White British Patients Research Articles

Racial Disparities in Pelvic Floor Disorders.

To investigate the impact of racial disparities and Socioeconomic Status (SES) on pelvic floor disorder (PFD) care. Racial disparities in colorectal PFD remain uninvestigated, despite prior research in urogynecology. This retrospective study was conducted at Guy's and St. Thomas' Hospital of London in 2023. Patients with colorectal PFD from 2013 to 2018 were evaluated. Patients were classified according to the Index of Multiple Deprivation (IMD) scores and divided into quintiles. The lowest quintile represents the most deprived, whereas the higher quintile represents the least deprived. Assessed variables: patient complaint, symptoms, consultant and biofeedback referrals, investigations, multidisciplinary meeting (MDM) discussions, treatment, and follow-up appointments. 2001 patients were considered. A total of 1126 patients were initially analyzed, and 875 patients were excluded owing to incomplete data. Eight ethnic groups were identified in this study. Constipation was the most common compliant across ethnic groups (P=0,03). Diagnostics, MDM discussions, and conservative treatment did not vary between ethnicities. White British and Asian patients were significantly more likely to be seen by a consultant (P=0.001) and undergo surgery (P=0.002). In the second part of the study, the IMD was calculated for 1992 patients who were categorized into quintiles. Diagnostic tests, discussion in MDM, Consultant review, and surgical treatments were significantly lower in the two lowest quintiles (P<0.001, P<0.001, P=0.02, and P=0.02, respectively). Conservative treatment did not vary between the IMD groups. Disparities in the diagnosis and treatment of colorectal PFD exist among ethnic minorities and patients of low SES. This study allows for the replication of service provision frameworks in other affected areas to minimize inequalities.

Genomic risk prediction of cardiovascular diseases among type 2 diabetes patients in the UK Biobank.

Background: Polygenic risk score (PRS) has proved useful in predicting the risk of cardiovascular diseases (CVD) based on the genotypes of an individual, but most analyses have focused on disease onset in the general population. The usefulness of PRS to predict CVD risk among type 2 diabetes (T2D) patients remains unclear. Methods: We built a meta-PRSCVD upon the candidate PRSs developed from state-of-the-art PRS methods for three CVD subtypes of significant importance: coronary artery disease (CAD), ischemic stroke (IS), and heart failure (HF). To evaluate the prediction performance of the meta-PRSCVD, we restricted our analysis to 21,092 white British T2D patients in the UK Biobank, among which 4,015 had CVD events. Results: Results showed that the meta-PRSCVD was significantly associated with CVD risk with a hazard ratio per standard deviation increase of 1.28 (95% CI: 1.23-1.33). The meta-PRSCVD alone predicted the CVD incidence with an area under the receiver operating characteristic curve (AUC) of 0.57 (95% CI: 0.54-0.59). When restricted to the early-onset patients (onset age ≤ 55), the AUC was further increased to 0.61 (95% CI 0.56-0.67). Conclusion: Our results highlight the potential role of genomic screening for secondary preventions of CVD among T2D patients, especially among early-onset patients.

BS P02 Equitable access to bariatric surgery: an exploration of trends in health inequalities and patient profiles over the last 15-years

Abstract Background Bariatric surgery is a safe and effective treatment for obesity and associated co-morbidities. Equality of access to bariatric surgery in the NHS has long posed a serious challenge with significant variation in eligibility criteria between different regions. Obesity disproportionately affects more deprived groups and some ethnic minorities, who have also been shown to experience a worse quality of healthcare and poorer health outcomes. This study aimed to understand the profile of patients accessing bariatric surgery and explore changes in trends over a 15-year period to identify important areas of development for obesity-related healthcare services in our region. Methods This was a retrospective study of all patients undergoing primary and revisional bariatric surgery (gastric band, sleeve gastrectomy, RNY and single anastomosis bypass) for weight loss at our regional bariatric surgical centre since its inception in 2008 until the end of 2022. Data was extracted from a combination of electronic records and a surgical database. Variables included gender demographic and procedure related data, baseline characteristics including height, weight, deprivation scores, co-morbidities, bloods, and micronutrient levels. Changes in patient profiles were mapped over the 15-year period and compared to population-level data derived from the national census and other publicly available sources. Results 2062 (mean age 47) patients were included. 11 (0.5%) patients were aged over 70 and 155 (7.5%) were less than 30 years of age. 75% patients were women; 42% of patients in 2013 were men which steadily decreased to 17% in 2022 (p &amp;lt; 0.05). The mean BMI of patients undergoing surgery was 54 in 2010 and gradually decreased to 48 in 2022 (p&amp;lt;0.05). White British patients represented 93% of all patients. This decreased from 96.5% in 2009 to 86% in 2022. White British ethnicity was estimated to make up 81% of patients with obesity in the NW of England. Conclusions Several major groups who are likely to significantly benefit from bariatric surgery are disproportionately under-represented by patients accessing treatments for obesity. This includes those at the extremes of ages, men, lower BMI patients and ethnic minority groups. Trends over the last 15 years have either worsened or have insufficiently improved to bridge the gap in health inequalities. The findings from our study underscore the urgent need for wider-scale targeted approaches which aim to address obesity and increase more equitable access to these life-changing treatments.

Diabetes mellitus and obesity among South Asians with ischemic stroke across three countries.

Diabetes mellitus and central obesity are more common among South Asian populations than among White British people. This study explores the differences in diabetes and obesity in South Asians with stroke living in the United Kingdom, India, and Qatar compared with White British stroke patients. The study included the UK, Indian, and Qatari arms of the ongoing large Bio-Repository of DNA in Stroke (BRAINS) international prospective hospital-based study for South Asian stroke. BRAINS includes 4580 South Asian and White British recruits from UK, Indian, and Qatar sites with first-ever ischemic stroke. The study population comprises 1751 White British (WB) UK residents, 1165 British South Asians (BSA), 1096 South Asians in India (ISA), and 568 South Asians in Qatar (QSA). ISA, BSA, and QSA South Asians suffered from higher prevalence of diabetes compared with WB by 14.5% (ISA: 95% confidence interval (CI) = 18.6-33.0, p < 0.001), 31.7% (BSA: 95% CI = 35.1-50.2, p < 0.001), and 32.7% (QSA: 95% CI = 28.1-37.3, p < 0.001), respectively. Although WB had the highest prevalence of body mass index (BMI) above 27 kg/m2 compared with South Asian patients (37% vs 21%, p < 0.001), South Asian patients had a higher waist circumference than WB (94.8 cm vs 90.8 cm, p < 0.001). Adjusting for traditional stroke risk factors, ISA, BSA, and QSA continued to display an increased risk of diabetes compared with WB by 3.28 (95% CI: 2.53-4.25, p < 0.001), 3.61 (95% CI: 2.90-4.51, p < 0.001), and 5.24 (95% CI: 3.93-7.00, p < 0.001), respectively. South Asian ischemic stroke patients living in Britain and Qatar have a near 3.5-fold risk of diabetes compared with White British stroke patients. Their body composition may partly help explain that increased risk. These findings have important implications for public health policymakers in nations with large South Asian populations.

Inflammatory Bowel Disease in Turkish Populations Served by English NHS Trusts

It is estimated that there are about 500,000 Turkish people living in the UK, of whom about 300,000 are of Cypriot origin. A Freedom of Information request was sent to the four NHS Trusts in London which served areas with significant Turkish communities. The request sought information on the total number of patients admitted between 2016 and 2020 with inflammatory bowel disease. Between 2016 and 2020, 1936 patients with inflammatory bowel disease were admitted to North Middlesex University Hospital NHS Trust. Some of these patients will have been readmitted in different years, leading to an inflation of the overall number. The average number of cases admitted each year was approximately 387. The proportion of White British patients with ulcerative colitis was 0.4; for Turkish Cypriots, it was 0.43 and for Turkish patients, 0.45. A z test comparison of these proportions showed that there was no difference between the Turkish communities (z = 0.52 ns) and no overall difference between White British and all Turkish patients (z = −1.5, ns). Between 2016 and 2020, the Homerton Healthcare Foundation Trust admitted 215 English patients with inflammatory bowel disease, of whom 113 had ulcerative colitis. Of the 26 Turkish patients, 4 had ulcerative colitis. The proportion of Turkish patients with Crohn’s disease was significantly greater than that amongst English patients (z = 3.58, p &lt; 0.0003). In the context of the relatively large number of Turkish people with inflammatory bowel disease in both trusts, the absence of published work on the impact of these chronic diseases is of concern. The results from this investigation should prompt specific qualitative research into the Turkish experience in the UK following a diagnosis of inflammatory bowel disease with the intention of developing better patient-centred care.

Repeat expansions in NOP56 are a cause of spinocerebellar ataxia Type 36 in the British population.

Spinocerebellar ataxias form a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by progressive cerebellar ataxia. Their prevalence varies among populations and ethnicities. Spinocerebellar ataxia 36 is caused by a GGCCTG repeat expansion in the first intron of the NOP56 gene and is characterized by late-onset ataxia, sensorineural hearing loss and upper and lower motor neuron signs, including tongue fasciculations. Spinocerebellar ataxia 36 has been described mainly in East Asian and Western European patients and was thought to be absent in the British population. Leveraging novel bioinformatic tools to detect repeat expansions from whole-genome sequencing, we analyse the NOP56 repeat in 1257 British patients with hereditary ataxia and in 7506 unrelated controls. We identify pathogenic repeat expansions in five families (seven patients), representing the first cohort of White British descent patients with spinocerebellar ataxia 36. Employing in silico approaches using whole-genome sequencing data, we found an 87 kb shared haplotype in among the affected individuals from five families around the NOP56 repeat region, although this block was also shared between several controls, suggesting that the repeat arises on a permissive haplotype. Clinically, the patients presented with slowly progressive cerebellar ataxia with a low rate of hearing loss and variable rates of motor neuron impairment. Our findings show that the NOP56 expansion causes ataxia in the British population and that spinocerebellar ataxia 36 can be suspected in patients with a late-onset, slowly progressive ataxia, even without the findings of hearing loss and tongue fasciculation.

Atrial fibrillation in UK South Asian hospitalized ischemic stroke patients: The BRAINS study.

South Asian diaspora comprise one of the largest ethnic minority groups in the world yet data about atrial fibrillation (AF) in this demographic is understudied. Our aim is to identify differences in AF prevalence and treatment between South Asians and white British stroke patients. The UK arm of a prospective ongoing large international repository on stroke was analysed. Ethnic differences in AF prevalence and management in those with ischemic stroke were analysed. Of the 3515 individuals recruited with ischemic stroke, 1482 (men: 972, women: 510) were South Asian and 2033 (men:1141, women:892) of white British ethnicity. AF was present in 462 white British and 193 South Asians stroke patients, with South Asians displaying a lower prevalence of AF (South Asians: 13.0% vs white British 22.7%, P<0.001). Despite adjustment for traditional AF risk factors, South Asians had a significantly lower OR of AF compared to white British stroke patients (OR: 0.40, 95%CI: 0.33:0.49, P<0.001). Among confirmed AF cases, 31.8% of South Asians and 41.4% of white British were untreated at admission (P = 0.02). Antiplatelet treatment was significantly higher among South Asians at both admission (South Asian: 47.4% vs. white British: 29.9%, P<0.001) and discharge (South Asian: 49.5% vs. white British: 34.7%, P = 0.001), although anticoagulation treatment was similar across both ethnic groups at admission (South Asian: 28.5% vs white British: 28.1%, P = 0.93), and discharge (South Asian: 45.1% vs white British: 43.1%, P = 0.64). Stroke patients of South Asian descent are at significantly lower risk of AF but more likely to be on antiplatelet treatment compared to their white British counterparts.

Relationship between ethnicity and stage at diagnosis in England: a national analysis of six cancer sites

ObjectivesCancer stage at diagnosis is a determinant of treatment options and survival. Previous research has shown differences in barriers to presentation with cancer between ethnic groups. The completeness and quality...

Ischaemic stroke in South Asians: The BRAINS study.

Studies on stroke in South Asian populations are sparse. The aim of this study was to compare differences in age of onset of ischaemic stroke in South Asian patients living in the United Kingdom and South Asian patients living in India versus White British stroke patients. We studied the UK and Indian arms of the ongoing BRAINS study, an international prospective hospital-based study of South Asian stroke patients. The BRAINS study includes 4038 South Asian and White British patients with first-ever ischaemic stroke, recruited from sites in the United Kingdom and India. Of the included patients, 1126 were South Asians living in India (ISA), while 1176 were British South Asian (BSA) and 1736 were White British (WB) UK residents. Patients in the ISA and BSA groups experienced stroke 19.5 years and 7.2 years earlier than their WB counterparts, respectively (mean [interquartile range] age: BSA 64.3[22]years vs. ISA 52.0[18]years vs. WB 71.5[19]years; p < 0.001). Patients in the BSA group had higher rates of hypertension, diabetes mellitus and hypercholesterolaemia than those in the ISA and WB groups. After adjustment for traditional stroke risk factors, an earlier age of stroke onset of 18.9 years (p < 0.001) and 8.9 years (p < 0.001) was still observed in the ISA and BSA groups, respectively. In multivariable stepwise linear regression analysis, ethnicity accounted for 24.7% of the variance in early age onset. Patients in the BSA and ISA groups experienced ischaemic stroke approximately 9 and 19 years earlier, respectively, than their WB counterparts. Ethnicity is an independent predictor of early age of stroke onset. Our study has considerable implications for public health policymakers in countries with sizable South Asian populations.

Surgery for Ulcerative Colitis in the White British and South Asian Populations in Selected Trusts in England 2001-2020: An Absence of Disparate Care and a Need for Specialist Centres.

Over the last decade, there has been extensive evidence that patients with inflammatory bowel disease from minority communities in the UK receive less than optimal care. In none of the studies has the role of surgery in the management of acute and severe ulcerative colitis been considered in any detail. A freedom of information (FOI) request was sent to 14 NHS Trusts in England, which serve significant South Asian populations. Details of the type of surgery patients from the South Asian and White British communities received between 2021 and 2020 were requested. Detailed responses were obtained from eight Trusts. Four hundred and ten White British patients underwent surgery for ulcerative colitis over this period at these eight Trusts, together with 67 South Asian patients. There was no statistically significant difference in the distribution across the types of surgery undergone by the two communities overall (χ2 = 1.3, ns) and the proportions who underwent an ileo-anal anastomosis with pouch (z = −1.2, ns). However, within individual trusts, at the University Hospital Southampton NHS Foundation Trust, a significantly greater proportion of South Asian patients had an ileo-anal anastomosis with pouch compared to White British patients. At Cambridge University Hospitals NHS Foundation Trust, all 72 patients who underwent surgery for ulcerative colitis were White British. This study has shown that, in general, for patients with a severe flare of ulcerative colitis where medical treatment has failed and surgery is warranted, the nature of the procedures offered is the same in the White British and South Asian communities. However, of concern is the number of units with low volume procedures. For most Trusts reported in this study, the overall number of Ileo-anal pouch anastomosis or anastomosis of ileum to anus procedures performed over a number of years was substantially below that required for a single surgeon to achieve competence. These findings reinforce the argument that inflammatory bowel disease surgery should be performed in a limited number of high-volume centres rather than across a wide range of hospitals so as to ensure procedures are carried out by surgeons with sufficient and on-going experience.

P-087: IS SCREENING FOR DIABETES II AMONG PATIENTS WITH SICKLE CELL TRAIT A POTENTIAL EXAMPLE OF STRUCTURAL RACISM IN HEALTHCARE?

Purpose: Ethnic minorities in the UK have a 3-5 times higher risk than white British patients of developing diabetes II, however not all of the HbA1c tests, which are widely used to screen for Type II diabetes, are unsuitable for some ethnic minority groups, such as where haemoglobin variants such as sickle haemoglobin (HbS) are common. Sickle cell trait (SCT) is found in up to 25% of ethnic groups of African, Middle Eastern and southern European heritage and there are 250,000 people with SCT in the UK. This paper will explore if the current HbA1c testing can illuminate mechanisms of structural racism in UK healthcare. Materials and methods: Methods of HbA1c testing and evidence of haemoglobin variant interference with different HbA1c testing systems were examined through literature searching and the USA National Glycohemoglobin Standardization Program database. A policy analysis and literature search explored potential mechanisms of structural racism in the case of HbA1c testing and finally a case study of a patient diagnosed with SCT through a HbA1c test was used to explore ethical dilemmas and possible information needs subsequent to incidental finding of SCT through HbA1c screening. Results: Five methods of testing and over 200 different kinds of machines used to assay HbA1c were found. Only 16% of all systems have been evaluated using robust methods, 57% of those evaluated showed an interference with at least one haemoglobin variant, 51% for HbS. Some systems gave false positives, some false negatives. The extent of use HbA1c machines that are inaccurate for SCT patients in the UK is unknown. No national or international guidance on HbA1c screening for haemoglobin variants was found. An inquiry into sickle cell care, ‘Nobody’s Listening’, found sub-standard care for SCD, low awareness of sickle cell among healthcare professionals and inadequate training and inadequate investment in sickle cell care. Various ethical dilemmas arise through an incidental finding of SCT through an HbA1c test. These include an unanticipated incidental diagnosis of SCT without prior informed consent, communicating and understanding incidence of potential symptoms associated with SCT, not being given timely access to genetic counselling services, how results are appropriately delivered to patients or carers and dealing with stigma and racism that may result as having a SCT status revealed. Conclusion: Screening for diabetes in the UK, and potentially globally, is fraught with lack of information regarding suitability of HbA1c testing systems for patients with haemoglobin variants, therefore potentially providing mechanisms for structural racism in health care for different ethnic groups. There is a need to conduct a thorough assessment of which HbA1c testing systems are in use and if these systems are able to accurately screen for diabetes in patients who may have haemoglobin variants such as HbS. If any systems in use are not able to accurately screen for Type II diabetes in patients with SCT alternative routes for screening should be made available so to not exacerbate health inequalities in ethnic minority groups in the UK. How and when SCT status results are communicated with patients should be carefully considered. The authors do not declare any conflict of interest

Uptake of COVID-19 Vaccination in a Medium Secure Psychiatric Hospital Population

AimsCompared with the general population, people with mental health disorders are at increased risk of negative physical and mental health outcomes following SARS-CoV-2 infection. In the UK, all adult mental health in-patients were offered COVID-19 vaccination as a priority group. Patients admitted to medium secure care have greatly increased mortality compared with the general population. Understanding COVID-19 vaccine uptake, and reasons for refusal, in patients in medium secure hospitals is important given the high prevalence of chronic physical health comorbidities such as obesity and diabetes, as these conditions are also associated with poor clinical outcomes in COVID-19 disease. Aims: To assess the proportions of patients who accepted or declined the COVID-19 vaccine, and explore their reasoning. To examine vaccine uptake between White and Black Asian minority ethnic (BAME) patients, and between younger/older patients.MethodsThe study took place at a medium secure hospital with male and female inpatients. All patients were offered a COVID-19 vaccine, and had a capacity and physical health evaluation completed by their Consultant Forensic Psychiatrist.ResultsData regarding capacity to consent to the vaccine, acceptance/refusal, and demographics were retrospectively collected from the clinical records. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent.A similar proportion of patients aged under and over 40 years old consented. Those from a BAME background were more likely to decline than White British patients. The reasons for capacitous refusal appeared similar to the general population.ConclusionCOVID immunisation was broadly acceptable for patients in medium secure hospitals. The prevalence and reasoning of capacitous refusal appears similar to the general English population.The indication that BAME patients were more likely than White patients to decline the vaccination echoes the findings of research conducted in the Leicester general hospital. Further consideration needs to be given to how the uptake of COVID-19 vaccination can be improved in people with BAME ethnicity, especially as this group is also overrepresented in secure hospital settings.The study demonstrates that similar services should be able to approach the vaccination process with confidence. As many people with severe mental disorder also have high physical comorbidity that would increase the risk of a poor clinical outcome if they contracted COVID-19, protecting this vulnerable population through vaccination must be a priority for mental health services.

68 Exploring Subconscious Bias: How Implicit Biases Can Affect Accessibility to Healthcare

Abstract Aim Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This article reviews healthcare professional's display of implicit bias towards patients in a tertiary centre. Method We retrospectively analysed a database of 285 patients who missed surgical outpatient appointments at a London tertiary hospital. Judges were asked to categorise all 285 patients into predefined ethnic categories: White British vs Black, Asian and Minority Ethnic vs White Non-British after reading the patient’s names. Results In the group where ethnicity was defined based on assessed origin of names, we report significant difference in discharge rates between White British vs Non-White British groups (34 vs 48%). There was also significant difference between White British vs Black, Asian and Minority Ethnic group (34% vs 57%). Discharge rates between males and females did not differ. Conclusions Clinicians are more likely to provide patients with another opportunity to attend an outpatient clinic after missing a booked appointment based on the patient having a perceived ethnicity of White British, whether deliberate or not. This study shows a bias of accessibility in healthcare dependent on ethnicity with greater flexibility given to White British patients.

Evidence of On-Going Disparate Levels of Care for South Asian Patients with Inflammatory Bowel Disease in the United Kingdom during the Quinquennium 2015–2019

Over the last decade, there have been a number of studies which have documented disparate levels of care in the management of inflammatory bowel disease amongst various minority communities in the UK. Similar findings had previously been described in the USA, where access to biologics has been an issue. In this study, data on admissions to hospital of South Asian and White British patients with inflammatory bowel disease between 2015 and 2019 were collected from 12 National Health Service (NHS) trusts in England, three Health Boards in Wales and two Scottish health organizations using Freedom of Information requests. The analyses of data were based on the assumption that inflammatory bowel disease (IBD) has the same prevalence in the South Asian community and the White British community in the UK. Comparisons were made between the proportion of hospitalised patients who were South Asian and the proportion who were White British in the local community using a z statistic. In Leicester, Bradford, Croydon and Lothian, the proportion of patients from the South Asian community admitted to hospital was significantly greater than the proportion from the local White British community, which is consistent with the greater frequency and severity of the disease in the South Asian community in the UK. However, in Coventry, Wolverhampton, Walsall, Acute Pennine Trust in the north-west of England, Barking, Havering and Redbridge and Glasgow, South Asian patients were significantly under-represented, indicating significant issues with access to hospital-based healthcare for inflammatory bowel disease. This study provides evidence of on-going evidence of disparate levels of care for patients from a South Asian background, with inflammatory bowel disease being underserved by a number of NHS Trusts, Health Boards and comparable organisations. When there is on-going failure to achieve the objectives of the NHS of achieving equality in the delivery of care, it is critical to introduce effective policies which will alter the in-built inertia to change within such organisations.

Patients concerns inventory (PCI) versus standard treatment pathway in the management of patients with head and neck cancer: a qualitative informed economic evaluation

BackgroundHead and neck cancer (HNC) patient concerns inventory (PCI) is a condition-specific prompt list that allows patients to raise concerns that might be overlooked. To our knowledge, this is the first economic evaluation of PCI in patients with HNC from a UK National Health Service (NHS) perspective, exploring the cost-effectiveness of the PCI in the treatment of patients with HNC. To triangulate our economic evaluation, we conducted qualitative interviews with a sample of consultants providing care. MethodsAlongside a 3-year cluster-randomised controlled trial, we undertook an economic evaluation. The trial start date was April 1, 2017, and it closed on June 30, 2020, while the health economic evaluation commenced in September, 2020. Client Service Receipt Inventory data were collected twice during the trial period, at 6 and 12 months after baseline. Patients were identified by a multidisciplinary team at the trial clinics. This economic analysis compared the PCI intervention (PCI group) with the non-PCI treatment pathway (non-PCI group). We did a probabilistic sensitivity analysis to investigate the cost per quality-adjusted life-year (QALY) gain of the intervention. We also collected qualitative data from seven consultants to corroborate study findings. FindingsOur economic model used data from 90 patients in the PCI intervention group and 101 patients in the non-PCI group. The PCI group had 62% male participants while the non-PCI group had 74% male participants. In both groups over 95% of the participants were white British patients . The PCI inventory was low cost at just over £13 per participant. The PCI intervention was cost-effective and cost-saving with an incremental cost difference of £295·91 over the 12-month follow-up period. The QALY values were higher in the PCI group (with a value of 0·79) than in the non-PCI group (with a value of 0·76) . The sensitivity analysis showed that at a Willingness to Pay threshold of £20 000, the PCI intervention had a probability of being cost-effective of 0·85 (95% CI 0·80–0·83). The qualitative results showed that consultants using the PCI reported an enhanced awareness of patients' overall post-treatment needs. InterpretationThe PCI provided an effective means to conduct the clinical consultations by avoiding unnecessary health-care costs and focusing on aspects of care most important to patients. The cost per QALY gain was within the National Institute for Health and Care Excellence guideline threshold. The PCI is a low-cost intervention that generates a cost-effective benefit to patients from an NHS perspective if rolled out as part of routine care. FundingNational Institute for Health Research.

Ethnic disparities in preventable hospitalisation in England: an analysis of 916 375 emergency admissions

ObjectivesTo study ethnic inequalities in ambulatory care sensitive conditions (ACSC) in England.DesignObservational study of inpatient hospital admission database enhanced with ethnicity coding of patient surnames. The primary diagnosis of the...

Uptake of COVID-19 vaccination in a medium secure psychiatric hospital population.

Patients in medium secure hospitals may be at particularly increased risk of coronavirus disease 2019 (COVID-19) infection and complications. We undertook a service evaluation involving all current in-patients within a single, English medium secure hospital to describe the uptake of the COVID-19 vaccine among this population. Data regarding capacity to consent to the vaccine, acceptance/refusal of this (and reasons for refusal) and demographics was retrospectively collected from the patients' clinical records and analysed. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent. A similar proportion of patients aged under and over 40 years old consented to have the vaccine. Those from a Black Asian minority ethnic background were more likely to decline the vaccine than White British patients. The reasons for capacitous refusal appeared similar to those seen in the general population.

An Ethnic Variation in the Acceptance of Biological Disease-Modifying Therapies: A University Hospital Experience.

Ethnic variations in the outcomes of rheumatological diseases are well documented. While physiological differences may account for these disparities, attitude to treatment is also likely to be a significant modifiable contributor. We sought to determine if an ethnic variation exists in the uptake of biological disease-modifying anti-rheumatic drugs (DMARD) among a multi-ethnic cohort when offered in-person through a healthcare system free at the point of access.We conducted a retrospective cross-sectional study of patients seen in a biologic therapy counselling clinic between December 2016 and April 2017. Clinic letters from consultations were reviewed, and data including ethnicity, language spoken, and decision to accept or reject the therapy were extracted. We chose to measure uptake over adherence, as we believe it is an earlier, more direct marker of attitudes to joint saving medications.Ninety-one cases were included in the analysis. Over 13.2% (12/91) of the cohort declined a biologic treatment when it was offered as the standard of care for joint disease. Non-Caucasian patients accepted treatment less often than Caucasian (White British) patients (OR 0.265, CI 0.73-0.959, p = 0.043), as did those who did not speak English as a first language (OR 0.094, CI 0.18-0.497, p = 0.005). Age, sex, and diagnosis were well matched between those who accepted and declined therapy.We demonstrate a disparity in the uptake of biologic therapies between the White British population and patients from other ethnicities. The reasons for this are likely multifactorial and could be related to socio-economic factors, language barriers, and cultural differences. Addressing this discrepancy is a crucial first step to tackling preventable disparities in the outcomes of rheumatological disease between different ethnicities.

Effects of ethnic density on the risk of compulsory psychiatric admission for individuals attending secondary care mental health services: evidence from a large-scale study in England.

Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density - the so-called 'ethnic density' hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission. Data from the 2010-2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density. Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95-0.99 and 0.94, 95% CI 0.93-0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11-1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission. We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.

Genomic Risk Prediction of Recurrent Cardiovascular Diseases in the UK Biobank

Polygenic risk score (PRS) shows promise in predicting the risk of cardiovascular diseases (CVD) based on the genotypes of an individual, but most analyses have traditionally focused on the diseases’ onset. The usefulness of PRS to predict recurrence remains unclear. In this study, we built a meta-PRSCVD upon the candidate PRSs developed from state-of-the-art PRS methods for three CVD subtypes of significant importance: coronary artery disease (CAD), ischemic stroke, and heart failure. To evaluate the prediction performance of the meta-PRSCVD, we restricted our analysis to 24,704 white British CAD patients in the UK Biobank, among which 6,999 had CVD recurrent events. Results showed that the meta-PRSCVDwas significantly associated with CVD recurrence with a hazard ratio per standard deviation increase of 1.24 (95% CI: 1.20-1.27). After adjustment for age, sex, and the first ten principal components of genotypes, the meta-PRSCVD predicted the recurrence with an AUC of 0.64 (95% CI: 0.62-0.66). When restricted to the early-onset patients (onset age <= 55), the AUC was further increased to 0.75 (95% CI 0.72-0.78). Our results highlight the potential role of genomic screening for secondary preventions of CVD, especially among early-onset CAD patients.