Areas Of Socioeconomic Deprivation Research Articles

Disparities in 1-Year Follow-up Rates After Proximal Humerus Fractures Treated With Open Reduction and Internal Fixation

Background: Proximal humerus fractures (PHFs) impose a serious burden on patients and are commonly treated with open reduction and internal fixation (ORIF). Several factors influence functional outcomes in treating PHFs. This study aims to evaluate how social determinants of health affect postoperative follow-up rates of patients treated with ORIF for PHF. Methods: A single-center retrospective review included 92 patients treated with ORIF for PHF. Loss to follow-up was defined as failing to return after the last advised follow-up. Patient zip codes were used to determine median household income as determined by the US Department of Housing and Urban Development (HUD) and the Federal Reserve and social disadvantage using the Social Deprivation Index (SDI). Results: A significant difference was observed in 12-month loss to follow-up rates between HUD and SDI subgroups. No difference was found in 6-month loss to follow-up rates or the reasons that patients were lost to follow-up among HUD, Federal Reserve, and SDI subgroups. Conclusion: Patients from areas of greater socioeconomic deprivation exhibited the highest 12-month loss to follow-up rates, emphasizing the importance of targeted interventions, such as in-house social workers and improved visit reminders, to address postoperative attrition and enhance patient care.

Big data research is everyone's research-Making epilepsy data science accessible to the global community: Report of the ILAE big data commission.

Epilepsy care generates multiple sources of high-dimensional data, including clinical, imaging, electroencephalographic, genomic, and neuropsychological information, that are collected routinely to establish the diagnosis and guide management. Thanks to high-performance computing, sophisticated graphics processing units, and advanced analytics, we are now on the cusp of being able to use these data to significantly improve individualized care for people with epilepsy. Despite this, many clinicians, health care providers, and people with epilepsy are apprehensive about implementing Big Data and accompanying technologies such as artificial intelligence (AI). Practical, ethical, privacy, and climate issues represent real and enduring concerns that have yet to be completely resolved. Similarly, Big Data and AI-related biases have the potential to exacerbate local and global disparities. These are highly germane concerns to the field of epilepsy, given its high burden in developing nations and areas of socioeconomic deprivation. This educational paper from the International League Against Epilepsy's (ILAE) Big Data Commission aims to help clinicians caring for people with epilepsy become familiar with how Big Data is collected and processed, how they are applied to studies using AI, and outline the immense potential positive impact Big Data can have on diagnosis and management.

Multimorbidity and person-centred care in a socioeconomically deprived community: a qualitative study.

People with multimorbidity (>2 long-term conditions) have poorer outcomes in areas of high socioeconomic deprivation (SED). High-quality person-centred care (PCC) is important in those with multimorbidity, but socially vulnerable populations have not, to our knowledge, informed current PCC models. To explore how wider community factors influence management of multimorbidity in the context of high SED, how high-quality PCC is defined by patients, and whether this influences healthcare management. Ethnographically informed case study in a community experiencing high SED in Scotland. Participant observation (138 h) was undertaken within four community groups who also took part in two participatory workshops. There were 25 in-depth interviews with people with multimorbidity, recruited from local general practices; emerging findings were discussed with interviewees in one focus group. Field notes/transcripts were analysed using inductive thematic analysis. Key aspects of PCC were 'patient as person', 'strong therapeutic relationship', 'coordination of care', and 'power sharing'; power sharing was particularly enabling but rarely happened (barriers often unseen by practitioners). Shared community experiences of 'being known', 'stigma', and 'none of the systems working' influenced how people approached health services and healthcare decisions. High-quality PCC may have been particularly effective in this setting because of its influence on ameliorating wider shared negative community experiences. In a high SED setting PCC is important and can enhance engagement. Wider community factors have a critical influence on engagement with health care in areas of high SED and PCC may be particularly important in this context because of its influence ameliorating these. Policymakers should prioritise and resource PCC.

Socioeconomic and ethnic disparities in preterm births in an English maternity setting: a population-based study of 1.3 million births

BackgroundPreterm birth is a major cause of infant mortality and morbidity and accounts for 7–8% of births in the UK. It is more common in women from socially deprived areas and from minority ethnic groups, but the reasons for this disparity are poorly understood. To inform interventions to improve child survival and their quality of life, this study examined the socioeconomic and ethnic inequalities in preterm births (< 37 weeks of gestation at birth) within Health Trusts in England.MethodsThis study investigated socioeconomic and ethnic inequalities in preterm birth rates across the National Health Service (NHS) in England. The NHS in England can be split into different units known as Trusts. We visualised between-Trust differences in preterm birth rates. Health Trusts were classified into five groups based on their standard deviation (SD) variation from the average national preterm birth rate. We used modified Poisson regression to compute risk ratios (RR) and 95% confidence intervals (95% CI) with generalised estimating equations.ResultsThe preterm birth rate ranged from 6.8/100 births for women living in the least deprived areas to 8.8/100 births for those living in the most deprived areas. Similarly, the preterm birth rate ranged from 7.8/100 births for white women, up to 8.6/100 births for black women. Some Health Trusts had lower than average preterm birth rates in white women whilst concurrently having higher than average preterm birth rates in black and Asian women. The risk of preterm birth was higher for women living in the most deprived areas and ethnicity (Asian).ConclusionsThere was evidence of variation in rates of preterm birth by ethnic group, with some Trusts reporting below average rates in white ethnic groups whilst concurrently reporting well above average rates for women from Asian or black ethnic groups. The risk of preterm birth varied substantially at the intersectionality of maternal ethnicity and the level of socioeconomic deprivation of their residency. In the absence of other explanations, these findings suggest that even within the same Health Trust, maternity care may vary depending on the women’s ethnicity and/or whether she lives in an area of high socioeconomic deprivation. Thus, social factors are likely key determinants of inequality in preterm birth rather than provision of maternity care alone.

Smoking prevalence and association with sociodemographic variables in cancer clinical trial participants.

Tobacco use (smoking) causes adverse clinical outcomes among patients with cancer, including increased cancer-related mortality. In participants in cancer clinical trials, the prevalence of tobacco use and the factors associated with tobacco use are not well described. Data were examined from participants enrolled in SWOG cancer clinical treatment trials between 2016 and 2022 who reported their smoking status at trial enrollment. Baseline variables (smoking status, insurance type, zip code, and demographic factors) were obtained from patient registration forms. Bivariate and multivariable associations were examined via logistic regression. Among 4326 patients enrolled in 29 trials, 48.1% reported currently/previously smoking, including 12.4% currently, 4.9% recently, and 30.7% formerly. Ever smoking was more commonly reported in males, patients aged ≥65 years, patients with Medicaid or no insurance, patients from areas of high socioeconomic deprivation, and rural patients. Patients of Hispanic ethnicity and Asian and Pacific Islander patients were less likely to have ever smoked. In multivariable regression, patients with lung cancer were most likely to report ever smoking compared to patients with breast cancer (odds ratio,4.98; p<.001). In the first comprehensive evaluation of smoking status among trial participants enrolled in National Cancer Institute network group treatment trials, nearly half reported ever smoking and one in six reported current or recent smoking. Smoking was more common among vulnerable population patients defined by demographic and socioeconomic factors. Tobacco use should be routinely assessed and reported in clinical trials to help reduce the negative cancer and overall health effects of persistent tobacco use and to address disparities among patients with cancer.

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

This study aimed to investigate the associa-tion between patient-reported outcome measures (PROMs), both pre- and post-operatively, and socio-economic deprivation among patients undergoing hip and knee replacement surgeries in the diverse socioeconomic region of Wirral. A retrospective cohort study was conducted, involving 1666 adult patients who underwent hip or knee replacement procedures between 2012 and 2019. Socioeconomic deprivation was assessed using the Index of Multiple Deprivation (IMD). Pre- and post-operative outcomes were measured using the Oxford Hip and Knee scores. The mean scores for both pre-and post-operative assessments (Q1 and Q2) exhibited a strong positive correlation with PROM scores, regardless of gender, across both hip and knee replacements. However, the mean difference in scores between Q1 and Q2 showed no significant correlation with the IMD decile. Notably, patients residing in areas of higher socioeconomic deprivation demonstrated lower PROMs both before and after the surgery. The Oxford Hip and Knee scores are widely employed for evaluating health status in patients. In our study, these scores were influenced by IMD decile, supporting the holistic assessment approach employed by the treating unit, which does not rely solely on PROM scores as a trigger for arthroplasty discussions. Furthermore, our findings align with the practice of NHS Digital, which publishes PROM scores based on changes in PROM scores pre- and post-operation rather than absolute PROM scores. This approach appears to be less influenced by deprivation in the catchment area, as the improvement or change in scores was poorly correlated with socioeconomic factors.

Neighborhood socioeconomic disadvantages associated with prolonged length of stay and non-home discharge following revision total hip and knee joint arthroplasty

BackgroundDischarge disposition and length of stay (LOS) are widely recognized markers of healthcare utilization patterns of total hip and knee joint arthroplasty (TJA). These markers are commonly associated with increased postoperative complications, patient dissatisfaction, and higher costs. Area deprivation index (ADI) has been validated as a composite metric of neighborhood-level disadvantage. This study aims to determine the potential association between ADI and discharge disposition or extended LOS following revision TJA. MethodsThis study conducted a retrospective analysis of a consecutive series of revision hip and knee TJA patients from a single tertiary institution. Univariate and multivariate regression analysis was used to determine the association between ADI and discharge disposition or LOS, adjusting for patient demographics and comorbidities. Results1047 consecutive revision TJA patients were identified across 463 different neighborhoods. 193 (18.4 %) had an extended LOS, and 334 (31.9 %) were discharged to non-home facilities. Compared with Q1 (least deprived cohort), Q2 (odds ratio [OR] = 1.63; p = 0.030) and Q4 (most deprived cohort: OR = 2.04; p = 0.002) cohorts demonstrated higher odds of non-home discharge. Patients in the highest ADI quartile (most deprived cohort) were associated with increased odds of prolonged LOS following revision TJA compared to those in the lowest ADI quartile (OR = 2.63; p < 0.001). ConclusionThis study suggests that higher levels of neighborhood-level disadvantage may be associated with higher odds of non-home discharge and prolonged LOS following revision TJA. Development of interventions based on the area deprivation index may improve discharge planning and reduce unnecessary non-home discharges in patients living in areas of socioeconomic deprivation.

Dietary fibre intake, adiposity, and metabolic disease risk in Pacific and New Zealand European women

The aim of this study was to explore associations between habitual dietary fibre intake, adiposity, and biomarkers of metabolic health in Pacific and New Zealand European women who are known to have different metabolic disease risks. Pacific (n = 126) and New Zealand European (NZ European; n = 161) women (18-45years) were recruited to the PROMISE cross-sectional study(1) based on normal (18-24.9kg/m2) and obese BMI (≥30kg/m2). Body fat percentage (BF%), measured using whole body DXA, was used to stratify participants into low (&lt;35%) or high (≥35%) BF% groups. Habitual dietary intake was calculated using the National Cancer Institute method, involving a 5-day-food-record and a semi-quantitative FFQ. Fasting blood was analysed for glucose, insulin, and lipid profile. NZ European women in the low- and high-BF% groups were older, less socioeconomically deprived, and consumed more dietary fibre (median 23.7g/day [25-75-percentile, 20.1, 29.9]; 20.9 [19.4, 24.9]) than Pacific women (18.8 [15.6, 22.1]; 17.8 [15.0, 20.8]; both p&lt;0.001), respectively. Pacific women consumed a higher proportion of their total fibre intake from discretionary fast foods, in contrast NZ European women consumed more dietary fibre from wholegrains. Regression analysis controlling for ethnicity, age, socioeconomic deprivation, energy intake, protein, total carbohydrate, and fat intake showed significant inverse associations between higher dietary fibre intake and BF% and visceral fat% (β = −0.47, 95% CI = −0.62, −0.31, p&lt;0.001; β = −0.61, [−0.82, −0.40], p&lt;0.001, respectively) among both Pacific and NZ European women. LDL-C (β = −0.04, [−0.06, −0.01]) was inversely associated with fibre intake following further adjustment for BF%-groups in NZ European women. Despite differences in intake, dietary fibre was inversely associated with adiposity and metabolic disease risk in both Pacific and NZ European women. However younger woman living in areas of higher socio-economic deprivation who consumed a higher proportion of total dietary fibre intake from discretionary fast foods were more likely to have low dietary fibre intakes than older, wealthier women. These women were also more likely to be Pacific women. Increasing habitual dietary fibre intake could help to reduce adiposity and metabolic disease risk; so implementing policies that make health-promoting high fibre foods more affordable, ensuring households have sufficient income to purchase nutritious food and limiting the amount of unhealthy food marketing that low income communities are exposed to should be public health priorities.

Socioeconomic Deprivation and Health Care Use in Patients Enrolled in SWOG Cancer Clinical Trials

Reducing acute care use is an important strategy for improving value. Patients with cancer are at risk for unplanned emergency department (ED) visits and hospital stays (HS). Clinical trial patients have homogeneous treatment; despite this, structural barriers to care may independently impact acute care use. To examine whether ED visits and HS within 12 months of trial enrollment are more common among Medicare enrollees who live in areas of socioeconomic deprivation or have Medicaid insurance. This cohort study included patients with cancer who were 65 years or older and treated in SWOG Cancer Research Network trials from 1999 to 2018 using data linked to Medicare claims. Data were collected from 1999 to 2019 and analyzed from 2022 to 2024. Outcomes were ED visits, HS, and costs in the first year following enrollment. Neighborhood socioeconomic deprivation was measured using patients' zip code linked to the Area Deprivation Index (ADI), measured on a 0 to 100 scale for increasing deprivation and categorized into tertiles (T1 to T3). Type of insurance was classified as Medicare with or without commercial insurance vs dual Medicare and Medicaid. Demographic, clinical, and prognostic factors were captured from trial records. Multivariable regression was used, and the association of ADI and insurance with each outcome was considered separately. In total, 3027 trial participants were analyzed. The median (range) age was 71 (65-98) years, 1280 (32.3%) were female, 221 (7.3%) were Black patients, 2717 (89.8%) were White patients, 90 (3.0%) had Medicare and Medicaid insurance, and 660 (22.3%) were in the areas of highest deprivation (ADI-T3). In all, 1094 patients (36.1%) had an ED visit and 983 patients (32.4%) had an HS. In multivariable generalized estimating equation, patients living in areas categorized as ADI-T3 were more likely to have an ED visit (OR, 1.34; 95% CI, 1.10-1.62; P = .004). A similar but nonsignificant pattern was observed for HS (OR, 1.36; 95% CI, 0.96-1.93; P = .08). Patients from areas with the highest deprivation had a 62% increase in risk of either an ED visit or HS (OR, 1.62; 95% CI, 1.25-2.09; P < .001). Patients with Medicare and Medicaid were 96% more likely to have an ED visit (OR, 1.96; 95% CI, 1.56-2.46; P < .001). In this cohort of older patients enrolled in clinical trials, neighborhood deprivation and economic disadvantage were associated with an increase in ED visits and HS. Efforts are needed to ensure adequate resources to prevent unplanned use of acute care in socioeconomically vulnerable populations.

Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions

BackgroundPhysical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently.MethodsThe aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM’s design, implementation and/or delivery. Data was analysed using Braun and Clarke’s reflexive thematic analysis.ResultsFour themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change.ConclusionsThese findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.

An evaluation of the social deprivation practice grant in Irish general practice.

The inverse care law states that availability of good medical care varies inversely with the need for it in the population served. In 2019, the main medical union and the Department of Health in the Republic of Ireland (RoI), agreed on funding a social deprivation practice grant for general practices in urban deprived areas. To examine the implementation and impact of the social deprivation practice grant in participating general practices. A mixed-methods study with sequential design based in Irish general practice. Data were collected using a questionnaire and online semi-structured interviews with GPs and practice staff. Data were analysed separately, and the findings compared to examine the extent to which they converged or diverged. There were 25 survey responses and nine interviews. All practices reported the grant was beneficial and most practices utilised the grant to fund additional doctor hours (17/25). Both surveys and interviews indicated that a small amount of additional funding allowed additional clinical need in areas of deprivation to be addressed, but there were some barriers identified in accessing the grant and implementing planned expenditure. Delivery of health care in areas of socioeconomic deprivation presents significant challenges. While there were some problems with implementation, the introduction of a small, targeted grant for general practices in areas of social deprivation allowed those practices to enhance their services, with tailored initiatives seeking to meet the needs of their patient populations.

Real-world Trends, Rural-urban Differences, and Socioeconomic Disparities in Utilization of Narrow versus Broad Next-generation Sequencing Panels.

We identified socioeconomic and rurality disparities in the use of genomic tests and trial matching by panel size, which may have implications for equal access to targeted therapies. The lack of association between large panel tests and clinical trial matching by socioeconomic status, suggests a potential health equity impact, while removing barriers in access to large panels for rural patients may improve access to trials. However, further research is needed.

Effect of timeframes to define long term conditions and sociodemographic factors on prevalence of multimorbidity using disease code frequency in primary care electronic health records: retrospective study

ObjectiveTo determine the extent to which the choice of timeframe used to define a long term condition affects the prevalence of multimorbidity and whether this varies with sociodemographic factors.DesignRetrospective study...

Periodontitis and Outer Retinal Thickness: a Cross-Sectional Analysis of the United Kingdom Biobank Cohort

PurposePeriodontitis, a ubiquitous severe gum disease affecting the teeth and surrounding alveolar bone can heighten systemic inflammation. We investigated the association between very severe periodontitis and early biomarkers of age-related macular degeneration, in individuals with no eye disease. DesignCross-sectional analysis of the prospective community-based cohort United Kingdom (UK) Biobank. ParticipantsSixty-seven thousand three hundred eleven UK residents aged 40-70 years recruited between 2006-2010 underwent retinal imaging. MethodsMacular-centered optical coherence tomography images acquired at the baseline visit were segmented for retinal sublayer thicknesses. Very severe periodontitis was ascertained through a touchscreen questionnaire. Linear mixed effects regression modeled the association between very severe periodontitis and retinal sublayer thicknesses adjusting for age, sex, ethnicity, socioeconomic status, alcohol consumption, smoking status, diabetes mellitus, hypertension, refractive error, and previous cataract surgery. Main Outcome MeasuresPhotoreceptor layer (PRL) and retinal pigment epithelium-Bruch’s membrane (RPE-BM) thicknesses. ResultsAmong 36,897 participants included in the analysis, 1,571 (4.3%) reported very severe periodontitis. Affected individuals were older, lived in areas of greater socioeconomic deprivation and were more likely to be hypertensive, diabetic and current smokers (all p<0.001). On average, those with very severe periodontitis were myopic (-0.29 ± 2.40 diopters) while those unaffected were hyperopic (0.05 ± 2.27 diopters, p<0.001). Following adjusted analysis, very severe periodontitis was associated with thinner PRL (-0.55 μm, 95% CI: -0.97, -0.12, p=0.022) but there was no difference in RPE-BM thickness (0.00 μm, 95% CI: -0.12, 0.13, p=0.97). The association between PRL thickness and very severe periodontitis was modified by age (p<0.001). Stratifying individuals by age, thinner PRL was seen among those aged 60-69 years with disease (-1.19 μm, 95% CI: -1.85, -0.53, p<0.001) but not among those under 60 years. ConclusionsAmong those with no known eye disease, very severe periodontitis is statistically associated with a thinner PRL, consistent with incipient age-related macular degeneration. Optimizing oral hygiene may hold additional relevance for people at risk of degenerative retinal disease.

How to address the inverse care law and increase GP recruitment in areas of socioeconomic deprivation: a qualitative study of GP trainees' views and experiences in the UK.

The Deep End network in the North East and North Cumbria (NENC) was set up to tackle health inequalities in general practice. One aim is to address the inverse care law and improve recruitment of GPs, which is known to be especially challenging in areas of socioeconomic deprivation. To explore GP trainees' experiences and perceptions of working in Deep End or Deprived Area Practices (DE/DAPs) to identify how GP recruitment can be improved. Qualitative study recruiting 13 doctors training to be GPs from the Northumbria training programme. Audio-recorded, online, semi-structured interviews and discussion groups were undertaken, transcribed verbatim, and analysed with a grounded theory approach, using a process of thematic analysis. Overall, seven interviews and two discussion groups (13 participants in total) were conducted. Three themes were identified. The first theme was working in areas of socioeconomic deprivation is challenging but has many advantages. The challenges of working in DE/DAPs were not deterring factors for GP trainees wanting to work in areas of socioeconomic deprivation. The second theme was trainees are willing to work in areas of socioeconomic deprivation but clinical experience is important. Training in DE/DAPs gives trainees the confidence to work in areas of deprivation. Familiarity with a practice also makes them more likely to stay post-training. The third theme was financial incentives are not an important attracting factor but support and development opportunities are. Non-pecuniary measures, such as clinical support and protected time for continuing professional development (CPD), were found to be important. To improve recruitment to DE/DAPs, investments should be made to increase the opportunities to train in these environments. This can be achieved by supporting more DE/DAPs to become training practices, and providing clinical support and protected time for CPD.

Factors Associated With New Analgesic Requirements Following Critical Illness.

Chronic opioid use represents a significant burden to global healthcare with adverse long-term outcomes. Elevated patient reported pain levels and analgesic prescriptions have been reported following discharge from critical care. We describe analgesic requirements following discharge from hospital and identify if a critical care admission is a significant factor for stronger analgesic prescriptions. This retrospective observational cohort study identified patients in the UK Biobank with a registered admission to any UK hospital between January 1, 2010 and December 31, 2015 and information on prescriptions drawn both prior to and following hospital discharge. Two matched cohorts were created from the dataset: critical care patients and hospital patients admitted without a critical care encounter. Outcomes were analgesic requirements following hospital discharge and factors associated with increased analgesic prescriptions. Multivariable logistic regression was used to identify factors associated with prescriptions from higher steps on the World Health Organization (WHO) analgesic ladder. In total, 660 formed the total study population. Strong opioid prescriptions following discharge were significantly higher in the critical care cohort (P value <.001). Critical care admission (OR = 1.45) and increasing Townsend deprivation (OR = 1.04) index were significantly associated with increasing strength of analgesic prescriptions following discharge. Critical care patients require stronger analgesic prescriptions in the 12 months following hospital discharge. Patients from areas of high socioeconomic deprivation may also be associated with increased analgesic requirements. Multidisciplinary support is required for patients who may be at risk of chronic opioid use and could be delivered within critical care recovery programs.

Centre‐based early education interventions for improving school readiness: A systematic review

Centre‐based early education interventions for improving school readiness: A systematic review

EGS P08 The effect of socioeconomic status on traumatic liver injuries: A prospective multicentre study

Abstract Background Abdominal traumas only represent 10% of all trauma-related injuries but is associated with significant morbidity and mortality. This is especially true for liver and pancreatic injuries. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and trauma in recent years. Evidence from the US demonstrates that social deprivation is strongly associated with violent traumas and more severe injuries. There is, however, a lack of research examining the relationship between socioeconomic deprivation and severe abdominal traumas. This prospective multicentre audit investigates the association between socioeconomic status and the mechanisms and outcomes of liver and pancreatic traumas. Methods This prospective, multicentre audit was conducted through the National Trauma Research and Innovation Collaborative at18 participating major trauma centres and units in the United Kingdom between 01/01/2021 and 01/10/2021. The differences in patient demographics, mechanism of injury, injury severity score, operative management, length of hospital stay, and mortality were compared between patients from the five socioeconomic groups. The socioeconomic status for each patient was determined using the Index of Multiple Deprivation (IMD) tool, which is a recognised and validated tool published by the UK government. Chi-squared, Fisher’s Exact, and Kruskal-Wallis tests were used to compare categorical variables as appropriate. Results Of the 232 patients included, 75% were male. There is an increasing trend of deprivation in males, with 82.9% of the most deprived patients being male compared to the 66.7% in the least deprived quintile. The most deprived group had a lower comorbidity burden and were younger with a median age of 26 (IQR 19-39) compared to the least deprived group (median age 42, IQR 28-61,p&amp;lt;0.01). Penetrating injuries occurred more frequently in the 3 most deprived groups, although this was not significant (p=0.09). There were no differences in the management, length of stay, and mortality between the 5 socioeconomic groups. Conclusions The findings of this prospective study adds to the growing body of evidence associating socioeconomic deprivation and major trauma in the UK. Despite the differences in patient demographics across the socioeconomic groups, the definitive management and mortality did not differ. The planning and provision of preventative public health intervention should target areas of higher socioeconomic deprivation.

Maternal depressive symptoms and child language development: Exploring potential pathways through observed and self-reported mother-child verbal interactions

AbstractMaternal depressive symptoms (MDS) in the postnatal period may impact children’s later development through poorer quality parent-child interactions. The current study tested a specific pathway from MDS (child age 9 months) to child receptive vocabulary (4 ½ years) through both self-reported and observed parent-child verbal interactions (at both 2 and 4 ½ years). Participants (n = 4,432) were part of a large, diverse, contemporary pre-birth national cohort study: Growing Up in New Zealand. Results indicated a direct association between greater MDS at 9 months and poorer receptive vocabulary at age 4 ½ years. There was support for an indirect pathway through self-reported parent-child verbal interactions at 2 years and through observed parent-child verbal interactions at 4 ½ years. A moderated mediation effect was also found: the indirect effect of MDS on child vocabulary through observed verbal interaction was supported for families living in areas of greater socioeconomic deprivation. Overall, findings support the potential role of parent-child verbal interactions as a mechanism for the influence of MDS on later child language development. This pathway may be particularly important for families experiencing socioeconomic adversity, suggesting that effective and appropriate supportive parenting interventions be preferentially targeted to reduce inequities in child language outcomes.

The wider health and wellbeing needs of those accessing paediatric care in England: engaging with the hidden voices of children and young people

BackgroundHealth need is inextricably linked with inequalities. Health outcomes are worse for those in lower socio-economic groups, ethnic minority groups, and those with protected characteristics. In the UK, this has been compounded by the COVID-19 pandemic and the cost-of-living crisis. Children and young people accessing hospitals can have unmet health and wellbeing needs, yet the role of hospitals in addressing these is not clear. We engaged with children and young people and caregivers from under-represented groups, often excluded from patient and public involvement, to understand their experiences, in order to support the co-design of future research and interventions. MethodsA series of virtual and physical engagement events were held in Northwest England between March 9, and May 19, 2023. Community groups in areas of high socioeconomic deprivation, carers of children living with disabilities, adolescent care leavers, and school children were contacted through local websites. The concept of health inequalities was introduced at the start of sessions, and participants were encouraged to reflect on their own experiences. Discussions were co-facilitated with community leaders. Events focused on exploring experiences of health inequalities in relation to health care and views on future research. Ethics approval was not required as this was preparatory work; however, written consent was sought. Financial compensation was provided. FindingsA total of 30 participants (aged 10 years and older) participated in four, 90 min events. Themes included: difficulties with transport and navigating services, lack of staff awareness about disabilities, and concerns about transitioning to adult services. Groups expressed varied opinions about research into health inequalities. The topic was considered to be important, and remuneration for participation was felt to be crucial. This is important because of the long-term nature of health inequality outcomes, which result in no immediate benefit to participants themselves. InterpretationUsers of health-care services—including rarely heard groups—welcome research into health inequalities, but they identified important future considerations. Limitations of the work include its small scale and its location in a single geographical area. The outputs of this study will be combined with a scoping review and a review of local population data and will be essential in designing future research and producing recommendations for health-care services. FundingManchester University NHS Foundation Trust Charity.