Measures Of Social Deprivation Research Articles

#1942 Social deprivation and chronic kidney disease: a population based cohort study in Italy

Abstract Background and Aims The impact of social deprivation on the progression of Chronic Kidney Disease (CKD) to End Stage Kidney Disease (ESKD) requiring Renal Replacement Therapies (RRTs) and death has been demonstrated by large cohort studies produced both in the US and the UK. Nonetheless, there is still insufficient evidence, which might depend on the difficulty of comparing Health Care Systems from different countries, the lack of a standardized measure of social deprivation and the difficulty of obtaining follow-ups long enough to intercept all clinical outcomes. This study aims to fill this gap by analyzing a large cohort of patients affected by CKD identified in Healthcare Electronic Records through a validated algorithm. Method The study population consisted of all adult incident CKD cases treated conservatively, residents in the Lazio Region, that occurred between the 1st of January 2012 and the 31st of December 2021. The exposure was the deprivation index (DI), a composite indicator at the census block level, which integrates many aspects: low level of education, unemployment, non-home ownership, one parent family and overcrowding. The DI divided the Lazio residents in 5 classes according to the quintiles of its distribution (form very low to very high deprivation). The study outcomes were all-cause mortality and ESKD. The health status of CKD patients was characterized using the hospital discharges for hypertension, heart failure, diabetes, ischemic cardiopathy, obesity and other conditions, in the two years before the identification. Patients were followed form the incident date up to the date of death, ESKD, emigration from Lazio region or 31/12/2022, whichever came first. Cox regression analyses were performed to study the association between DI and adverse outcomes, estimating crude and adjusted Hazard Ratios (HR) and 95% Confidence Intervals (95% CI). The interaction between DI and sex was tested. Results From 2012 to 2021, there were 127 457 new CKD cases, 55.9% males. The average age was 72.2 (±13.7 SD) for males and 74.4 (±14.8 SD) for females, characteristics by deprivation index are reported in Table 1. During the follow-up, on average 4.3 years (±3.2 SD), 57 158 patients (45%) died and 5994 developed ESKD requiring RRTs (5%). The mortality analysis showed a statistically significant interaction between DI and sex. In males, there was a strong association between DI and mortality in both age-adjusted and fully-adjusted models (Fig. 1A), with a statistically significant trend across DI classes. In females, there was an association with a statistically significant trend across DI categories but the only statistically significant different HR was very high DI VS. very low DI (HR = 1.05; 95% CI = 1.00-1.09) (Fig. 1B). The association was much stronger for males then for females. In the ESKD outcome analysis there was not an interaction between sex and DI; hence, sex was used as confounder. The age-adjusted HR and the fully-adjusted HR of DI on ESKD did not show any trend across the DI categories and then the low and medium deprived had a lower ESKD risk compared to the very deprived. Conclusion The present study is so far the largest European prospective cohort regarding the association between socioeconomic position and CKD. The HR of mortality was inferior to the one found in the UK studies (HR 1.6). The most likely explanation is that we have stratified by sex and adjusted for comorbidities. In our study the most deprived patients have a higher risk of death, but not of ESKD requiring RRTs, showing socioeconomic inequalities in the worst possible outcome, that probably occurred before the progression of the disease in most deprived patients. Further studies are needed to confirm this association that can lead both individual and Public Health decisions.

Socioeconomic status and post-covid illness trajectory

Abstract Background The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain. Methods A prospective, multicentre, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated at 28-60 days post-discharge (visit 2) and in the longer term. Serial research blood tests (biomarkers), digital electrocardiography, and patient-reported outcome measures were obtained at both visits. Novel, multisystem imaging, including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, was acquired at visit 2. The analysis of primary and secondary outcomes by socioeconomic status was prespecified. The Scottish Index of Multiple Deprivation (SIMD), a small-area measure of social deprivation based on domiciled post code reflecting seven factors including income, employment, education, health, access to services, crime, and housing, and categorized into general population quintiles, was used to measure social deprivation. The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. Follow-up of clinical outcomes was undertaken using electronic health records. Results Two hundred and fifty-two patients (mean±SD age 55.0 ±12.0 years, body mass index (BMI) 31.3 ±6.9 kg/m2,101 (40%) female, and 59 (23%) with diabetes) were enrolled and had follow-up completed at a median 428 (IQR 385, 538) days. Deprivation status was positively associated with BMI (p=0.0444) and diabetes (p=0.0239). One hundred and eighty-six (74%) patients reattended for investigation 28-60 days post-discharge. Lung ground glass opacity and/or consolidation (p=0.0085), obstructive coronary artery disease (p=0.0128) and renal inflammation (p=0.0421) were associated with deprivation. At 28-60 days post-discharge (n=184), health-related quality of life (EQ-5D-5L utility score, p=0.0084), illness perception, (BIPQ, p=0.0004), anxiety and depression (PHQ-4 score, p=0.0038), physical activity (DASI, p=0.002) and estimated peak oxygen consumption (ml/min/kg) (p=0.002) were worse with greater deprivation. At 3 months (n=252), deprivation status was associated with more referrals to secondary care because of ongoing COVID-19 symptoms (p=0.0438). Clinical outcomes did not associate with deprivation. Conclusion In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19.

Association of area-level structural racism with racial disparities in cancer mortality.

172 Background: Structural racism (SR) refers to interactive systems of discrimination that perpetuate advantage for one racial group over others. Single-variable SR measures, such as residential segregation and historical red-lining, are associated with cancer disparities but do not represent all aspects of SR. We aimed to develop a composite measure of SR for cancer research and examine the association of county-level SR with disparities in cancer mortality. Methods: Adapting methods from obesity and public safety research, we developed a SR composite score (SRCS) by calculating the ratio of Black to White performance on eight county-level variables across five domains (housing, education, employment, income and healthcare) using race-stratified census data from 2006-2020. Using North Carolina as a test set, we rank-ordered counties on a min-max scale 1-100 for each domain and averaged scores across domains to create the SRCS, where higher SRCS suggests greater SR. Outcomes were county age-standardized mortality rates (per 100k) for all cancers combined, breast, prostate, colorectal and lung cancers, extracted from CDC Wonder for non-Hispanic Blacks and Whites (2000-2020). We used generalized estimating equations to regress mortality rates on SRCS, race, and their interaction. Results: County-level SRCS was positively associated with county-level racial disparities in all-cancer mortality; for each 10-unit increase in SRCS, Black-White difference in rates increased by 15.3/100k (p<0.001). For individual cancers, a 10 unit rise in county SRCS was associated with a 1.93/100k increase in the colorectal cancer mortality gap (p=0.003) and a 6.18/100k increase in the lung cancer mortality gap (p<0.001). SRCS was not associated with mortality disparities for breast and prostate cancers, although these disparities were large. For all-cancer mortality and all tumor types except breast cancer, mortality rates of Whites significantly decreased as SRCS increased, while mortality rates for Blacks remained roughly stable with rising SRCS. Adjustment for county-level measures of social deprivation, unemployment, primary care provider ratio, and severe housing problems did not attenuate the relationship of SRCS with mortality. Conclusions: A composite measure of SR is associated with racial disparities in overall cancer mortality and mortality of specific solid tumors. Continued research is needed to further understand the role of area-level social determinants, ecologic fallacy, and differences in the relationship of SRCS to mortality across cancers. Nevertheless, increased SR is associated with lower county-level cancer mortality among Whites, suggesting that SR may perpetuate cancer mortality disparities via relative advantage to White residents rather than direct disadvantage to Black residents.

A Retrospective Review of Social Deprivation Index and Maternal Outcomes with Placenta Accreta Spectrum from a Single Referral Center.

Little is known about how community characteristics influence placenta accreta spectrum (PAS) outcomes. Our objective was to evaluate whether adverse maternal outcomes among pregnant people (gravidae) with PAS delivering at a single referral center differ by community-level measures of social deprivation. We conducted a retrospective cohort study of singleton gravidae with histopathology confirmed PAS delivering from January 2011 to June 2021 at a referral center. Data abstraction collected relevant patient information, including resident zip code, which was linked to Social Deprivation Index (SDI) score (a measure of area-level social deprivation). SDI scores were divided into quartiles for analysis. Primary outcome was a composite of maternal adverse outcomes. Bivariate analyses and multivariable logistic regression were performed. Among our cohort (n = 264), those in the lowest (least deprived) SDI quartile were older, had lower body mass index, and were more likely to identify as non-Hispanic white. Composite maternal adverse outcome occurred in 81 (30.7%), and did not differ significantly by SDI quartile. Intraoperative transfusion of ≥4 red blood cell units occurred more often among those living in deprived areas (31.2% in the highest [most deprived] vs. 22.7% in the lowest [least deprived] SDI quartile, p = 0.04). No other outcomes differed by SDI quartile. In multivariable logistic regression, a quartile increase in SDI was associated with 32% increased odds of transfusion of ≥4 red blood cell units (adjusted odds ratio: 1.32, 95% confidence interval: 1.01-1.75). Within a cohort of gravidae with PAS delivered at a single referral center, we found that those living in more socially deprived communities were more likely to receive transfusion of ≥4 red blood cell units, but other maternal adverse outcomes did not differ. Our findings highlight the importance of considering how characteristics of the surrounding community can impact PAS outcomes and may assist with risk stratification and resource deployment. · Little is known about how community characteristics influence PAS outcomes.. · In a referral center, transfusion was more common in gravidae living in socially deprived areas.. · Future research should consider how community characteristics can impact PAS outcomes..

Impact of Neighborhood Social Deprivation on Health Care Costs Associated With TAVR

BACKGROUND: Cumulative costs of transcatheter aortic valve replacement (TAVR) differ in the referral, procedural and postprocedural phases depending on patient comorbidities, type of procedure, and procedural complications. Our goal was to determine the association between neighborhood measures of social deprivation and TAVR costs in each of the 3 phases. METHODS: Demographics, patient comorbidities, procedural details, in-hospital complications, and costs for adults undergoing TAVR between 2017 and 2020 in Ontario, Canada were obtained from administrative databases and linked to social deprivation data using the Ontario Marginalization Index. The 3 dimensions of social deprivation assessed were (1) material deprivation, (2) residential instability, and (3) ethnic concentration. Hierarchical generalized linear models were used to determine the association between neighborhood social deprivation and cumulative TAVR costs, reported in 2018 Canadian dollars. RESULTS: We identified a total of 7617 TAVR referrals with 3784 patients undergoing TAVR within our study period. Cumulative mean costs in the referral, procedural and postprocedural phases were $8116±$11 374, $32 790±$17 766, and $18 901±$32 490, respectively. After adjustment for clinical and demographic variables, higher factor scores in residential instability were associated with greater cumulative costs in the postprocedural phase, whereas higher factor scores in the other 2 dimensions of marginalization were not significantly associated with higher costs in any of the 3 phases. CONCLUSIONS: This analysis shows that residential instability is associated with higher cumulative costs in the postprocedural phase of TAVR. This lays the foundation for future studies to understand the mechanism of this finding and identify potential mitigation policies.

Neighbourhood characteristics and the treated incidence rate of borderline personality pathology among young people.

The impact of the wider social environment, such as neighbourhood characteristics, has not been examined in the development of borderline personality disorder. This study aimed to determine whether the treated incidence rate of full-threshold borderline personality disorder and sub-threshold borderline personality disorder, collectively termed borderline personality pathology, was associated with the specific neighbourhood characteristics of social deprivation and social fragmentation. This study included young people, aged 15-24 years, who attended Orygen's Helping Young People Early programme, a specialist early intervention service for young people with borderline personality pathology, from 1 August 2000-1 February 2008. Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Personality Disorders, and census data from 2006 were used to determine the at-risk population and to obtain measures of social deprivation and fragmentation. The study included 282 young people, of these 78.0% (n = 220) were female and the mean age was 18.3 years (SD = ±2.7). A total of 42.9% (n = 121) met criteria for full-threshold borderline personality disorder, and 57.1% (n = 161) had sub-threshold borderline personality disorder, defined as having three or four of the nine Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) borderline personality disorder criteria. There was more than a sixfold increase in the treated incidence rate of borderline personality pathology in the neighbourhoods of above average deprivation (Quartile 3) (incidence rate ratio = 6.45, 95% confidence interval: [4.62, 8.98], p < 0.001), and this was consistent in the borderline personality disorder sub-groups. This association was also present in the most socially deprived neighbourhood (Quartile 4) (incidence rate ratio = 1.63, 95% confidence interval: [1.10, 2.44]), however, only for those with sub-threshold borderline personality disorder. The treated incidence of borderline personality pathology increased incrementally with the level of social fragmentation (Quartile 3: incidence rate ratio = 1.93, 95% confidence interval: [1.37, 2.72], Quartile 4: incidence rate ratio = 2.38, 95% confidence interval: [1.77, 3.21]). Borderline personality pathology has a higher treated incidence in the more socially deprived and fragmented neighbourhoods. These findings have implications for funding and location of clinical services for young people with borderline personality pathology. Prospective, longitudinal studies should examine neighbourhood characteristics as potential aetiological factors for borderline personality pathology.

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

Did the Physical and Mental Health of Orthopaedic Patients Change After the Onset of the COVID-19 Pandemic?

How Should We Measure Social Deprivation in Orthopaedic Patients?

Social deprivation negatively affects a myriad of physical and behavioral health outcomes. Several measures of social deprivation exist, but it is unclear which measure is best suited to describe patients with orthopaedic conditions. (1) Which measure of social deprivation, defined as "limited access to society's resources due to poverty, discrimination, or other disadvantage," is most strongly and consistently correlated with patient-reported physical and behavioral health in patients with orthopaedic conditions? (2) Compared with the use of a single measure alone, how much more variability in patient-reported health does the simultaneous use of multiple social deprivation measures capture? Between 2015 and 2017, a total of 79,818 new patient evaluations occurred within the orthopaedic department of a single, large, urban, tertiary-care academic center. Over that period, standardized collection of patient-reported health measures (as described by the Patient-reported Outcomes Measurement Information System [PROMIS]) was implemented in a staged fashion throughout the department. We excluded the 25% (19,926) of patient encounters that did not have associated PROMIS measures reported, which left 75% (59,892) of patient encounters available for analysis in this cross-sectional study of existing medical records. Five markers of social deprivation were collected for each patient: national and state Area Deprivation Index, Medically Underserved Area Status, Rural-Urban Commuting Area code, and insurance classification (private, Medicare, Medicaid, or other). Patient-reported physical and behavioral health was measured via PROMIS computer adaptive test domains, which patients completed as part of standard care before being evaluated by a provider. Adults completed the PROMIS Physical Function version 1.2 or version 2.0, Pain Interference version 1.1, Anxiety version 1.0, and Depression version 1.0. Children ages 5 to 17 years completed the PROMIS Pediatric Mobility version 1.0 or version 2.0, Pain Interference version 1.0 or version 2.0, Upper Extremity version 1.0, and Peer Relationships version 1.0. Age-adjusted partial Pearson correlation coefficients were determined for each social deprivation measure and PROMIS domain. Coefficients of at least 0.1 were considered clinically meaningful for this purpose. Additionally, to determine the percentage of PROMIS score variability that could be attributed to each social deprivation measure, an age-adjusted hierarchical regression analysis was performed for each PROMIS domain, in which social deprivation measures were sequentially added as independent variables. The model coefficients of determination (r2) were compared as social deprivation measures were incrementally added. Improvement of the r2 by at least 10% was considered clinically meaningful. Insurance classification was the social deprivation measure with the largest (absolute value) age-adjusted correlation coefficient for all adult and pediatric PROMIS physical and behavioral health domains (adults: correlation coefficient 0.40 to 0.43 [95% CI 0.39 to 0.44]; pediatrics: correlation coefficient 0.10 to 0.19 [95% CI 0.08 to 0.21]), followed by national Area Deprivation Index (adults: correlation coefficient 0.18 to 0.22 [95% CI 0.17 to 0.23]; pediatrics: correlation coefficient 0.08 to 0.15 [95% CI 0.06 to 0.17]), followed closely by state Area Deprivation Index. The Medically Underserved Area Status and Rural-Urban Commuting Area code each had correlation coefficients of 0.1 or larger for some PROMIS domains but neither had consistently stronger correlation coefficients than the other. Except for the PROMIS Pediatric Upper Extremity domain, consideration of insurance classification and the national Area Deprivation Index together explained more of the variation in age-adjusted PROMIS scores than the use of insurance classification alone (adults: r2 improvement 32% to 189% [95% CI 0.02 to 0.04]; pediatrics: r2 improvement 56% to 110% [95% CI 0.01 to 0.02]). The addition of the Medically Underserved Area Status, Rural-Urban Commuting Area code, and/or state Area Deprivation Index did not further improve the r2 for any of the PROMIS domains. To capture the most variability due to social deprivation in orthopaedic patients' self-reported physical and behavioral health, insurance classification (categorized as private, Medicare, Medicaid, or other) and national Area Deprivation Index should be included in statistical analyses. If only one measure of social deprivation is preferred, insurance classification or national Area Deprivation Index are reasonable options. Insurance classification may be more readily available, but the national Area Deprivation Index stratifies patients across a wider distribution of values. When conducting clinical outcomes research with social deprivation as a relevant covariate, we encourage researchers to consider accounting for insurance classification and/or national Area Deprivation Index, both of which are freely available and can be obtained from data that are typically collected during routine clinical care. Level III, therapeutic study.

Sociodemographic characteristics and patient and family experience survey response biases

Enhancing Patient and Family Experience (PFE) is vital to the delivery of quality healthcare services. Sociodemographic differences affect health outcomes and experiences, but research is limited on biases in PFE survey methodology. We sought to assess survey participation rates across sociodemographic characteristics. This retrospective study analyzed a health system’s ambulatory PFE survey data, collected January 1 – July 31, 2019. Outcomes of interest were rates of survey response, completion, and comments. Predictors included respondent-reported race, ethnicity, language, and measure of social deprivation attached to a respondent’s home address. Addresses were geocoded to census tracts. The tract’s degree of socioeconomic deprivation was defined using the Deprivation Index (DPI). Associations between outcomes and predictors were assessed using the Chi square test. 77,627 unique patient encounters were analyzed. Patients were predominantly White (76%); 5% were Hispanic; and 1% were Spanish-speaking. The overall response, completion, and comment rates were 20.1%, 17.6%, and 4.1%, respectively. There were significant differences across assessed sociodemographic characteristics in response, completion, and comment rates. White patients were most likely to respond, complete, and leave a comment. Spanish-speaking respondents and those living in the most deprived areas were more likely to respond and complete the survey, but less likely to comment than English-speaking respondents and those living in less deprived areas, respectively. PFE survey participation differs across a range of sociodemographic characteristics, potentially introducing noteworthy biases. Health systems should minimize differences in how they collect feedback and account for potential biases when responding to experience data.

Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation

PurposeAlthough baseline biopsychosocial factors are associated with short-term patient-reported outcomes following distal radius fracture open reduction internal fixation (ORIF), their effect on mid-term outcomes is unclear. We aimed to evaluate the effect of social deprivation, previously established as a surrogate for depression, pain interference, and anxiety, on quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores >1 year following distal radius ORIF.MethodsAdult patients (≥18 years) with an isolated distal radius fracture treated with ORIF by orthopedic trauma and hand surgeons at a single tertiary academic center over a 3-year period were included. Outcomes at ≥1 year postoperatively were evaluated using QuickDASH. Age, follow-up duration, area deprivation index (ADI; a measure of social deprivation), subspecialty (hand vs trauma), and postoperative alignment were assessed using linear regression with 95% confidence intervals after bootstrapping and a permutation test for P values to test for their association with the final QuickDASH score.ResultsFollow-up data were obtained for 98 of 220 (44.5%) patients at a mean of 3.1 ± 1.0 years after surgery. Mean age and ADI were 53.2 ± 15.4 years and 26.8 ± 18.7, respectively. Most fractures were intra-articular (67.3%), and 72.4% had acceptable postoperative alignment parameters, as defined by the American Academy of Orthopaedic Surgeons clinical practice guidelines. The mean QuickDASH score was 13.0 ± 16.5. There were no significant associations between the final QuickDASH score and any studied factor, including ADI, as determined using univariable analysis. Multivariable analysis showed no association between ADI and the final QuickDASH score, independent of age, sex, treating service, follow-up duration, and fracture alignment or pattern.ConclusionsAt mid-term follow up after distal radius ORIF, ADI did not correlate with QuickDASH scores, and the QuickDASH scores of the patients did not differ from those of the general population. However, our cohort mostly comprised patients with levels of deprivation below the national median. Although studies have shown that the short-term outcomes of distal radius ORIF are influenced by biopsychosocial factors, outcomes at the time of final recovery may not be associated with social deprivation.Type of study/level of evidencePrognostic IV.

Abstract PO-169: Racial distribution of neighborhood social deprivation in a retrospective cohort of prostate cancer survivors

Abstract Background: Cancer incidence and mortality rates vary across geographic areas; however, a better understanding of neighborhood level variables is needed to increase the precision of cancer control interventions that target geographic determinants of cancer health disparities. The purpose of this study is to characterize the distribution of neighborhood deprivation features in a cohort of racially diverse prostate cancer survivors based on social determinants (e.g., race) and clinical characteristics (e.g., Gleason score, tumor stage). Methods: A retrospective cohort of prostate cancer patients who were treated with radical prostatectomy from 2011 to 2019 was established using the tumor registry at the Hollings Cancer Center at the Medical University of South Carolina. Data on clinical variables (e.g., stage, grade) and social determinants (e.g., race) were abstracted from electronic medical records. Residential addresses were geocoded and neighborhood-level social deprivation measures (income, education, employment, housing, household characteristics, transportation and demographics) from the 2011-2015 American Community Survey five-year estimates were used to generate a composite Social Deprivation Index (SDI) using factor analysis. Next, descriptive, bivariate and correlation analyses were conducted to characterize SDI and examine the association between social determinants, clinical characteristics, and SDI. Results: The study sample included 249 men (168 white men and 81 African American men) who had an average age of 66 years (+6.6). The mean for SDI was 44.5 (+27.4) and the range was 97 (1-98). White men that were married were 88.7% while African American men that were married were 77.8% (p: 0.02). Men who lived in neighborhoods that had a high level of social deprivation (i.e., SDI score of 48 to 98) were 121 (48.6%). There were significant racial differences in SDI between African American and white men. The mean SDI score was 58.5 (+26.9) among African American men compared to 37.8 (+25.0) among white men (p&amp;lt;0.01). In the logistic regression model, African American men had a significantly greater likelihood of living in a socially deprived neighborhood compared to white men (OR=4.2, 95% C.I. 2.4-7.5, p&amp;lt;0.01). In addition, men between the ages of 47-67 years were significantly more likely than men ages 68-80 to in a deprived neighborhood (OR=1.8, 95% C.I.=1.1-3.0, p- value=0.02). None of the clinical characteristics were associated significantly with SDI. Conclusion: This study demonstrates that SDI varies considerably among men. Greater efforts may be needed to address neighborhood level factors among African American men who have a personal history of prostate cancer. Citation Format: Oluwole Adeyemi Babatunde, John Pearce, Melanie Jefferson, Lewis Frey, Peggi Angel, Rick Drake, Caitlin Allen, Chanita Hughes- Halbert. Racial distribution of neighborhood social deprivation in a retrospective cohort of prostate cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-169.

Environmental vulnerability and resilience: Social differentiation in short‐ and long‐term flood impacts

This paper finds that social differentiation in flood impacts is relatively small soon after a flood, with some surprising results such as professionals and homeowners badly affected in the short‐term – but widens over time, with socially disadvantaged groups displaying less recovery. The paper concludes that vulnerability and resilience to flooding are sensitive to financial resources, institutional support (chiefly from a landlord), and capacity to deal with disruption (chiefly time availability, which is low among professionals and high among retired people). An implication of these findings is that existing indices of flood vulnerability that use multiple measures of social deprivation should be used with caution, as not all conventional aspects of social deprivation are necessarily associated with greater vulnerability to flood impacts.

Reporting of social deprivation in musculoskeletal trials: An analysis of 402 randomised controlled trials.

Social deprivation is broadly defined as the restriction of access an individual has to social or cultural interactions due to poverty, discrimination or other disadvantages. While social deprivation is a widely acknowledged determinant of outcome in musculoskeletal conditions, it remains unclear how this is considered in the conduct and interpretation of musculoskeletal trials. To determine the frequently to which measures of social deprivation are reported in trials recruiting people with musculoskeletal diseases. We conducted a Pubmed search of randomised controlled trials published between 01 January 2019 and 01 June 2020. We included full-text papers of trials recruiting people with musculoskeletal diseases, irrespective of intervention type or origin. We extracted data relating to trial characteristics, setting, trial design, funding source and musculoskeletal disease. We extracted data on any reported social deprivation index or measure of social deprivation based on internationally adopted indicators. We analysed data descriptively to summarise the reporting of each social deprivation index and measure of social deprivation within trials. From 2133 potentially eligible citations, 402 were eligible. Mean age of participants was 51.7 years; 63% were female. Trials most frequently recruited people with spinal pain (24.6%) or osteoarthritis (10.0%). Two trials (0.5%) reported social deprivation indices/scores. When assessed by discrete measures of social deprivation, 164 trials (40.8%) reported one or more social deprivation measures. The most commonly reported measures were morbidity (20.2%), employment status (17.7%) and educational attainment (15.5%). Race (6.7%), ethnicity (6.2%) and annual salary (1.3%) were infrequently reported. One trial (0.3%) presented subgroup results by social deprivation measures. Social deprivation is inconsistently reported in musculoskeletal trials. Trialists should report baseline measures of social deprivation in trial reports and aid generalisability to target population, and to examine whether social deprivation might modify treatment effects of interventions for musculoskeletal conditions.

Prevalence of suspected COVID-19 infection in patients from ethnic minority populations: a cross-sectional study in primary care.

BackgroundThe first wave of the London COVID-19 epidemic peaked in April 2020. Attention initially focused on severe presentations, intensive care capacity, and the timely supply of equipment. While general practice has seen a rapid uptake of technology to allow for virtual consultations, little is known about the pattern of suspected COVID-19 presentations in primary care.AimTo quantify the prevalence and time course of clinically suspected COVID-19 presenting to general practices, to report the risk of suspected COVID-19 by ethnic group, and to identify whether differences by ethnicity can be explained by clinical data in the GP record.Design and settingCross-sectional study using anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four adjacent east London clinical commissioning groups. The study population includes 55% of people from ethnic minorities and is in the top decile of social deprivation in England.MethodSuspected COVID-19 cases were identified clinically and recorded using SNOMED codes. Explanatory variables included age, sex, self-reported ethnicity, and measures of social deprivation. Clinical factors included data on 16 long-term conditions, body mass index, and smoking status.ResultsGPs recorded 8985 suspected COVID-19 cases between 10 February and 30 April 2020.Univariate analysis showed a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. In a fully adjusted analysis that included clinical factors, South Asian patients had nearly twice the odds of suspected infection (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.83 to 2.04). The OR for black patients was 1.47 (95% CI = 1.38 to 1.57).ConclusionUsing data from GP records, black and South Asian ethnicity remain as predictors of suspected COVID-19, with levels of risk similar to hospital admission reports. Further understanding of these differences requires social and occupational data.

Measuring geographical disparities in England at the time of COVID-19: results using a composite indicator of population vulnerability.

ObjectivesThe growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics.DesignWe combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability.Setting91 Clinical Commissioning Groups (CCGs) in England.Main outcome measuresWe merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities.ResultsWe find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments.ConclusionsEvidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.

Chronic kidney disease of unknown origin is associated with environmental urbanisation in Belfast, UK

Chronic kidney disease (CKD), a collective term for many causes of progressive renal failure, is increasing worldwide due to ageing, obesity and diabetes. However, these factors cannot explain the many environmental clusters of renal disease that are known to occur globally. This study uses data from the UK Renal Registry (UKRR) including CKD of uncertain aetiology (CKDu) to investigate environmental factors in Belfast, UK. Urbanisation has been reported to have an increasing impact on soils. Using an urban soil geochemistry database of elemental concentrations of potentially toxic elements (PTEs), we investigated the association of the standardised incidence rates (SIRs) of both CKD and CKD of uncertain aetiology (CKDu) with environmental factors (PTEs), controlling for social deprivation. A compositional data analysis approach was used through balances (a special class of log contrasts) to identify elemental balances associated with CKDu. A statistically significant relationship was observed between CKD with the social deprivation measures of employment, income and education (significance levels of 0.001, 0.01 and 0.001, respectively), which have been used as a proxy for socio-economic factors such as smoking. Using three alternative regression methods (linear, generalised linear and Tweedie models), the elemental balances of Cr/Ni and As/Mo were found to produce the largest correlation with CKDu. Geogenic and atmospheric pollution deposition, traffic and brake wear emissions have been cited as sources for these PTEs which have been linked to kidney damage. This research, thus, sheds light on the increasing global burden of CKD and, in particular, the environmental and anthropogenic factors that may be linked to CKDu, particularly environmental PTEs linked to urbanisation.

Acute Kidney Injury in Children Based on Electronic Alerts

To define the incidence and outcome of acute kidney injury (AKI) in pediatrics using data collected from a national electronic alert system. A prospective national cohort study was undertaken to collect data on all cases of pediatric AKI, excluding neonates, identified by an e-alert, from April 2015 to March2019. There were 2472 alerts in a total of 1719 patients, giving an incidence of 77.3 per 100 000 person-years. Of the patients, 84.2% of all AKI were stage 1 and 58.3% occurred with a triggering creatinine within the reference range. The incidence of AKI was associated with measures of social deprivation. Thirty-day mortality was 1.7% but was significantly higher in hospital-acquired AKI (2.1%), compared with community-acquired AKI (0.8%, P<.001) and was associated with the severity of AKI at presentation. A significant proportion of patients had no repeat measure of creatinine (39.8%). This was higher in community-acquired AKI (69.7%) compared with hospital-acquired AKI (43.0%, P<.001), and higher in patients alerting with patients triggering with a creatinine within the reference range (48.4% vs 24.5%, P<.001). The majority of patients (84.7%) experienced only 1 AKI episode. Repeated episodes of AKI were associated with increased 30-mortaltiy (11.6% vs 4.6%, P<.001) and higher residual renal impairment (13.3% vs 5.4%, P<.001). The results suggest that the significance of the alert is missed in many cases reflecting that a large proportion of cases represent modest elevations in serum creatinine (SCr), triggered by a SCr level that may be interpreted as being normal despite a significant increase from the baseline for the patient.

Measuring Geographical Disparities in England at the Time of Covid-19: Results Using a Composite Indicator of Population Vulnerability

Objectives – The growth of COVID-19 infections in England raises questions about system vulnerability. Several factors that vary across geographies, such as age, existing disease prevalence, medical resource availability, and deprivation, can trigger adverse effects on the National Health System during a pandemic. In this paper, we present data on these factors and combine them to create an index to show which areas are more exposed. This technique can help policy makers to moderate the impact of similar pandemics.Design – We combine several sources of data, which describe specific risk factors linked with the outbreak of a respiratory pathogen, that could leave local areas vulnerable to the harmful consequences of large-scale outbreaks of contagious diseases. We combine these measures to generate an index of community-level vulnerability.Setting – 191 Clinical Commissioning Groups (CCGs) in England.Main outcome measures – We merge 15 measures spatially to generate an index of community-level vulnerability. These measures cover prevalence rates of high-risk diseases; proxies for the at-risk population density; availability of staff and quality of healthcare facilities.Results – We find that 80% of CCGs that score in the highest quartile of vulnerability are located in the North of England (24 out of 30). Here, vulnerability stems from a faster rate of population ageing and from the widespread presence of underlying at-risk diseases. These same areas, especially the North-East Coast areas of Lancashire, also appear vulnerable to adverse shocks to healthcare supply due to tighter labour markets for healthcare personnel. Importantly, our Index correlates with a measure of social deprivation, indicating that these communities suffer from long-standing lack of economic opportunities and are characterised by low public and private resource endowments.Conclusions – Evidence-based policy is crucial to mitigate the health impact of pandemics such as COVID-19. While current attention focuses on curbing rates of contagion, we introduce a vulnerability index combining data that can help policy makers identify the most vulnerable communities. We find that this index is positively correlated with COVID-19 deaths and it can thus be used to guide targeted capacity building. These results suggest that a stronger focus on deprived and vulnerable communities is needed to tackle future threats from emerging and re-emerging infectious disease.

Community social deprivation and availability of substance use treatment and mutual aid recovery groups

BackgroundThe spatial distribution of substance use services impacts their use, with greater access to services associated with more positive outcomes. Findings from availability of primary healthcare indicate service shortages exist in areas characterized by social deprivation. This study investigated whether community social deprivation was associated with a lack of availability of substance use treatment or mutual aid recovery support services.MethodsThis is an ecological analysis investigating the availability of substance use services at a community level in the state of New Hampshire. Several public data sources were combined to represent community social deprivation and availability of substance treatment of mutual aid recovery support groups. Principal components analysis and negative binomial regression were used to test the relationship between community structure and the availability of substance use services.ResultsCommunity social deprivation was characterized by high rates of poverty, no access to motor vehicles, renter-occupied housing, less than a high school degree, and nonemployment. Communities high in measures of social deprivation were associated with increased availability of both substance use treatment and recovery support services.ConclusionsContrary to findings in access to primary healthcare services, social disadvantage was positively related to availability for both types of substance use services. This relationship may reflect the stigma associated with substance use where services associated with stigmatized conditions locate in areas with the least resistance to their presence or be a function of affordability of space. Future research could investigate the relationship between access to services and individual client outcomes.

Acute Kidney Injury, Age, and Socioeconomic Deprivation: Evaluation of a National Data Set

IntroductionThis study examined the relationship among age, measures of social deprivation, and incidence and outcome of acute kidney injury (AKI).MethodsThe Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients 18 years or older between March 2015 and January 2017. Socioeconomic classification of patients was derived from the Welsh Index of Multiple Deprivation (WIMD). Patients were grouped according to their WIMD score, and Multivariate Cox proportional hazard modeling was used to adjust the data for age. The ranked data were categorized into percentiles and correlated with incidence, and measures of AKI severity and outcome.ResultsAnalysis included 57,654 patients. For the whole cohort, the highest 90-day survival was associated with the most socially deprived cohorts. There was a significant negative relationship between age-adjusted incidence of AKI and the WIMD score. In patients 60 years or older, there was an inverse correlation between WIMD score and survival that was not evident in those younger than 60. AKI severity at presentation was worse in patients from areas of social deprivation. Social deprivation was associated with a significantly higher proportion of preexisting chronic kidney disease (CKD) in patients with AKI older than 60, but not in those younger than 60.ConclusionOverall mortality following AKI was higher in least-deprived areas, reflecting an older patient cohort. In contrast, social deprivation was associated with higher age-adjusted AKI incidence and age-adjusted mortality following AKI. The excess mortality observed in more deprived areas was associated with more severe AKI and a higher proportion of preexisting CKD.