (P=.18). London-based Deliveroo outlets offering alcohol are common and are sometimes operating from self-storage units that have policies prohibiting alcohol storage. This and the potential for increased alcohol accessibility online have implications for public health given the relationship between alcohol's availability and consumption or harm. There is a need to ensure that regulations for delivery are adequate for protecting children and vulnerable adults. The Licensing Act 2003 may require modernization in the digital age. Future research must explore a relationship between online alcohol availability and deprivation.

The inequity of education, health and care plan provision for children and young people with intellectual and developmental disabilities.

Children and young people (CYP) with intellectual and developmental disabilities (IDDs) have significant additional educational needs compared with the general population. In England, the government has established a system of education, health and care plans (EHCPs) to support children with special educational needs and disabilities, but disparities exist between the degree of need and the availability of support. We conducted a prospective UK national cohort study (IMAGINE) of children with rare pathogenic genomic variants, all of which are associated with IDD, to investigate associated neuropsychiatric risk. Subsequently, we obtained information from the UK's National Pupil Database on their educational progress through the state school system. We aimed to identify whether they had received EHCP provision and whether that support was associated with their family's socioeconomic status, region of domicile, ethnicity, sex, primary special educational needs (SEN) type, academic performance and mental health well-being. We recruited 2738 CYP from England into the IMAGINE study between 2014 and 2019. The educational histories of the participants (6-28years old, mean±standard deviation= 14±4years, 56% male) were obtained from the Department for Education's National Pupil Database in 2021. Educational data included attainment scores from the Early Year Foundation Stage (<5years) to key stage 4 (15-16years). Each family was assigned an index of multiple deprivation (IMD) score based on their home address postcode. Parents or carers rated their child's emotional and behavioural adjustment on the Strengths and Difficulties Questionnaire (SDQ). The association between receiving an EHCP and the child's IMD score, eligibility for free school meals, English region of domicile, ethnicity, sex, primary SEN type, academic attainment and SDQ score was investigated. In this cohort, 78% of participants had received an EHCP. CYP living in the most deprived IMD deciles were substantially less likely to receive EHCP support than those in the least deprived decile, irrespective of their degree of intellectual developmental disability, academic performance or associated mental health problems. There were no sex differences. Children of Asian heritage were more likely to have been granted an EHCP than White children from equivalent IMD deciles. There were striking regional disparities. Participants living in London were significantly more likely to have been awarded an EHCP than participants living anywhere else in England, regardless of their IMD decile; those in the least deprived decile had almost 100% EHCP provision. This study found evidence for nationwide regional inconsistencies in the awarding of EHCP to CYP with significant intellectual impairments of known genetic aetiology. Disparities in funds available to education authorities could be a contributory factor. EHCP support was potentially influenced by how strongly a parent advocates for their child.

Education to improve timeliness of shingles diagnosis in primary care: a cluster randomised study within a trial with nested qualitative study.

Herpes zoster (shingles) is normally diagnosed clinically. Timely diagnosis is important so that antiviral treatment can be started soon after rash onset. To assess whether a practice-level educational intervention, aimed at non-clinical patient-facing staff, improves the timely assessment of patients with shingles. This was a cluster randomised study within a trial (SWAT) with nested qualitative study in general practices in England. Practices were cluster randomised 1:1, stratified by centre and minimised by practice list size and Index of Multiple Deprivation score. Intervention practices were sent educational materials, highlighting the common presenting features of shingles and what action to take if suspected. The primary and secondary outcomes were the mean proportion of patients per practice seen within 72 and 144 h of rash onset, respectively. Comparison between groups was conducted using linear regression, adjusting for randomisation variables. Semi-structured interviews with practice staff in intervention practices explored views and opinions about the intervention. In total, 67 practices were enrolled; 34 randomised to the intervention and 33 to the control. The mean difference in proportion of patients seen within 72 and 144 h was -0.132 (95% confidence interval [CI] = -0.308 to 0.043) and -0.039 (95% CI = -0.158 to 0.080), respectively. In intervention practices, 90.9% reported distributing the educational materials; however, engagement with these was suboptimal. Twelve participants were interviewed, and the poster component of the intervention was said to be easiest to implement. Our educational intervention did not improve the timely assessment of patients with shingles. This may be the result of poor intervention engagement.

Descriptive study of COVID-19 vaccinations and infections within an NHS workforce.

Healthcare workers were a priority group for coronavirus disease 2019 (COVID-19) vaccination during the pandemic. Occupational exposure may account for some of the increased risk faced. Describe COVID-19 vaccine uptake and infection rates in staff across a large NHS board in Scotland to better understand occupational risk during the pandemic. Descriptive cross-sectional study. Demographic data were extracted on 5 August 2021 from 26 058 members of staff. COVID-19 vaccination status and positive polymerase chain reaction (PCR) results were extracted on two separate dates to describe the timeline of staff infections between March 2020 and January 2022. There was high uptake of all three vaccine doses across all demographic groups in hospital staff. PCR positivity decreased with increasing age and Scottish Index of Multiple Deprivation score. Staff and nosocomial COVID-19 infections followed peaks in community infection rates. NHS Lothian is a typical NHS workforce with good vaccine uptake. Beyond very early cases, there seems to be minimal evidence of occupational acquisition of COVID-19. The large number of nosocomial infections at the start of the pandemic may, in fact, reflect lack of community testing at this time. Despite protection from high vaccine coverage, job type and good Infection Prevention and Control practices, it seems that staff remain at high risk of catching the highly transmissible omicron variant from the community rather than work.

Clinical and health inequality risk factors for non-COVID-related sepsis during the global COVID-19 pandemic: a national case-control and cohort study

Sepsis, characterised by significant morbidity and mortality, is intricately linked to socioeconomic disparities and pre-admission clinical histories. This study aspires to elucidate the association between non-COVID-19 related sepsis and health inequality risk factors amidst the pandemic in England, with a secondary focus on their association with 30-day sepsis mortality. With the approval of NHS England, we harnessed the OpenSAFELY platform to execute a cohort study and a 1:6 matched case-control study. A sepsis diagnosis was identified from the incident hospital admissions record using ICD-10 codes. This encompassed 248,767 cases with non-COVID-19 sepsis from a cohort of 22.0 million individuals spanning January 1, 2019, to June 31, 2022. Socioeconomic deprivation was gauged using the Index of Multiple Deprivation score, reflecting indicators like income, employment, and education. Hospitalisation-related sepsis diagnoses were categorised as community-acquired or hospital-acquired. Cases were matched to controls who had no recorded diagnosis of sepsis, based on age (stepwise), sex, and calendar month. The eligibility criteria for controls were established primarily on the absence of a recorded sepsis diagnosis. Associations between potential predictors and odds of developing non-COVID-19 sepsis underwent assessment through conditional logistic regression models, with multivariable regression determining odds ratios (ORs) for 30-day mortality. The study included 224,361 (10.2%) cases with non-COVID-19 sepsis and 1,346,166 matched controls. The most socioeconomic deprived quintile was associated with higher odds of developing non-COVID-19 sepsis than the least deprived quintile (crude OR 1.80 [95% CI 1.77-1.83]). Other risk factors (after adjusting comorbidities) such as learning disability (adjusted OR 3.53 [3.35-3.73]), chronic liver disease (adjusted OR 3.08 [2.97-3.19]), chronic kidney disease (stage 4: adjusted OR 2.62 [2.55-2.70], stage 5: adjusted OR 6.23 [5.81-6.69]), cancer, neurological disease, immunosuppressive conditions were also associated with developing non-COVID-19 sepsis. The incidence rate of non-COVID-19 sepsis decreased during the COVID-19 pandemic and rebounded to pre-pandemic levels (April 2021) after national lockdowns had been lifted. The 30-day mortality risk in cases with non-COVID-19 sepsis was higher for the most deprived quintile across all periods. Socioeconomic deprivation, comorbidity and learning disabilities were associated with an increased odds of developing non-COVID-19 related sepsis and 30-day mortality in England. This study highlights the need to improve the prevention of sepsis, including more precise targeting of antimicrobials to higher-risk patients. The UK Health Security Agency, Health Data Research UK, and National Institute for Health Research.

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.

Demographics and deprivation in obstetric brachial plexus palsy: a retrospective cohort study.

The present study analyses the relationships between deprivation and obstetric brachial plexus palsy (OBPP). A retrospective observational study was conducted of infants with OBPP seen between 2008 and 2020 (n = 321). The index of multiple deprivation (IMD) was used to assign an IMD rank to patients based on birth postcode and the relationship with OBPP was analysed, including deprivation, gestational diabetes, age at referral and at first assessment. Quintile-based analysis demonstrated over-representation of patients from more deprived neighbourhoods (n = 109, 39%) living in the top 20% most deprived neighbourhoods. A total of 48 (15%) mothers had diabetes and 98 (31%) infants underwent surgical brachial plexus exploration (a marker of disease severity). Neither diabetes, age at referral nor age at first assessment were associated with IMD score. This suggests that neighbourhood deprivation is associated with OBPP, though the mechanisms are unclear. Further studies in this area may enable targeted health intervention for more deprived maternal and infant groups.Level of evidence: III.

WTP3.11 The impact of inpatient Magnetic Resonance Cholangiopancreatography on total length of hospital stay

Abstract Aims Magnetic resonance cholangiopancreatography (MRCP) is a frequently performed inpatient imaging modality to rule out bile duct stones (BDS). The aim of the study was to quantify the time delays from request of MRCP to its execution. Methods A retrospective cohort study of all consecutive adult inpatient MRCPs was conducted in a single centre from October 2021 to September 2022. Patient demographics, indications for MRCP, system timestamps for MRCP scans and length of stay (LOS) were analysed. Peak liver function test values were used pre-MRCP. Results A total of 302 patients were identified, 181 (59.9%) were female. Median age was 65 (IQR 50-76) and median Scottish Index of Multiple Deprivation score was 5 (IQR 3-8). 59 (19.5 %) MRCPs were performed for jaundice and 55 (18.2 %) were for gallstone pancreatitis. 104 (34.3%) had proven bile duct stones (BDS). Ultrasound and/or CT evidence of dilated bile ducts was strongly correlated with positive MRCP findings (p&amp;lt;0.001). Patient age, gender, bilirubin and alkaline phosphatase levels were not predictive for BDS. 112 (37.1%) were urgent requests. The median wait time for urgent MRCP was 1.0 days (IQR 0.6- 1.8) compared to 1.2 days (IQR 0.9- 2.7) for routine requests. Median LOS was 5.9 days (IQR 3.6-10.9). Conclusion Inpatient MRCP does not significantly impact total LOS. We conclude that patients with high risk factors for BDS should undergo MRCP as inpatients to mitigate complications of BDS.

P-444 The use of socioeconomic deprivation as an explanation of variation in IVF success rates between clinics

Abstract Study question Can differences in the live birth rate (LBR) between clinics with similar standard operating procedures (SOPs) be explained by variations in socioeconomic deprivation? Summary answer Socioeconomic deprivation does not appear to explain differences in LBR between clinics with similar SOPs in this cohort What is known already IVF success rates vary markedly between clinics. Numerous factors determine whether an IVF cycle is likely to be successful. It has been suggested that more socioeconomically deprived women are significantly less likely to achieve a live birth per cycle than less deprived women. In the UK, there is considerable variation in the levels of socioeconomic deprivation between different cities. Study design, size, duration We undertook a multi-center, retrospective review of prospectively collected data. We included all women undergoing their first IVF/ICSI cycle between January 2016 and December 2020 in eight different clinics belonging to the same IVF group. Clinics were located across England: three were situated in ‘very deprived’ cities, two in ‘predominantly affluent’ cities and the remaining cities were ‘neither very deprived nor very affluent’ i.e. their distribution was not skewed. Participants/materials, setting, methods We included all women undergoing their first IVF/ICSI cycle involving transfer of a single, fresh embryo. SOPs for medical and laboratory aspects of treatment were similar across all eight clinics. Socioeconomic deprivation was assessed using the Index of Multiple Deprivation (IMD) determined by the residential postcode of each woman undergoing treatment. Patients were categorized into quintiles according to IMD score. Live birth rates across IMD quintiles were calculated. Statistical analysis was performed using SPSS 22. Main results and the role of chance In total, across the 8 clinics, 17171 women underwent an IVF/ICSI cycle. The LBR ranged from 17.9 - 35.7% (p &amp;lt; 0.001) with both upper and lower extremes in clinics in cities classified as ‘neither very deprived nor very affluent’. The overall LBR ranged from 23.7-26.0% across the IMD quintiles. This difference was neither linear nor statistically significant. Similar trends were noted whether the treatment was NHS (n = 4992) or self-funded (n = 12179). The proportion of women in each IMD quintile varied significantly (p &amp;lt; 0.001) across the different clinics: in the most deprived quintile this ranged from 3.2 - 22.8% and in the least deprived quintile this ranged from 19.1 - 30.8%. The LBR in each IMD quintile also varied significantly (p &amp;lt; 0.001) across the different clinics. The LBR in the most deprived quintile ranged from 7.1 - 46.1% and in the least deprived quintile ranged from 19.4 - 22.9%. Limitations, reasons for caution Our results require caution as the distribution of deprivation amongst women undergoing IVF was not representative of the cities in which clinics were located with a skew towards greater affluence seen. Further unknown variables appear responsible for the significant variation in LBRs between clinics rather than IMD categorization alone. Wider implications of the findings The distribution of deprivation amongst women undergoing IVF was not representative of the cities in which clinics were located. Whilst not unexpected due to the cost of IVF, ethical questions regarding access to fertility care are highlighted and efforts to promote inclusion should be prioritized. Trial registration number Not applicable

O020 Comparison of indices of deprivation and screening uptake within a local AAA screening programme

Abstract Introduction The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) was established nationally to reduce the number of deaths caused by ruptured AAA. NAAASP invites all men in their 65th year for a simple abdominal ultrasound scan. Across the country uptake to the programme varies greatly. The aim of this study is to determine the impact of deprivation on local screening programme attendance. Methods The attendance for patients invited to screening within the Leicester, Leicestershire and Rutland screening NAAASP programme between the years 2016 and 2021 was compared to indices of multiple deprivation (IMD) (derived from their Lower Layer Super Output Area (LSOA) for each patient). Multiple logistic regression was used to determine the most significant component contributing to the IMD score. Results 28,730 men in total were invited to attend. Mean IMD for those that attended screening was 15.6 versus 20.6 for non-attenders (P value &amp;lt;0.001). Multiple regression revealed the IMD domains most associated with non-attendance to screening to be; Health Deprivation and Disability domain (P&amp;lt;0.001), Outdoor living environment domain (P&amp;lt;0.001) and Adult skills and English language proficiency domain (P&amp;lt;0.001). Barriers to housing and service domain including ‘geographical barriers’ which relate to the physical proximity of local services and employment domains did not show any association with attendance. Conclusion In line with the contemporary medical literature, social deprivation affects the uptake of the local National Abdominal Aortic Aneurysm Screening Programme (NAAASP). Health deprivation and disability, Outdoor living environment and adult education domains are most contributory to non-attendance.

Use of historical remote monitoring data to determine predictors of CPAP non-compliance in patients with OSA.

Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnoea. This study aimed to use complete usage data collected remotely from modern CPAP devices to identify compliance trends and clinical predictors of CPAP usage. Group usage data were analysed for a large cohort at a single tertiary sleep-centre before a detailed review of a 90-day reporting window for each patient was conducted. Individual data were collected for a smaller cohort of patients including demographics, past medical history and diagnostic sleep study results. A zero-inflated negative binomial regression model was used to determine associations between patient characteristics and usage days. Of 6450 patients who wereprescribed CPAP and included in the initial service analysis, 476 patients wereincluded in the sub-group. Complete usage data revealed that 46% of patients were fully compliant with CPAP therapy. Compliance fell from 55 to 46% by day 90 and remained at this rate going forward. Significant predictors of CPAP non-compliance included being in the lowest quartile of Index of Multiple Deprivation scores (most deprived) compared with the highest quartile (least deprived) (p = .005), and less severe oxygen desaturation index (ODI) on diagnosis (p = .03). Complete usage data show that compliance at day 90 appears to be a good indicator of future CPAP usage. Predictors of CPAP non-compliance may include lower socioeconomic status, and lower ODI.

Weighting of risk factors for low birth weight: a linked routine data cohort study in Wales, UK

ObjectiveGlobally, 20 million children are born with a birth weight below 2500 g every year, which is considered as a low birthweight (LBW) baby. This study investigates the contribution of...

Cross-sectional survey of child weight management service provision by acute NHS trusts across England in 2020/2021

ObjectiveWith one in five children in England living with obesity, we mapped the geographical distribution and format of child weight management services provided by acute National Health Service (NHS) trusts...

The influence of neighbourhood-level socioeconomic deprivation on developing type 2 diabetes in older men: a longitudinal analysis of the British Regional Heart Study cohort data

BackgroundEvidence from the British longitudinal studies on the influence of neighbourhood-level socioeconomic deprivation in older men on developing type 2 diabetes mellitus is scarce. This study investigates the prospective associations of neighbourhood-level deprivation and individual socioeconomic position with type 2 diabetes mellitus incidence in older men. MethodsThe British Regional Heart Study comprises a cohort of 4252 men aged 60–79 years in 1998–2000 from 24 towns across the UK. Neighbourhood-level deprivation was based on the country specific 2004–05 Index of Multiple Deprivation (IMD) quintiles for participants' postcode of residence at baseline. Individual socioeconomic position was defined as occupational social class based on longest-held occupation at recruitment. Participants with prevalent diabetes were excluded. The incidence of type 2 diabetes mellitus was ascertained from biannual reviews of primary care records over 18 years of follow-up. Cox proportional hazard models were undertaken to examine associations. FindingsThe incidence of type 2 diabetes mellitus cases observed was 368 (9·9%), amongst the 3706 male participants. Age-adjusted rates of type 2 diabetes mellitus increased from IMD quintile 1 (least deprived) to quintile 4 (second most deprived), before decreasing in quintile 5. Compared with quintile 1, the age and individual social class adjusted hazard ratio (aHR) in quintile 4 was 1·52 (95% CI 1·09–2·13), remaining significant after further adjustments for obesity and family history of type 2 diabetes mellitus. Participants in the lowest social class had the highest rates of type 2 diabetes mellitus. The aHR by age and IMD scores for type 2 diabetes mellitus in the lowest social class compared with the highest social class was 2·12 (95% CI 1·15–3·89). InterpretationNeighbourhood-level and individual-level socioeconomic factors remain important predictors of developing type 2 diabetes mellitus in older men, demonstrating that inequalities persist in later life. Inequalities in diabetes and its underlying modifiable risk factors need to be addressed to reduce the burden of this disease in socioeconomically deprived older-age populations. FundingNone.

Socioeconomic deprivation: an important largely unrecognized risk factor in primary prevention of cardiovascular disease

Abstract Background Socioeconomic deprivation is associated with higher cardiovascular morbidity and mortality. Whether deprivation status should be incorporated in more cardiovascular risk estimation scores remains unclear. Purpose This study evaluates how socioeconomic deprivation status affects the performance of three primary prevention cardiovascular risk scores. Methods The Generation Scotland Scottish Family Health Study was used to evaluate the performance of three cardiovascular risk scores with (ASSIGN) and without (SCORE2, PCE) socioeconomic deprivation as a covariate in the risk prediction model. Deprivation was defined by Scottish Index of Multiple Deprivation score. The predicted 10-year risk was evaluated against the observed event rate for the cardiovascular outcome of each risk score. The comparison was made across three groups defined by the deprivation index score consisting of group 1 defined as most deprived, group 3 defined as least deprived and group 2 which consisted of individuals in the middle deprivation categories. Results The study population consisted of 15,506 individuals (60.0% female, median age of 51). Across the population 1,808 (12%) individuals were assigned to group 1 (most deprived), 8,119 (55%) to group 2, and 4,708 (32%) to group 3 (least deprived). Risk scores based on models that did not include deprivation status significantly under predicted risk in the most deprived (6.4% observed versus 4.6% predicted for SCORE2 and 6.7% observed versus 4.7% predicted for PCE, p&amp;lt;0.001 for both). Both risk scores also significantly overpredicted the risk in the least deprived group (4.0% observed versus 4.7% predicted for SCORE2, p=0.007 and 4.2% observed versus 4.9% predicted for PCE, p=0.028). In contrast, no significant difference was demonstrated in the observed versus predicted risk when using the ASSIGN risk score, which included socioeconomic deprivation status in the risk model. Conclusions Socioeconomic status is a largely unrecognized risk factor in primary prevention of cardiovascular disease. Risk scores that exclude socioeconomic deprivation as a covariate under- and overestimate the risk in the most and least deprived individuals, respectively. This study highlights the importance of incorporating socioeconomic deprivation status in risk estimation systems to ultimately reduce inequalities in health care provision for cardiovascular disease. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation.Health Data Research UK which receives its funding from HDR UK Ltd (HDR-5012) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and the Wellcome Trust.

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.

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.