Influence Of Socioeconomic Deprivation Research Articles

Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study.

The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. A total of 1,748 patients were included. Median age was 62.9 [47.4-74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1-6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1-2] deprivations and all had housing deprivation, phenotype D patients had 2 [1-2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2-4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65-1.12); phenotype C (HR, 0.56; 95% CI 0.34-0.93); phenotype D (HR, 1.09; 95% CI 0.78-1.51); phenotype E (HR, 1.20; 95% CI 0.73-1.96). In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions.

DOES SOCIOECONOMIC DEPRIVATION INFLUENCE PATIENT OUTCOMES AFTER PERIACETABULAR OSTEOTOMY?

Higher levels of socioeconomic deprivation have been associated with worse health outcomes. The influence of socioeconomic deprivation on patients undergoing periacetabular osteotomy (PAO) has not previously been investigated.A total of 217 patients (171 female, 46 male; median age 23.4 years) who underwent PAO by a single surgeon were identified. Patients were categorised into three groups according to their New Zealand Deprivation (NZDep) Index: minimal deprivation (NZDep Index 1–3, n=89), moderate deprivation (NZDep Index 4-6, n=94), and maximal deprivation (NZDep Index 7-10, n=34). The three groups were compared with respect to baseline variables, surgical details, complications, and pre-operative and two-year post-operative functional scores (including International Hip Outcome Tool (iHOT-12), EQ-5D quality of life score, and University of California Los Angeles (UCLA) activity score). Multivariate regression was undertaken to assess for the effect of NZDep Index on patient outcomes.Patients in the maximal deprivation group were more likely to be Māori (p<0.001) and have surgery in a public rather than a private hospital (p=0.004), while the minimal deprivation group demonstrated a lower BMI (p=0.005). There were otherwise no other significant differences in baseline variables, surgical details, complications, nor pre-operative or two-year post-operative functional scores between the three groups (all p>0.05). Multivariate analysis identified a higher NZDep Index to be independently predictive of a lower pre-operative UCLA activity score (p=0.014) and a higher two-year iHOT-12 score (p<0.001).Our results demonstrate an inequality in access to PAO, with patients exposed to higher levels of socioeconomic deprivation under-represented in our study population. When provided access to PAO, these vulnerable patients achieve significant functional improvement at least as great as patients with less socioeconomic deprivation. Initiatives to improve access to hip preservation care in socioeconomically deprived populations appear warranted.

Numbers and types of neurological emergencies in England and the influence of socioeconomic deprivation: a retrospective analysis of hospital episode statistics data

ObjectivesIn this first large-scale analysis of neurological emergency admissions in England, we determine the number and types of emergency admissions with neurological emergency diagnostic codes, how many are under the...

The Influence of Socioeconomic Deprivation on Dementia Mortality, Age at Death, and Quality of Diagnosis: A Nationwide Death Records Study in England and Wales 2001-2017.

Socioeconomic deprivation may be an important determinant of dementia risk, mortality, and access to diagnostic services. Premature mortality from other causes and under-representation of deprived individuals in research may lead to this effect being overlooked. We assessed the relationship between deprivation and dementia mortality using comprehensive death certificate data for England and Wales from 2001 to 2017. We used standardized mortality ratios (SMR) and a Poisson model to compare likelihood of dying from dementia in each deprivation decile. We also examined the associations of deprivation with age at death from dementia, and with likelihood of receiving a diagnosis of unspecified dementia. Risk of dying from dementia was higher in more deprived deciles (Mean SMR [95% CI] in decile 1 : 0.528 [0.506 to 0.550], decile 10:0.369 [0.338 to 0.400]). In 2017, 14,837 excess dementia deaths were attributable to deprivation (21.5% of all dementia deaths that year). There were dose-response associations of deprivation with likelihood of being older at death with dementia (odds ratio [95% CI] for decile 10 (least deprived): 1.31 [1.28 to 1.33] relative to decile 1), and with likelihood of receiving a diagnosis of unspecified dementia (odds ratio [95% CI] for decile 10:0.78 [0.76 to 0.80] relative to decile 1). Socioeconomic deprivation in England and Wales is associated with increased dementia mortality, younger age at death with dementia, and poorer access to specialist diagnosis. Reducing social inequality may have a role in the prevention of dementia mortality.

Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with COVID-19 to critical care units in Scotland: A national cohort study.

BackgroundCoronavirus disease 2019 (COVID-19) can lead to significant respiratory failure with between 14% and 18% of hospitalised patients requiring critical care admission. This study describes the impact of socioeconomic deprivation on 30-day survival following critical care admission for COVID-19, and the impact of the COVID-19 pandemic on critical care capacity in Scotland.MethodsThis cohort study used linked national hospital records including ICU, virology testing and national death records to identify and describe patients with COVID-19 admitted to critical care units in Scotland. Multivariable logistic regression was used to assess the impact of deprivation on 30-day mortality. Critical care capacity was described by reporting the percentage of baseline ICU bed utilisation required.FindingsThere were 735 patients with COVID-19 admitted to critical care units across Scotland from 1/3/2020 to 20/6/2020. There was a higher proportion of patients from more deprived areas, with 183 admissions (24.9%) from the most deprived quintile and 100 (13.6%) from the least deprived quintile. Overall, 30-day mortality was 34.8%. After adjusting for age, sex and ethnicity, mortality was significantly higher in patients from the most deprived quintile (OR 1.97, 95%CI 1.13, 3.41, p=0.016). ICUs serving populations with higher levels of deprivation spent a greater amount of time over their baseline ICU bed capacity.InterpretationPatients with COVID-19 living in areas with greatest socioeconomic deprivation had a higher frequency of critical care admission and a higher adjusted 30-day mortality. ICUs in health boards with higher levels of socioeconomic deprivation had both higher peak occupancy and longer duration of occupancy over normal maximum capacity.FundingNone.

Influence of Socioeconomic Deprivation on Interventions and Outcomes for Patients Admitted with COVID-19 to Critical Care Units in Scotland: A National Cohort Study

Background: Coronavirus disease 2019 (COVID-19) can lead to significant respiratory failure with between 14% and 18% of hospitalised patients requiring critical care admission. This study describes the impact of socioeconomic deprivation on 30-day survival following critical care admission for COVID-19, and the impact of the COVID-19 pandemic on critical care capacity in Scotland.Methods: This cohort study used linked national hospital records including ICU, virology testing and national death records to identify and describe patients with COVID-19 admitted to a critical care unit in Scotland. Multivariable logistic regression was used to assess the impact of deprivation on 30-day mortality. Critical care capacity was described by reporting the percentage of baseline ICU bed utilisation required.Results: There were 735 patients with COVID-19 admitted to critical care units across Scotland from 1/3/2020 to 20/6/2020. There was a higher proportion of patients from more deprived areas, with 183 admissions (24.9%) from the most deprived quintile and 100 (13.6%) from the least deprived quintile. 30-day mortality was 34.8%. After adjusting for age, sex and ethnicity, mortality was significantly higher in patients from the most deprived quintile (OR 1.97, 95%CI 1.13, 3.41, p=0.016). ICUs serving populations with higher levels of deprivation spent a greater amount of time over their baseline ICU bed capacity.Conclusion: Patients with COVID-19 living in areas with greater socioeconomic deprivation had a higher frequency of critical care admission and a higher adjusted 30-day mortality. ICUs in health boards with higher levels of socioeconomic deprivation had both higher peak occupancy and longer duration of occupancy over normal maximum capacity.Funding Statement: None.Declaration of Interests: All authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; NL is Director of Research, Intensive Care Society; JM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019-02-16). Ethics Approval Statement: The Scottish Intensive Care Society Audit Group in Public Health Scotland has a legislative remit to process personal data in relation to public health. Linkage to additional datasets was approved following scrutiny by the Public Benefit and Privacy Panel for Health and Social Care (ref 1920-0093). Access and use of the data for the purpose of this work were approved following a Public Health Scotland information governance review of linking additional internal datasets to identify patients with COVID-19. Only analysts working in Public Health Scotland had access to the linked patient data which could only be accessed via an NHS secure network.

The Influence of Socio-economic Deprivation on Mobility, Participation, and Quality of Life Following Major Lower Extremity Amputation in the West of Scotland

Lower extremity amputation (LEA) is more common in people from lower socio-economic groups. This study examined this further by investigating the influence of socio-economic status on mobility, participation, and quality of life (QoL) after LEA. Prospective data were gathered for all LEAs performed in one year in one Scottish Health Board, commencing March 2014. A postcode derived Scottish Index of Multiple Deprivation (SIMD) was applied by quintile (SIMD 1=most deprived). Routine data were collected on the cohort of 171 patients; 101 participants consented and received postal questionnaires on QoL (EQ-5D-5L), participation (Reintegration to Normal Living Index [RNLI]), and mobility (Prosthetic Limb User Survey of Mobility), six (n=67) and 12 months (n=50) after LEA. The mean±SD age of the cohort was 66.2±11.4 years; 75% were male and 53% had diabetes. In total, 67% lived in SIMD 1 and 2 and 11.1% in SIMD 5. Sixty per cent had a transtibial amputation. Mortality was 6% at 30 days 17% at six, and 29% at 12 months. Those in SIMD 1 were significantly younger (62.9 years) than those in SIMD 5 (76.3 years). Significantly more participants with a transfemoral amputation (TFA) lived in SIMD 1 (44%) compared with SIMD 5 (11%) (p=.004). Participation was low (RNLI scores: 6 months=55.7; 12 months=56.6) and PLUS M scores suggested mobility was poor overall at six (39.1) and 12 months (38.9). Mean QoL was 0.37at 6 months and 0.33at 12 months. Although this study observed more LEAs in those from low socio-economic areas, it is impossible to conclude whether QoL after LEA is truly influenced by socio-economic status. There was an association between the disproportionately high rate of LEAs in SIMD groups 1 and 2 and the high prevalence of smoking, 61% vs. only 21% of those in the least deprived areas (SIMD 3, 4, and 5) being current smokers.

A Study on the Influence of Socio-economic Deprivation on Depression

A Study on the Influence of Socio-economic Deprivation on Depression

The Effect of Socioeconomic Deprivation on the Association between an Extended Lifestyle Score and Health Outcomes in the UK Biobank Cohort

Background - Combinations of unhealthy lifestyle factors can interact synergistically to increase associated mortality. While combinations of 'traditional' risk factors such as smoking and alcohol consumption are well described, the mortality associated with combinations that incorporate a wider range of 'emerging' lifestyle factors' (e.g. television viewing time) is not. The influence of socioeconomic deprivation on wider lifestyle risks also remains unclear. We aimed to examine whether deprivation modifies the association between an 'extended' lifestyle score and adverse health outcomes. Methods - Analyses performed using 328,594 adult participants' data from UK Biobank. Cox-proportional hazard models were used to examine how the association between an extended lifestyle score (incorporating sleep, TV viewing, smoking, alcohol, diet and physical activity) and health outcomes (all-cause mortality and cardiovascular disease (CVD) mortality and incidence) is modified by deprivation. Findings - There was a significant interaction (p<0.0001) between lifestyle score and deprivation for all-cause and CVD mortality. Hazard ratios (HR) for these outcomes were highest for those in the less healthy lifestyle category and most deprived quintile. In the least deprived quintile, the HR for all-cause and CVD mortality in individuals from the less healthy lifestyle category, compared with the more healthy category, was 1·65 (95% CI: 1·25-2·19) and 1·93 (1·16-3·20), respectively. Whereas in the most deprived quintile those from the less healthy category had a HR of 2·47 (2·04-3·00) for all-cause mortality and 3·36 (2·36-4·76) for CVD mortality. Interpretation - Wide combinations of lifestyle factors are associated with disproportionate harm in deprived populations. Public health and individual level interventions that address a wider range of unhealthy lifestyle factors in areas of deprivation may reduce inequalities. Funding - Research presented here used UK Biobank data and was designed, conducted, analysed and interpreted entirely independently of any funding sources. Conflicts of Interest - The authors declare that they have no competing interests. Ethics committee approval - All participants provided written informed consent to participate in the UK Biobank study agreeing to data collection, analysis and record linkage. The UK Biobank study was approved by the North West Multi-Centre Research Ethics Committee. This study is part of UK Biobank project 7155 (NHS National Research Ethics Service (16/NW/0274)).

The influence of socioeconomic deprivation, access to healthcare and physical environment on old-age survival in Portugal.

Spatial inequalities in old-age survival exist in Portugal and might be associated with factors pertaining to three distinct domains: socioeconomic, physical environmental and healthcare. We evaluated the contribution of these factors on the old-age survival across Portuguese municipalities deriving a surrogate measure of life expectancy, a 10-year survival rate that expresses the proportion of the population aged 75-84 years old who reached 85-94. As covariates we used two internationally comparable multivariate indexes: the European deprivation index and the multiple physical environmental deprivation index. A national index was developed to evaluate the access to healthcare. Smoothed rates and odds ratios (OR) were estimated using Bayesian spatial models. Socioeconomic deprivation was found to be the most relevant factor influencing old-age survival in Portugal [women: least deprived areas OR=1.132(1.064-1.207); men OR=1.044(1.001- 1.094)] and explained a sizable amount of the spatial variance in survival, especially among women. Access to healthcare was associated with old-age survival in the univariable model only; results lost significance after adjustment for socioeconomic circumstances [women: higher access to healthcare OR=1.020(0.973- 1.072); men OR=1.021(0.989-1.060)]. Physical environmental deprivation was unrelated with old-age survival. In conclusion, socioeconomic deprivation was the most important determinant in explaining spatial disparities in old-age survival in Portugal, which indicates that policy makers should direct their efforts to tackle socioeconomic differentials between regions.

Influence of Socioeconomic Deprivation on Visual Acuity in Patients Undergoing Corneal Transplantation.

To determine whether there is an association between socioeconomic status and best-corrected visual acuity (BCVA) in patients undergoing corneal transplantation in the United Kingdom. Retrospective cohort study of 4306 patients registered on the national United Kingdom Transplant Registry and undergoing penetrating keratoplasty, anterior lamellar keratoplasty, or endothelial keratoplasty in 2002, 2008, and 2013. Socioeconomic status was determined by applying a validated deprivation index to generate a score based on 5 categories. Patients' demographic details, preoperative BCVA, copathology, surgical center volume, and socioeconomic status were analyzed for univariate effects of categorical and continuous variables. Binary logistic regression was used to determine whether preoperative BCVA was affected by socioeconomic status after adjusting for other factors. A larger percentage of the most deprived group was female in each period compared with the least deprived, but this was only significant in 2002 (48.7% vs. 40.3%; P = 0.04). There was no interaction between socioeconomic status and the preoperative BCVA in the grafted eye. However, BCVA in the fellow eye was poorer for the most economically deprived patients compared with the least deprived in 2013 (P = 0.01). We found no evidence of a relationship between socioeconomic deprivation and BCVA in the transplant recipient eye. However, there was clear evidence of an association between socioeconomic deprivation and reduced acuity in fellow eyes, for which barriers to access or low patient demand may be possible contributors.

The influence of socioeconomic deprivation on early outcomes in vascular access surgery

Socioeconomic deprivation is an important factor in determining poor health and is associated with a higher prevalence of many chronic diseases including diabetes and renal failure, and often poorer outcomes for patients with such conditions. The influence of deprivation on outcomes following vascular access surgery has not previously been reported. The Welsh Index of Multiple Deprivation was used to assess the influence of socioeconomic deprivation on outcomes following 507 consecutive first upper limb arteriovenous (AV) fistulas from a single institution in the United Kingdom, performed between 2011 and 2014. The primary outcome measures were early failure and maturation into a working fistula. Four hundred and five (80%) patients had a patent AV fistula at the 2-week follow-up clinic. Three hundred and fifty-nine (71%) patients developed a functionally mature AV fistula as determined by clinical assessment and a Doppler scan. There were no differences in either early failure rates (p = 0.95) or maturation rates (p = 0.77) between the least and most deprived groups of patients. In conclusion, this study has shown that socioeconomic deprivation does not influence outcomes following vascular access surgery.

PWE-204 Acute pancreatitis: incidence, management and outcome trends over 15 years

Introduction Acute pancreatitis is a common general surgical presentation, requiring input from both surgeons and gastroenterologists. The Newcastle upon Tyne Trust is the regional HPB referral centre for complex pancreatitis for 9 Trusts. The aetiology of acute pancreatitis in the North East is 42.5% gallstone disease,1and the BSG2recommend that cholecystectomy is undertaken in these patients on their index admission. This study describes changes in acute pancreatitis incidence, management and outcomes the last 15 years. Method Information departments at Newcastle and Gateshead Foundation Trusts were contacted to request data for all emergency admissions under a general surgeon from 2000–2014 after necessary approvals. Acute pancreatitis was identified using the ICD-10 code K85, cholecystectomy using the OPCS code J18, and laparoscopy using code Y50.8, Y75.1 and Y75.2. Data on demographics, co-morbidities, interventions and outcomes were collected and analysed. Results Acute pancreatitis was common, occurring in 2,334/80,814 cases (2.9%). Mean age was 52.8 years (95% CI: 52.1 to 53.6 years), and 54.3% of patients were men. The overall mean length of stay (LoS) was 11.1 days (95% CI: 10.3 to 11.9 days), and patients who were managed conservatively (1368; 58.6%) had a significantly shorter LoS than those who underwent a procedure (6.0 days vs. 18.3 days, p Conclusion The number of procedures performed within this cohort is skewed due to the preponderance of severe cases requiring intervention and are unlikely to represent usual practice in a general hospital. The rates of cholecystectomy on index admission with acute pancreatitis are increasing; however they remain substantially lower than the 42.5% identified by Ellis et al.1We show an increasing incidence of acute pancreatitis, with decreasing mortality, suggesting current management strategies including referral of severe cases to subspecialist multi-disciplinary units is beneficial. Disclosure of interest None Declared. References Ellis MP, French JJ, Charnley RM. Acute pancreatitis and the influence of socioeconomic deprivation. Br J Surg. 2009;96:74–80. doi: 10.1002/bjs.6414. BSG. UK Working Party on Acute Pancreatitis. UK guidelines for the management of acute pancreatitis. Gut 2005;54:iii1–iii9.

The Influence of Socioeconomic Deprivation on Allograft and Patient Survival Following Kidney Transplantation.

Background: Whether socioeconomic deprivation confers worse allograft or patient outcomes after kidney transplantation is not known. We examined its influence on allograft and patient survival following kidney transplantation in Ireland. Methods: We identified all adult deceased donor first kidney transplant recipients from 1990 to 2009. Those with a valid Irish postal address on record were assigned a deprivation score based on the Pobal Hasse-Pratschke deprivation index. Cox proportional analysis and Kaplan Meier survival analysis by quartile were used to investigate any association of socioeconomic deprivation with outcomes. Results: We identified 1,977 eligible kidney transplant recipients, with 33 excluded due an invalid/missing address. The median follow-up time was 8.2 years (IQR 4.4 - 13.3). Patient survival was not associated with deprivation score (HR 1.0, 95% CI 0.93-1.08, p=0.88). The deprivation score was not associated with reduced uncensored or death-censored allograft survival (HR 0.997, 95% CI 0.989-1.003, p=0.33 and HR 0.995, 95% CI 0.986-1.004, respectively), with no difference amongst quartiles in either uncensored or death-censored allograft survival at 5- and 10-years. The most deprived quartile had a longer duration of dialysis therapy before transplantation compared to the least deprived (22months vs. 18months, p=0.02). Conclusion: In a healthcare model affording free or subsidised medication and healthcare coverage for eligible patients, there was no socioeconomic status disparity in allograft or patient outcomes following kidney transplantation. This gives further impetus to calls in other jurisdictions for universal healthcare and medication coverage for kidney transplant recipients.

The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study.

BackgroundMultimorbidity occurs at a younger age in individuals in areas of high socioeconomic deprivation but little is known about the ‘typology’ of multimorbidity in different age groups and its association with socioeconomic status.AimTo characterise multimorbidity type and most common conditions in a large nationally representative primary care dataset in terms of age and deprivation.Design and settingCross-sectional analysis of 1 272 685 adults in Scotland.MethodMultimorbidity type of participants (physical-only, mental-only, mixed physical, and mental) and most common conditions were analysed according to age and deprivation.ResultsMultimorbidity increased with age, ranging from 8.1% in those aged 25–34 to 76.1% for those aged ≥75 years. Physical-only (56% of all multimorbidity) was the most common type of multimorbidity in those aged ≥55 years, and did not vary substantially with deprivation. Mental-only was uncommon (4% of all multimorbidity), whereas mixed physical and mental (40% of all multimorbidity) was the most common type of multimorbidity in those aged <55 years and was two- to threefold more common in the most deprived compared with the least deprived in most age groups. Ten conditions (seven physical and three mental) accounted for the top five most common conditions in people with multimorbidity in all age groups. Depression and pain featured in the top five conditions across all age groups. Deprivation was associated with a higher prevalence of depression, drugs misuse, anxiety, dyspepsia, pain, coronary heart disease, and diabetes in multimorbid patients at different ages.ConclusionMixed physical and mental multimorbidity is common across the life-span and is exacerbated by deprivation from early adulthood onwards.

Socioeconomic deprivation predicts outcome following radial head and neck fractures

IntroductionThere is increasing evidence demonstrating an association between fracture epidemiology and socioeconomic status. However, the influence of socioeconomic deprivation on fracture outcome has not been documented before. The aim of this study was to determine if socioeconomic deprivation influenced the short-term outcome following a fracture of the radial head or neck. MethodsWe identified from a prospective database all patients who sustained a radial head or neck fracture over an 18-month period. The primary outcome measure for this study was the patient-reported short musculoskeletal function assessment (SMFA). The Index of Multiple Deprivation (IMD) was used to quantify deprivation, and any correlation with functional outcome was determined. Multivariate regression analysis was used to determine the influence of deprivation on outcome once other significant demographic and fracture characteristics had been accounted for. ResultsThere were 200 patients in the study cohort, of which 107 (53.5%) were female and the mean age was 44 years (16–83). At a mean follow-up of 6 months the median SMFA score was 0.54 (0–55.4). The SMFA was found to be influenced by the IMD, with increasing deprivation associated with a poorer outcome (p=0.006). On multivariate analysis, the AO fracture classification, compensation and increasing deprivation were the only independent predictors of outcome (all p<0.05). ConclusionsWe have a shown a clear correlation between functional outcome and socioeconomic status, with the most deprived patients reporting a poorer outcome. Future work should be aimed at determining which aspects of deprivation influence patient outcome, with modifiable factors targeted in future health-care planning.

The Influence of Socio-economic Deprivation on Rates of Major Lower Limb Amputation Secondary to Peripheral Arterial Disease

To investigate a hypothesised link between socio-economic deprivation and rates of major lower limb amputation within the catchment of a district general hospital in the United Kingdom. An analysis of a demographic database collated using patients identified by the OPCS codes for lower limb amputations. All patients undergoing a lower limb amputation as a result of peripheral vascular disease, as identified by ICD-10 code, between January 2003 and January 2009 were included in the study. A case–control study was undertaken, comparing the Index of Multiple Deprivation 2007 (IMD) scores of major lower limb amputees, to those of the catchment population. Multivariate analysis was not undertaken. A total of 327 patients underwent 445 lower limb amputations during the 6-year period. A comparative plot of cumulative frequency of IMD score in the catchment and amputation groups indicates greater numbers of major amputations in more deprived postcodes (P = 0.004). The catchment population was further divided into population-matched deprivation quintiles. A significant increase in the number of amputations occurred in the two most deprived quintiles (OR (95%CI) = 1.654 (1.121–2.440), P = 0.011). This study indicates a positive association between increasing social deprivation and rates of lower limb amputation. If the most deprived quintiles are combined, this increase in amputation rates is approximately 65%. This inequity should be further investigated, and consideration given to targeted care within areas of greater social deprivation.

The Influence of Socio-economic Deprivation on Rates of Major Lower Limb Amputation Secondary to Peripheral Arterial Disease

Objectives To investigate a hypothesised link between socio-economic deprivation and rates of major lower limb amputation within the catchment of a district general hospital in the United Kingdom. Design An analysis of a demographic database collated using patients identified by the OPCS codes for lower limb amputations. Materials All patients undergoing a lower limb amputation as a result of peripheral vascular disease, as identified by ICD-10 code, between January 2003 and January 2009 were included in the study. Methods A case–control study was undertaken, comparing the Index of Multiple Deprivation 2007 (IMD) scores of major lower limb amputees, to those of the catchment population. Multivariate analysis was not undertaken. Results A total of 327 patients underwent 445 lower limb amputations during the 6-year period. A comparative plot of cumulative frequency of IMD score in the catchment and amputation groups indicates greater numbers of major amputations in more deprived postcodes ( P = 0.004). The catchment population was further divided into population-matched deprivation quintiles. A significant increase in the number of amputations occurred in the two most deprived quintiles (OR (95%CI) = 1.654 (1.121–2.440), P = 0.011) Conclusions This study indicates a positive association between increasing social deprivation and rates of lower limb amputation. If the most deprived quintiles are combined, this increase in amputation rates is approximately 65%. This inequity should be further investigated, and consideration given to targeted care within areas of greater social deprivation.

Influence of Socioeconomic Deprivation on the Relation Between Air Pollution and β-Agonist Sales for Asthma

Air pollution triggers asthma attacks hours to days after exposure. It remains unclear whether socioeconomic deprivation modulates these effects. Investigation of these interactions requires adequate statistical power, obtainable by using either a sufficient number of observations or very sensitive indicators of asthma attacks. Using a small-area temporal ecologic approach, we studied the short-term relations between ambient air pollution and sales of short-acting beta-agonist (SABA) drugs, a frequent and specific treatment for control of asthma attacks in children and young adults, and then tested the influence of deprivation on these relations. The study took place in Strasbourg, France in 2004. Health insurance funds provided data on 15,121 SABA sales for patients aged 0 to 39 years. Deprivation was estimated by small geographic areas using an index constructed from census data. Daily average ambient concentrations of particulate matter (particles with an aerodynamic diameter < 10 microm [PM(10)]), nitrogen dioxide (NO(2)), and ozone (O(3)) were modeled on a small-area level. Adjusted case-crossover models were used for statistical analysis. Increased of 10 microg/m(3) in ambient PM(10), NO(2), and O(3) concentrations were associated, respectively, with increases of 7.5% (95% confidence interval [CI], 4 to 11.2%), 8.4% (95% CI, 5 to 11.9%), and 1% (95% CI, - 0.3 to 2.2%) in SABA sales. Deprivation had no influence on these relations. The associations observed are consistent with those reported by studies focusing on SABA use. Similar studies in other settings should confirm whether the lack of interaction with deprivation is due to specific local conditions.

Acute pancreatitis and the influence of socioeconomic deprivation

A comprehensive epidemiological study of acute pancreatitis (AP) using reliable objective methods of patient identification with the inclusion of socioeconomic factors has not been reported previously. The study included all patients with AP identified by raised serum amylase or lipase levels admitted to 18 hospitals over 6 months. Clinical records were reviewed to confirm the diagnosis, aetiology and outcome. Patients were stratified into quintiles of socioeconomic deprivation. Age-standardized incidence (ASI) and mortality were calculated. Clinical data were reviewed for all 963 identified patients. The ASI was 56.5 per 10(5) per annum, double the highest figure reported previously in the UK. Univariable logistic regression analysis showed a high ASI among older age groups (odds ratio (OR) 1.06 per year; P < 0.001) and in areas of high deprivation (OR 2.40 between least and most deprived; P < 0.001); the latter was predominantly related to alcoholic aetiology (OR 6.50 (95 per cent confidence interval 3.90 to 10.84)). The incidence of AP based on a highly sensitive method of case identification was higher than previously reported. A clear relationship was found between socioeconomic deprivation and incidence of AP, which was largely explained by a higher incidence of alcoholic aetiology.