United Kingdom Population Research Articles

Clinical Characteristics of Patients With Chronic Stevens-Johnson Syndrome Treated at a Major Tertiary Eye Hospital Within the United Kingdom.

The purpose of this study is to provide a comprehensive review of the clinical characteristics in chronic Stevens-Johnson syndrome (SJS) patients within the United Kingdom population, their causative factors, treatment profile and prognosis. This retrospective series included 91 patients with chronic SJS treated at Moorfields Eye Hospital (London, United Kingdom). A chart review included visual acuity and presence of clinical findings (including lid abnormalities and ocular surface findings). All medical and surgical treatments were also recorded. Approximately a half of patients were White British but there were significant numbers of patients from other ethnic groups, South Asian and Black in particular. Oral antibiotics were the causative agent in almost a half of the patients with SJS, systemic infections in 14%, non-steroidal anti-inflammatory drugs in 8% and anticonvulsants in 7%. The age of onset was varied but a significant proportion of patients developed acute SJS in childhood. There was a significant correlation between visual acuity at initial referral to final recorded vision. Vision was found to continue to significantly deteriorate over time despite therapeutic interventions. Our regression model shows that ~62% of the variance in final vision can be explained by the initial vision and duration disease. The majority of our patients were on advanced ocular surface treatments including serum drops, topical ciclosporin and retinoic acid drops. Of particular significance, approximately a third of our patient cohort was also on systemic immune suppression. In conclusion, chronic SJS within the UK population under tertiary care remains an area of unmet clinical need. Current medical and surgical modalities prevent worsening of vision in severe ocular disease from SJS.

UK general population willingness to pay for scale and polish, and detailed and personalized oral hygiene advice.

Understanding the value the general population place on dentistry services is important for policymakers to aide service planning. Willingness to pay (WTP) is an economic method used to elicit the value of a good or service. The aim of this study is to estimate United Kingdom (UK) general population WTP for commonly provided scale and polish, and detailed and personalized oral hygiene advice (OHA), and to investigate what factors influence WTP. Participants completed an online hypothetical WTP survey for scale and polish and detailed and personalized oral hygiene advice. The estimation sample consisted of 1405 participants, nationally representative of the UK general population in terms of age and sex. Regression analysis was used to estimate WTP and determine what factors are associated with WTP. Analyses were conducted including and excluding protest answers. The mean (SD) WTP for a scale and polish is £26.77 (£21.91) excluding protest answers and £24.80 (£22.71) for the full sample. The mean (SD) WTP for detailed and personalized OHA is £16.56 (£19.75) excluding protest answers and £12.77 (£22.28) for the full sample. Participants on higher incomes, private attenders and those who stated that maintaining clean and healthy gums was important had higher WTP for both services. Participants in Scotland and Northern Ireland were WTP less than their English counterparts, reflecting the different regional specific payment systems. The general UK population value scale and polish, and detailed and personalized OHA. This study provides estimates of WTP for these services which can be used to inform resource allocation decisions.

An exploration of normative values in New Zealand to inform the Targeted Interventions for Patellofemoral Pain approach

BackgroundThe Targeted Interventions for Patellofemoral Pain studies (TIPPs) have identified three subgroups exist in United Kingdom and Turkish patellofemoral pain (PFP) populations: Strong; Weak and Tight; and Weak and Pronated, based on six clinical assessments. The thresholds used to develop the subgrouping algorithms were based on normative values sourced from various populations and countries. ObjectivesExplore normative scores from the clinical assessments in a singular non-PFP population whilst considering potential differences between ethnicities and sex (primary aim). Revisit inter-rater reliability of each assessment (secondary aim). DesignCross-sectional and test-retest. MethodThe six assessments; rectus femoris length, gastrocnemius length, patellar mobility, hip abductor strength, quadriceps strength, and Foot Posture index (FPI) were measured in 89 New Zealanders (34% Māori, 45% female). Two raters independently assessed 17 participants to examine inter-rater reliability. ResultsSignificant interactions between ethnic group and sex were noted for rectus femoris length and patella mobility. Māori versus European males exhibited greater rectus femoris tightness (p = 0.001). Māori versus European females demonstrated greater patellar mobility (p = 0.002). Females were significantly weaker than males in normalised strength measures (p < 0.001), and had lower FPIs. Mean differences between testers for all measures were small and not significant, except for FPI which had a 2.0 point median difference (p = 0.021). ConclusionsOur results indicate that sex is an important factor worth considering within the TIPPs subgrouping approach, more than ethnicity, especially for the normalised strength measures. The sub-optimal reliability of FPI warrant reconsideration of its inclusion within TIPPs.

Experiences and emotional strain of NHS frontline workers during the peak of the COVID-19 pandemic

Background:The mental health of the population has been negatively affected due to the pandemic. Frontline healthcare workers with increased exposure to COVID diagnosis, treatment and care were especially likely to report psychological burden, fear, anxiety and depression.Aim:To elicit how working as a health professional during the pandemic is impacting on the psychological wellbeing of frontline staff.Method:United Kingdom population of healthcare workers were approached by advertising the survey via social media, NHS trusts and other organisations. Open-ended survey answers were qualitatively explored using content analysis.Results:Survey collected data from 395 NHS staff was developed into three themes; (1) Despair and uncertainty: feeling overwhelmed trying to protect everyone, (2) Behavioural and psychological impact: affecting wellbeing and functioning and (3) Coping and employer support: getting the right help.Conclusion:NHS staff felt enormous burden to adequately complete their professional, personal and civil responsibility to keep everyone safe leading to negative psychological and behavioural consequences and desire for NHS employers to offer better support. As the pandemic progresses, the results of this study may inform NHS employers on how optimum support can be offered to help them cope with negative psychological consequences of the pandemic.

Clinical and Economic Burden of Mild-to-Moderate Atopic Dermatitis in the UK: A Propensity-Score-Matched Case-Control Study.

IntroductionThe burden of mild-to-moderate atopic dermatitis (AD) in the United Kingdom (UK) is not well understood. Long-lasting AD flares may lead to systemic inflammation resulting in reversible progression from mild to more severe AD. This study aimed to assess the clinical and economic burden of mild-to-moderate AD in the UK.MethodsAD patients were identified in the Health Improvement Network (THIN) from 2013 to 2017 and propensity score matched to non-AD controls by demographics. Patients were identified based on continuous disease activity using validated algorithms and sufficient patient status to fully validate data integrity for the entire period. Mild-to-moderate AD patients were identified by using treatment as a surrogate. Demographics, clinical characteristics and healthcare resource use (HCRU) were obtained from THIN. Literature reviews were conducted to obtain additional outcomes. A cost-of-illness model was developed to extrapolate the burden in 2017 to the UK population and in subsequent years (2018–2022).ResultsIn 2017, the prevalence of mild-to-moderate AD in THIN was 1.28%. These patients reported higher comorbidity rates and significantly higher (p < 0.0001) HCRU, encompassing mean general practitioner visits (5.57 versus 3.59), AD-related prescriptions (5.85 versus 0.68) and total referrals (0.97 versus 0.82) versus matched non-AD controls. The model projected total HCRU and drug excess costs of €462.99M over the 5 years. The excess cost decreased to €417.35M after excluding patients on very potent topical corticosteroids, who most likely had at least moderate disease. The excess costs increased to €1.21B and €7.06B when considering comorbidity burden and productivity losses, respectively.ConclusionMild-to-moderate AD patients had higher comorbidity burden, HCRU and cost compared with matched non-AD controls. Overall, UK country-based economic burden was high given partly the high prevalence of this disease. Moreover, productivity burden and comorbidities had considerable impact on the economic burden, which further suggests the importance of optimal disease management.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00519-7.

Manipulating the Microbiome: An Alternative Treatment for Bile Acid Diarrhoea

Bile acid diarrhoea (BAD) is a widespread gastrointestinal disease that is often misdiagnosed as irritable bowel syndrome and is estimated to affect 1% of the United Kingdom (UK) population alone. BAD is associated with excessive bile acid synthesis secondary to a gastrointestinal or idiopathic disorder (also known as primary BAD). Current licensed treatment in the UK has undesirable effects and has been the same since BAD was first discovered in the 1960s. Bacteria are essential in transforming primary bile acids into secondary bile acids. The profile of an individual’s bile acid pool is central in bile acid homeostasis as bile acids regulate their own synthesis. Therefore, microbiome dysbiosis incurred through changes in diet, stress levels and the introduction of antibiotics may contribute to or be the cause of primary BAD. This literature review focuses on primary BAD, providing an overview of bile acid metabolism, the role of the human gut microbiome in BAD and the potential options for therapeutic intervention in primary BAD through manipulation of the microbiome.

Non-white cases of sporadic Creutzfeldt-Jakob disease: A 28 year review of United Kingdom National Surveillance Data

AimsDescriptions of sporadic Creutzfeldt-Jakob disease (sCJD) in non-White populations are limited. Improved understanding may aid diagnoses and case ascertainment within surveillance programmes. We aimed to: 1) Ascertain the proportion of sCJD cases with non-White ethnicity in the United Kingdom (UK); 2) Compare clinical and investigation findings between non-White and White cases. MethodsWe analysed records of probable and definite sCJD cases assessed by the UK National CJD Research and Surveillance Unit over 28 years (1990–2017). Cases were stratified into White and non-White groups. Demographics, clinical features, investigation findings, and post-mortem numbers were compared. Results1697 sCJD cases were included: 1642 (97%) White, 55 (3%) non-White (Asian/Asian British, Black/African/Caribbean). The proportion of non-Whites among sCJD cases is 7% lower than the proportion the non-White population make up in the UK (p < 0.001). This was not statistically significant when age-matched by ≥60 years (p = 0.071). Age at symptom onset was 4 years lower in the non-White population (p = 0.007). Clinical and investigation characteristics were otherwise similar between ethnic groupings. The proportion of non-Whites undergoing autopsy and classification as definite was 30% and 24% lower (p < 0.001) respectively in comparison to those for White cases. ConclusionsApproximately 3% of sCJD cases in the UK are non-White, despite non-Whites representing approximately 10% of the UK population. This difference was not statistically significant when age-matched at ≥60 years. Non-White cases tend to be younger and likelihood of autopsy is lower; relevant considerations for surveillance programmes. Reasons for these differences in non-White populations are unclear and merit further evaluation.

Waist circumference prediction for epidemiological research using gradient boosted trees

BackgroundWaist circumference is becoming recognized as a useful predictor of health risks in clinical research. However, clinical datasets tend to lack this measurement and self-reported values tend to be inaccurate. Predicting waist circumference from standard physical features could be a viable method for generating this information when it is missing or mitigating the impact of inaccurate self-reports. This study determined the degree to which the XGBoost advanced machine learning algorithm could build models that predict waist circumference from height, weight, calculated Body Mass Index, age, race/ethnicity and sex, whether they perform better than current models based on linear regression, and the relative importance of each feature in this prediction.MethodsWe trained tree-based models (via XGBoost gradient boosting) and linear models (via regression) to predict waist circumference from height, weight, Body Mass Index, age, race/ethnicity and sex (n = 60,740 participants). We created 10 iterations of each model, each using 90% of the dataset for training and the remaining 10% for testing performance (this group was different for each iteration). We calculated model performance and feature importance as an average across 10 iterations. We then externally validated the ensembled version of the top model.ResultsThe XGBoost model predicted waist circumference with a mean bias ± standard deviation of 0.0 ± 0.04 cm and a root mean squared error of 4.7 ± 0.05 cm, with performance varying slightly by sex and race/ethnicity. The XGBoost model showed varying degrees of improvement over linear regression models. The top 3 predictors were Body Mass Index, weight and race (Asian). External validation found that on average this model overestimated waist circumference by 4.65 cm in the United Kingdom population (mainly due to overprediction in females) and underestimated waist circumference by 1.7 cm in the Chinese population. The respective root mean squared errors were 7.7 cm and 7.1 cm.ConclusionsXGBoost-based models accurately predict waist circumference from standard physical features. Waist circumference prediction using this approach would be valuable for epidemiological research and beyond.

COVID-19 demand-induced scarcity effects on nutrition and environment: investigating mitigation strategies for eggs and wheat flour in the United Kingdom.

The COVID-19 pandemic has drawn attention to food insecurity in developed countries. Despite adequate levels of agricultural production, consumers experienced demand-induced scarcity. Understanding the effects on nutrition and the environment is limited, yet critical to informing ecologically embedded mitigation strategies. To identify mitigation strategies, we investigated wheat flour and egg retail shortages in the United Kingdom (UK), focusing on consumer behavior during the COVID-19 lockdown. The 6 Steps for Quality Intervention Development (6SQuID) framework informed the methodology. Mixed qualitative and quantitative methods were used to pinpoint the causes of the shortages, and ecological impacts of consumer behavior were related using survey results (n = 243) and environmental and nutritional databases. This research confirmed consumers’ narrowed consideration set, willingness to pay, and significant reliance on processed foods which indicates agronomic biofortification, breeding strategies, selective imports and improved processed food quality are important mitigation strategies. We identified positive and negative synergies in consumer, producer and retailer behavior and related these to mitigation strategies in support of a circular bio-economy for food production. We found that the substitutes or alternative foods consumed during the COVID-19 lockdown were nutritionally inadequate. We identified the most ecological substitute for wheat flour to be corn flour; and for eggs, yogurt. Our findings also indicate that selenium deficiency is a risk for the UK population, especially to the increasing fifth of the population that is vegetarian. Due to the need to implement short-, medium-, and long-term mitigation strategies, a coordinated effort is required by all stakeholders.

The SPECTRUM Consortium: a new UK Prevention Research Partnership consortium focussed on the commercial determinants of health, the prevention of non-communicable diseases, and the reduction of health inequalities.

The main causes of non-communicable diseases (NCDs), health inequalities and health inequity include consumption of unhealthy commodities such as tobacco, alcohol and/or foods high in fat, salt and/or sugar. These exposures are preventable, but the commodities involved are highly profitable. The economic interests of 'Unhealthy Commodity Producers' (UCPs) often conflict with health goals but their role in determining health has received insufficient attention. In order to address this gap, a new research consortium has been established. This open letter introduces the SPECTRUM ( S haping Public h Ealth poli Cies To Reduce ineq Ualities and har M)Consortium: a multi-disciplinary group comprising researchers from 10 United Kingdom (UK) universities and overseas, and partner organisations including three national public health agencies in Great Britain (GB), five multi-agency alliances and two companies providing data and analytic support. Through eight integrated work packages, the Consortium seeks to provide an understanding of the nature of the complex systems underlying the consumption of unhealthy commodities, the role of UCPs in shaping these systems and influencing health and policy, the role of systems-level interventions, and the effectiveness of existing and emerging policies. Co-production is central to the Consortium's approach to advance research and achieve meaningful impact and we will involve the public in the design and delivery of our research. We will also establish and sustain mutually beneficial relationships with policy makers, alongside our partners, to increase the visibility, credibility and impact of our evidence. The Consortium's ultimate aim is to achieve meaningful health benefits for the UK population by reducing harm and inequalities from the consumption of unhealthy commodities over the next five years and beyond.

Online survey into developing a model for a legal cannabis market in the United Kingdom

Background Despite rescheduling of cannabis to Schedule 2 and amendments to the law permitting legal availability of cannabis for the treatment of medical conditions, access to cannabis for medical use remains challenging for patients in the United Kingdom (UK). Recreational use is widespread despite laws stating users can be sentenced to prison for up to 5 years for possession. Objective The aim of the study was to develop a model for a legal cannabis market in the UK building upon the results of a preceding study in which a UK population sample determined that pharmacies are the most suitable primary legal vendor of cannabis as opposed to regulated shops or the black market. Methods An online survey was developed using Qualtrics software and advertised via the Multidisciplinary Association for Psychedelic Studies’ Facebook, Twitter and Instagram social media accounts and monthly newsletter. Results Three hundred and ninety seven individuals, a majority having used cannabis at least once, consented to participate in the study. The participants concluded that there is enough evidence for cannabis to be prescribed to treat a range of medical conditions. In addition to pharmacies providing cannabis to patients with a prescription, a majority of participants supported cannabis being sold in pharmacies for harm reduction purposes and allowing access to medicinal cannabis in cases where supporting evidence is insufficient to merit a prescription. Participants supported greater integration between dispensing pharmacies and mental health services. Overall, the participants did not oppose a consultation or screening for potential cannabis users prior to obtaining access from licensed vendors. UK participants were supportive of the concept of a cannabis card, which users can present to licensed vendors such as pharmacies, with specific recommendations (such as strains relevant to a patient’s medical condition) being coded into the card. A majority of participants supported the existence of shisha-type bars for the purchase and onsite consumption of cannabis and determined that such vendors should not be part of a pharmacy chain of stores or regulated by pharmacy regulators. The participants generally preferred that laws regarding public consumption are in line with existing smoking legislation. Participants determined that it should be legally permitted to grow cannabis at home for personal medical and non-medical purposes but not to sell for profit. Conclusion The results are suggestive of a regulatory system that medical and non-medical cannabis users can use which aims to maximise therapeutic applications, minimise harms and respect individual liberty.

1481. Incidence of Pertussis in Older Adults in England and the United Kingdom: A Large, Retrospective Database Analysis

BackgroundPertussis affects people of all ages and can lead to severe complications in adults, including hospitalization. Pertussis immunity, whether vaccine-induced or from natural infection, wanes over time. Therefore, despite extensive pediatric vaccination against pertussis, adults remain susceptible to the disease. Here we present the reported incidence of pertussis in people ≥ 50 years old (≥ 50yo) in England and the United Kingdom (UK).MethodsWe performed an observational, retrospective database analysis using the UK Clinical Practice Research Datalink GOLD and Aurum primary care databases, and Hospital Episode Statistics database when available for English subjects (HES-Eng), 2009-2018. Occurrence of pertussis was identified by diagnostic codes recorded in primary care only for the UK subset, and primary care and/or secondary care for HES-Eng.ResultsIn the ≥ 50yo UK population, a total of 47.1 million (m) person-years of follow-up (PYFU) including 28.5m PYFU for HES-Eng, were included. In the UK, the pertussis Incidence Rate (IR) across all years was 5.44 per 100,000 PYFU. Yearly IRs ranged from 0.79 – 11.40 per 100,000 PYFU and reflected the cyclic epidemiology of pertussis. A peak of IR was observed in 2012, known to be an outbreak year, and observed IRs were higher in 2013-2018 (4.75 – 9.73 per 100,000 PYFU) than 2009-2011 (0.79 – 1.48 per 100,000 PYFU). In the HES-Eng population, overall IR was 5.76 per 100,000 PYFU. IRs were highest in the younger age groups (HES-Eng: 8.88 in 50-54 yo; 1.42 in ≥ 85 yo) (see table 1 and 2).Table 1 Table 2 ConclusionThe observed reported IR of pertussis was similar in the UK and HES-Eng populations, noting the inclusion of secondary care diagnoses in the latter. The dynamics of IRs across years are consistent with estimated IRs from Public Health England data. Considering the burden of pertussis established elsewhere in older adults, and their non-negligible contribution to the whole population incidence, strategies for the prevention of pertussis should include this age group.DisclosuresEmmanuel Aris, PhD, the GSK group of companies (Employee, Shareholder) Esse Ifebi Akpo, n/a, the GSK group of companies (Employee, Shareholder) Amit Bhavsar, MBBS, MHA, the GSK group of companies (Employee) Lauriane Harrington, n/a, the GSK group of companies (Employee) Evie Merinopoulou, MSc, Evidera Ltd (Employee)the GSK group of companies (Consultant) Nicola Sawalhi-Leckenby, MSc, Evidera Ltd (Employee)the GSK group of companies (Consultant) Elisa Turriani, PhD, the GSK group of companies (Employee) Kinga Meszaros, MBA, the GSK group of companies (Employee, Shareholder) Dimitra Lambrelli, PhD, MPharm, Evidera Ltd (Employee)the GSK group of companies (Consultant) Piyali Mukherjee, MBBS, MPH, the GSK group of companies (Employee, Shareholder)

Familial chylomicronaemia syndrome: National genetics testing results from the United Kingdom

Background and Aims: Familial chylomicronaemia syndrome (FCS) is a rare disorder of lipid metabolism characterised by severe (>10mmol/L) fasting hypertriglyceridaemia and elevated circulating chylomicrons. MEDLINE and Embase literature searches established that only limited published data is available about genetic causes of FCS affecting the United Kingdom population. In this study, we aimed to provide the most comprehensive overview to date of FCS mutations identified within the United Kingdom.

Micro-simulation model to predict effects of low-dose aspirin on colorectal cancer, cardiovascular disease and safety outcomes among low-dose aspirin users

Abstract Background Regular use of low-dose aspirin (LDA) has been shown to reduce the risk of cardiovascular disease (CVD). Recent evidence indicates that regular LDA use also reduces the risk of colorectal cancer (CRC). Use of LDA has also been associated with an increased risk of gastrointestinal (GI) bleeding, peptic ulcers and intracranial hemorrhage (ICH). Purpose We aim to evaluate the population-level benefits and risks of daily and/or regular LDA among individuals taking LDA for primary or secondary CVD prevention in the United Kingdom (UK) accounting for the evidence on the reduced CRC risk. Methods Individual-level state transition modelling was used to predict the impact of LDA on CRC, CVD, safety events (GI bleeding, ICH and symptomatic peptic ulcers) and related deaths in a UK population. Individual event histories were simulated for hypothetical cohorts of 1 million adults aged 50–59 years and aged 60–69 years indicated to take LDA for primary or secondary CVD prevention. The QRISK CVD prediction score was used to simulate adults indicated to use LDA for CVD prevention. Model parameters were informed based on published scientific literature on CVD, CRC and safety outcomes mimicking the UK epidemiology and prevention guidelines. Monte Carlo simulation was used to account for parameter uncertainty. Results In the cohort of subjects for which low-dose aspirin use was initiated between 50–59 years, the decrease in incidence rates (IRs) (per 100,000person years) of non-fatal CVD was smaller when low-dose aspirin use was initiated for primary prevention compared to initiation for secondary prevention (−203 [95% UI, −277 to −115] versus −794 [95% UI, −997 to −536]). Similar results were obtained for fatal CVD (−97 [95% UI, −136 to −60] versus −381 [95% UI, −502 to −257]). Whether low-dose aspirin treatment was initiated for primary or secondary CVD prevention did not greatly influence the changes in the IR of the non-CVD outcomes. The changes in IR for fatal CRC were −46 [−69, −31] and −44 [−67, −26] for primary and secondary CVD prevention while the changes in IR for fatal bleeding were 5 [1, 9] and 5 [1, 10]. Similar results were obtained when low-dose aspirin use was initiated between 60–69 years. Conclusions In all simulation settings considered, low-dose aspirin related reductions in non-fatal and fatal CVD outcomes were larger in case of secondary CVD prevention compared to primary CVD prevention. These reductions were larger than the increases in fatal safety events. This favorable benefit-risk profile is more pronounced in the case of secondary CVD prevention. The results from the simulation model can be used to inform discussions with patients about the potential benefits and risk of LDA initiation. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

Psychosocial and productivity impact of caring for a child with peanut allergy

BackgroundLimited previous research has assessed the psychosocial burden and productivity impact of caring for a child with peanut allergy and factors associated with burden. The objective of this research was to explore caregiver burden in terms of psychosocial and productivity impact of caring for a child with peanut allergy, the influence of caregiver and child gender on caregiver burden, and factors predicting caregiver burden in peanut allergy.MethodsA cross-sectional survey of caregivers of children with peanut allergy was conducted in the United Kingdom, and included sociodemographic and clinical questions, EQ-5D, Hospital Anxiety and Depression Scale, Food Allergy Quality of Life-Parental Burden, Food Allergy Independent Measure, and productivity questions.ResultsOne hundred caregivers (55% female) of children with peanut allergy (aged 4–15 years) completed the survey. Male and female caregivers reported mean levels of anxiety significantly higher than United Kingdom population norms. Caregivers of children with severe peanut allergy reported significant impacts on their careers and health-related quality of life. Neither caregiver nor child gender impacted burden, indicating that male and female caregivers are equally anxious and suffer the same level of negative career, productivity, and health-related quality-of-life impact due to their child’s peanut allergy. Caregivers’ perceived risk of outcomes related to their child’s peanut allergy (e.g., death or severe reaction) as measured by the Food Allergy Independent Measure independently predicted burden.ConclusionsCaregivers of children with peanut allergy in the United Kingdom experience health-related quality-of-life, psychosocial, and productivity burden; this study demonstrates the high levels of anxiety reported by both male and female caregivers.

Early years pathways to inequalities in childhood asthma? A causal mediation analysis

Abstract Background Asthma affects one in five children in the United Kingdom (UK). Children in deprived areas have twice as many unplanned admissions for wheeze but mediating pathways between socioeconomic circumstances and asthma remain unclear. We aimed to quantify which early years pathways explain inequalities in childhood asthma in the UK. Methods We analysed data on 10650 children from the Millennium Cohort Study (MCS), a nationally representative sample of the UK population. Early life socioeconomic circumstance (SEC) was measured by maternal education at birth. Our outcome was parent-reported asthma at 5 years of age categorised as none, diagnosed asthma and diagnosed asthma with wheeze symptoms in the preceding year. Mediators were grouped into perinatal characteristics (maternal BMI, breastfeeding duration, birthweight, gestation, maternal smoking and alcohol use during pregnancy), neighbourhood features (pollution, grime and environment issues, traffic volume, housing quality) and the home environment (damp/condensation, tenure, pets, tobacco smoke). We used multinomial regression to examine the total effect of SEC on childhood asthma, then adjusted for all potential mediators. Using causal mediation analysis, we will estimate the proportion mediated by blocks of mediators and the natural indirect effect (NIE) via each block of mediators. Results Children whose mothers had no qualifications were more than twice as likely to have asthma by the age of 5 years with a wheeze episode in the preceding year compared with those whose mothers had degree-level qualifications (relative risk (RR) 2.21, 95% CI 1.44 to 3.40). After adjustment for all mediators, there was a 69% reduction to aRR 1.38 (95% CI 0.89 to 2.14). Conclusions Perinatal characteristics and early years neighbourhood features and measures of the home environment partially contribute to inequalities in childhood asthma. Key messages The antenatal period and early years of development are important for targeting interventions to reduce inequalities in asthma. About two-thirds of the social inequality in childhood asthma was explained by perinatal characteristics, early years neighbourhood features and the home environment.

A Genetic Risk Score to Personalize Prostate Cancer Screening, Applied to Population Data.

A polygenic hazard score (PHS), the weighted sum of 54 SNP genotypes, was previously validated for association with clinically significant prostate cancer and for improved prostate cancer screening accuracy. Here, we assess the potential impact of PHS-informed screening. United Kingdom population incidence data (Cancer Research United Kingdom) and data from the Cluster Randomized Trial of PSA Testing for Prostate Cancer were combined to estimate age-specific clinically significant prostate cancer incidence (Gleason score ≥7, stage T3-T4, PSA ≥10, or nodal/distant metastases). Using HRs estimated from the ProtecT prostate cancer trial, age-specific incidence rates were calculated for various PHS risk percentiles. Risk-equivalent age, when someone with a given PHS percentile has prostate cancer risk equivalent to an average 50-year-old man (50-year-standard risk), was derived from PHS and incidence data. Positive predictive value (PPV) of PSA testing for clinically significant prostate cancer was calculated using PHS-adjusted age groups. The expected age at diagnosis of clinically significant prostate cancer differs by 19 years between the 1st and 99th PHS percentiles: men with PHS in the 1st and 99th percentiles reach the 50-year-standard risk level at ages 60 and 41, respectively. PPV of PSA was higher for men with higher PHS-adjusted age. PHS provides individualized estimates of risk-equivalent age for clinically significant prostate cancer. Screening initiation could be adjusted by a man's PHS. Personalized genetic risk assessments could inform prostate cancer screening decisions.

COVID-19 pandemic in the United Kingdom

ObjectivesTo describe epidemiological data on cases of COVID-19 and the spread of Severe Acute Respiratory Syndrome Coronavirus 2 in the United Kingdom (UK), and the subsequent policy and technological response to the pandemic, including impact on healthcare, business and the economy. MethodsEpidemiological, business and economic data were extracted from official government sources covering the period 31st January to 13th August 2020; healthcare system data up to end of June 2019. ResultsUK-wide COVID-19 cases and deaths were 313,798 and 46,706 respectively (472 cases and 70 deaths per 100,000 population) by 12th August. There were regional variations in England, with London and North West (756 and 666 cases per 100,000 population respectively) disproportionately affected compared with other regions. As of 11th August, 13,618,470 tests had been conducted in the UK. Increased risk of mortality was associated with age (≥60 years), gender (male) and BAME groups. Since onset of the pandemic, emergency department attendance, primary care utilisation and cancer referrals and inpatient/outpatient referrals have declined; emergency ambulance and NHS111 calls increased. Business sectors most impacted are the arts, entertainment and recreation, followed by accommodation and food services. Government interventions aimed at curtailing the business and economic impact have been implemented, but applications for state benefits have increased. ConclusionsThe impact of COVID-19 on the UK population, health system and economy has been profound. More data are needed to implement the optimal policy and technological responses to preventing further spikes in COVID-19 cases, and to inform strategic planning to manage future pandemics.

Predicting social distancing and compulsive buying behaviours in response to COVID-19 in a United Kingdom sample

This study examines differences between key socio-demographic groups and the impact of strength of social network, political trust, and fear of COVID-19 on working from home (a key social distancing behaviour) and compulsive buying (a maladaptive behaviour) in response to COVID-19. This study used a correlational cross-sectional survey design. A sample of 411 participants in the United Kingdom (UK) completed measures of strength of social network, political trust, fear of COVID-19, length of self-isolation and compulsive buying. Results showed that older people and lower income groups are less likely to work from home in response to COVID-19; that people with a diagnosed mental health disorder exhibited less political trust, more fear of COVID-19, and more compulsive buying; and that people reporting COVID-19 symptomatology had been in self-isolation for longer and exhibited more compulsive buying than those with no COVID-19 symptomatology. The structural equation model showed that age, having a diagnosed mental health disorder, having COVID-19 symptomatology and strength of social network impacted on working from home and compulsive buying, through the mediators of political trust, fear of COVID-19 and length of self-isolation. The results demonstrate that some groups in the UK population may be vulnerable to maladaptive behaviours and poor social, psychological, and physical health outcomes as a result of the COVID-19 pandemic. These groups may require special support to cope effectively with the effects of COVID-19.

Resource use and direct medical costs of acute respiratory illness in the UK based on linked primary and secondary care records from 2001 to 2009.

BackgroundPrevious studies have shown that influenza is associated with a substantial healthcare burden in the United Kingdom (UK), but more studies are needed to evaluate the resource use and direct medical costs of influenza in primary care and secondary care.MethodsA retrospective observational database study in the UK to describe the primary care and directly-associated secondary care resource use, and direct medical costs of acute respiratory illness (ARI), according to age, and risk status (NCT Number: 01521416). Patients with influenza, ARI or influenza-related respiratory infections during 9 consecutive pre-pandemic influenza peak seasons were identified by READ codes in the linked Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) dataset. The study period was from 21st January 2001 to 31st March 2009.ResultsA total of 156,193 patients had ≥1 general practitioner (GP) episode of ARI, and a total of 82,204 patients received ≥1 GP prescription, at a mean of 2.5 (standard deviation [SD]: 3.0) prescriptions per patient. The total cost of GP consultations and prescriptions equated to £462,827 per year per 100,000 patients. The yearly cost of prescribed medication for ARI was £319,732, at an estimated cost of £11,596,350 per year extrapolated to the UK, with 40% attributable to antibiotics. The mean cost of hospital admissions equated to a yearly cost of £981,808 per 100,000 patients. The total mean direct medical cost of ARI over 9 influenza seasons was £21,343,445 (SD: £10,441,364), at £136.65 (SD: £66.85) per case.ConclusionsExtrapolating to the UK population, for pre-pandemic influenza seasons from 2001 to 2009, the direct medical cost of ARI equated to £86 million each year. More studies are needed to assess the costs of influenza disease to help guide public health decision-making for seasonal influenza in the UK.