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Background: Children and young people (CYP) with intellectual and developmental disabilities (IDDs) have significant additional educational needs compared with the general population. In England, the government has established a system of education, health and care plans (EHCPs) to support children with special educational needs and disabilities, but disparities exist between the degree of need and the availability of support. We conducted a prospective UK national cohort study (IMAGINE) of children with rare pathogenic genomic variants, all of which are associated with IDD, to investigate associated neuropsychiatric risk. Subsequently, we obtained information from the UK's National Pupil Database on their educational progress through the state school system. We aimed to identify whether they had received EHCP provision and whether that support was associated with their family's socioeconomic status, region of domicile, ethnicity, sex, primary special educational needs (SEN) type, academic performance and mental health well‐being. Methods: We recruited 2738 CYP from England into the IMAGINE study between 2014 and 2019. The educational histories of the participants (6–28 years old, mean ± standard deviation = 14 ± 4 years, 56% male) were obtained from the Department for Education's National Pupil Database in 2021. Educational data included attainment scores from the Early Year Foundation Stage (<5 years) to key stage 4 (15–16 years). Each family was assigned an index of multiple deprivation (IMD) score based on their home address postcode. Parents or carers rated their child's emotional and behavioural adjustment on the Strengths and Difficulties Questionnaire (SDQ). The association between receiving an EHCP and the child's IMD score, eligibility for free school meals, English region of domicile, ethnicity, sex, primary SEN type, academic attainment and SDQ score was investigated. Results: In this cohort, 78% of participants had received an EHCP. CYP living in the most deprived IMD deciles were substantially less likely to receive EHCP support than those in the least deprived decile, irrespective of their degree of intellectual developmental disability, academic performance or associated mental health problems. There were no sex differences. Children of Asian heritage were more likely to have been granted an EHCP than White children from equivalent IMD deciles. There were striking regional disparities. Participants living in London were significantly more likely to have been awarded an EHCP than participants living anywhere else in England, regardless of their IMD decile; those in the least deprived decile had almost 100% EHCP provision. Conclusions: This study found evidence for nationwide regional inconsistencies in the awarding of EHCP to CYP with significant intellectual impairments of known genetic aetiology. Disparities in funds available to education authorities could be a contributory factor. EHCP support was potentially influenced by how strongly a parent advocates for their child. [ABSTRACT FROM AUTHOR]

Aim: Obesity has a significant impact on all‐cause mortality rate and overall health care resource use (HCRU). These outcomes are also strongly linked to age, sex and local deprivation of the population. We aimed to establish the lifetime costs of obesity by demographic group/geographic area using published mortality rates and HCRU use for integrated care boards (ICB) in England in the context of costs of therapeutic intervention. Methods: Population and expected mortality rates by age, sex and deprivation were obtained from national data. Obesity class prevalence was taken from the health of the nation study. The published impact of obesity by age, group, sex and deprivation on mortality and HCRU were applied to estimate life years lost and lifetime HCRU [by sex, age band and body mass index (BMI) class for each ICB]. The year 2019 was chosen as the study basis data to avoid influences of COVID‐19 pandemic on obesity rates with application of 2022/23 HCRU values. Outcomes including prevalence, deaths, life years lost, HCRU and lifetime HCRU were compared by age and sex groups across four BMI classes normal/underweight (BMI <25 kg/m2), overweight (25‐29.9 kg/m2), obese class I and II (30‐39.9 kg/m2), and obese class III (≥40), with benchmarking being set against all population being BMI <25 kg/m2 overall and by each of the 42 ICBs. We also associated future life with deaths to provide an estimate of 'future life years lost' occurring each year. Results: Total population aged >16 years was 45.4 million (51% female). Prevalence: 13.7 million (28% of the total adult population) had a BMI ≥30 mg/m2 and BMI ≥40 kg/m2 were 1.50 million (12%) of these 1.0 million (68%) were female and of these 0.6 million 40% were women aged 16‐49 years. In addition, 35% of those with a BMI ≥40 kg/m2 were in the top deprivation quintile (i.e. overall 20%). Mortality was based on expected deaths of 518K/year, and modelling suggested that if a BMI <25 kg/m2 was achieved in all individuals, the death rate would fall by 63K to 455K/year for the English population (12% reduction). For those with a BMI ≥40 kg/m2 the predicted reduction was 12K deaths (54% lower); while in those aged 16‐49 years with a BMI ≥40 kg/m2 72% of deaths were linked to obesity. For future life years lost, we estimated 2.5 years were lost in people with BMI 30‐39.9 kg/m2 6.7 years when BMI ≥40 kg/m2. However, for those aged 16‐49 years with a BMI ≥40 kg/m2, 8.3 years were lost. HCRU, for weight reduction, the annual HCRU decrease from BMI ≥40 kg/m2 to BMI 30‐39.9 kg/m2 was £342 per person and from BMI 30‐39.9 to 25‐29.9 kg/m2 the reduction was £316/person. However, lifetime costs were similar because of reduced life expectancy for obese individuals. In quality adjusted life years (QALY), overall, 791 689 future life years were lost (13.1% of all) in people with BMI ≥25 kg/m2 and were related to excess weight. When the NICE £30 000 per QALY value was applied to the estimated total 791 689 future life years lost then the potential QALY value reduction lost was equivalent to £24 billion/year or £522/person in the obese population. For morbidly obese men and women the potential QALY value lost was £2864/person/year. Regarding geography, across the 42 ICBs, we observed significant variation in the prevalence of BMI ≥40 (1.8%‐4.3%), excess mortality (11.6%‐15.4%) and HCRU linked to higher BMI (7.2%‐8.8%). The areas with the greatest impact on HCRU were in the north‐west, north‐east and Midlands of England, while the south shows less impact. Conclusion: The expected increases in annual HCRU because of obesity, when considered over a lifetime, are being mitigated by the increased mortality of obese individuals. Our data suggest that simple short‐term HCRU reduction brought about through BMI reduction will be insufficient to fund additional specialist weight reduction interventions. The HRCUs associated with BMI are not in most cases related to short‐term health conditions. They are a cumulative result over a number of years, so for age 16‐49 years reducing BMI from ≥40 to 30‐39.9 kg/m2 might show an annual decrease in HCRU/person by £325/year for women and £80/year for men but this might not have immediately occurred within that year. For those aged >70 years reducing BMI from ≥40 to 30‐39.9 kg/m2 might show an annual decrease in HCRU/person by £777/year for women and £796/year for men but also may not be manifest within that year. However, for the morbidly obese men and women, the potential QALY value lost was £2864 per person per year with the potential for these funds to be applied to intensive weight management programmes, including pharmacotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Studies show that the COVID-19 pandemic disproportionately affected people with diabetes and those from disadvantaged backgrounds. During the first 6 months of the UK lockdown, > 6.6 M glycated haemoglobin (HbA1c) tests were missed. We now report variability in the recovery of HbA1c testing, and its association with diabetes control and demographic characteristics. Methods: In a service evaluation, we examined HbA1c testing across ten UK sites (representing 9.9% of England's population) from January 2019 to December 2021. We compared monthly requests from April 2020 to those in the equivalent 2019 months. We examined effects of (i) HbA1c level, (ii) between-practice variability, and (iii) practice demographics. Results: In April 2020, monthly requests dropped to 7.9–18.1% of 2019 volumes. By July 2020, testing had recovered to 61.7–86.9% of 2019 levels. During April–June 2020, we observed a 5.1-fold variation in the reduction of HbA1c testing between general practices (12.4–63.8% of 2019 levels). There was evidence of limited prioritization of testing for patients with HbA1c > 86 mmol/mol during April–June 2020 (4.6% of total tests vs. 2.6% during 2019). Testing in areas with the highest social disadvantage was lower during the first lockdown (April–June 2020; trend test p < 0.001) and two subsequent periods (July–September and October–December 2020; both p < 0.001). By February 2021, testing in the highest deprivation group had a cumulative fall in testing of 34.9% of 2019 levels versus 24.6% in those in the lowest group. Conclusion: Our findings highlight that the pandemic response had a major impact on diabetes monitoring and screening. Despite limited test prioritization in the > 86 mmol/mol group, this failed to acknowledge that those in the 59–86 mmol/mol group require consistent monitoring to achieve the best outcomes. Our findings provide additional evidence that those from poorer backgrounds were disproportionately disadvantaged. Healthcare services should redress this health inequality. [ABSTRACT FROM AUTHOR]

Aims: Previous evidence suggests that engagement with heritage such as visiting heritage sites provides benefits for people's mental and social wellbeing, and helps to establish social capital. However, far less is known about whether living in areas of historic built environment also helps build social capital. Furthermore, it remains unclear how the association between historic built environment and social capital may vary across heritage engagement frequency and areas of deprivation levels. This study was therefore designed to explore the cross-sectional relationship between historic built environment and social capital., Methods: Analysis was based on three datasets: Understanding Society: The UK Household Longitudinal Study Waves 5 (2013/2015) and 6 (2014/2016), 2019 National Heritage List for England, and 2015 English Index of Multiple Deprivation (IMD). Ordinary least squares (OLS) regressions were applied to estimate the relationships between historic built environment (listed buildings, scheduled monuments, and registered parks and gardens) and social capital (personal relationships, social network support, civic engagement, and trust and cooperative norms)., Results: We found that people living in places with greater historic built environment experienced higher levels of personal relationships, social network support, and civic engagement. However, these associations were attenuated once rurality was adjusted. Individuals living in areas of greater levels of historic built environment displayed higher levels of trust and cooperative norms, even after adjusting for all relevant covariates. Heritage engagement frequency was found to moderate the association between historic built environment and personal relationships. Similarly, IMD was also found to moderate the association between historic built environment and trust and cooperative norms., Conclusion: These findings highlight the importance of neighbourhood environment in building social capital in communities. Particularly, areas with heritage assets may provide both socially inviting and aesthetically pleasing environments that could help strengthen community and restore pride in place., Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Hip fracture risk varies by geography and by levels of deprivation. We examined the effect of local area-level deprivation on hip fracture incidence across nine regions in England, using 14 years of hospital data, to determine whether inequalities in hip fracture incidence rates vary across geographic regions in England. Study design: Sequential annual cross-sectional studies over 14 years. Methods: We used English Hospital Episodes Statistics (2001/02-2014/15) to identify hip fractures in adults aged 50+ years and mid-year population estimates (2001-2014) from the Office for National Statistics. The Index of Multiple Deprivation was used to measure local area deprivation. We calculated age-standardised hip fracture incidence rates per 100,000 population, stratified by gender, geographic region, deprivation quintiles and time-period, using the 2001 English population as the reference population. Using Poisson regression, we calculated age-adjusted incidence rate ratios (IRRs) for hip fracture, stratified as above. Results: Over 14 years, we identified 747,369 hospital admissions with an index hip fracture. Age-standardised hip fracture incidence was highest in the North East for both men and women. In North England (North East, North West and Yorkshire and the Humber), hip fracture incidence was relatively higher in more deprived areas, particularly among men: IRR most vs least deprived quintile 2.06 (95% confidence interval [CI] = 2.00-2.12) in men, 1.62 (95% CI 1.60-1.65) in women. A relationship, albeit less marked, between deprivation and hip fracture incidence was observed among men in the Midlands and South, but with no clear pattern among women. Conclusions: Regional variation in hip fracture incidence exists across England, with the greatest absolute burden of incident hip fractures observed in the North East for both men and women. Across local areas in North England, absolute and relative inequalities in hip fracture incidence were greater than in other regions. Our findings highlight the need for improved fracture prevention programmes that aim to reduce regional and social inequalities in hip fracture incidence. [ABSTRACT FROM AUTHOR]

Summary: Deprivation predicts increased hip fracture risk. Over 14 years, hip fracture incidence increased among men with persisting inequalities. Among women, inequalities in incidence were less pronounced; whilst incidence decreased overall, this improvement was seen marginally less in women from the most deprived areas. Hip fracture prevention programmes have not reduced inequalities. Purpose: Deprivation is associated with increased hip fracture risk. We examined the effect of area-level deprivation on hip fracture incidence in England over 14 years to determine whether inequalities have changed over time. Methods: We used English Hospital Episodes Statistics (2001/2002-2014/2015) to identify hip fractures in adults aged 50+ years and mid-year population estimates (2001-2014) from the Office for National Statistics. The Index of Multiple Deprivation measured local area deprivation. We calculated age-adjusted incidence rate ratios (IRR) for hip fracture, stratified by gender and deprivation quintiles. Results: Over 14 years, we identified 747,369 hospital admissions with an index hip fracture; the number increased from 50,640 in 2001 to 55,092 in 2014; the proportion of men increased from 22.2% to 29.6%. Whereas incidence rates decreased in women (annual reduction 1.1%), they increased in men (annual increase 0.6%) (interaction p < 0.001). Incidence was higher in more deprived areas, particularly among men: IRR most vs. least deprived quintile 1.50 [95% CI 1.48, 1.52] in men, 1.17 [1.16, 1.18] in women. Age-standardised incidence increased for men across all deprivation quintiles from 2001 to 2014. Among women, incidence fell more among those least compared to most deprived (year by deprivation interaction p < 0.001). Conclusions: Deprivation is a stronger relative predictor of hip fracture incidence in men than in women. However, given their higher hip fracture incidence, the absolute burden of deprivation on hip fractures is greater in women. Despite public health efforts to prevent hip fractures, the health inequality gap for hip fracture incidence has not narrowed for men, and marginally widened among women. [ABSTRACT FROM AUTHOR]

Objective: The objective of this analysis was to explore the healthcare-seeking behaviours and experiences of maternity care among women from different socio-economic groups in order to improve understanding of why socially disadvantaged women have poorer maternal health outcomes in the UK.Design: Secondary analysis of a national survey of women conducted 3 months after they had given birth.Setting: England.Sample: A total of 5332 women.Methods: Logistic regression analysis to investigate differences in outcomes among different socio-economic groups, classified by the Index of Multiple Deprivation (IMD).Main Outcome Measures: Healthcare-seeking behaviours, outcomes and experiences of maternity care.Results: With each increase in IMD quintile (decrease in socio-economic position), women were shown to be 25% (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.63-0.90) less likely to have had any antenatal care and 15% (aOR 0.85; 95% CI 0.80-0.90) less likely to have had a routine postnatal check-up. They were 4% (aOR 1.04; 95% CI 0.99-1.10) more likely to have had an antenatal hospital admission, 7% (aOR 1.07; 95% CI 0.99-1.16) more likely to have been transferred during labour and 4% (aOR 1.04; 95% CI 0.99-1.09) more likely to have had a caesarean birth, although these results were not statistically significant. With decreasing socio-economic position women were more likely to report that they were not treated respectfully or spoken to in a way they could understand by doctors and midwives.Conclusions: This analysis suggests the need for a focusing of professionals and services towards pregnant women from lower socio-economic groups and more targeted maternal public health education towards socially disadvantaged women. [ABSTRACT FROM AUTHOR]

There is an assumption that marine activities, particularly seafood-based activities, are an important source of employment and income in poor coastal areas. Linking the 2010 Index of Multiple Deprivation ( IMD) for England with the 2010 Business Structure Dataset ( BSD), this paper examines whether employment in the marine sector is concentrated in areas of high deprivation as is assumed. Merging the IMD 2010 with the BSD allows us to examine rates of marine-based employment and their location both across (inter) and within (intra) regions. This analysis provides the first empirical evidence that employment in the marine sector, particularly fishing and seafood processing, are located in areas with higher than average deprivation, even if the overall regional rate of deprivation is relatively low (the South East and the South West of England). Methodologically, this analysis indicates that an index such as the IMD based on a wide range of social and economic data can be used to understand the socioeconomic impacts of a sector within an area. Whilst most importantly this paper further demonstrates that intra-regional analysis is more insightful in exploring the geographical socioeconomic impact of the marine sector than inter-regional level analysis. With regard to the academic contribution, this paper also aims to conceptualise marine activity as a core economic activity located both in peripheral and non-peripheral areas. [ABSTRACT FROM AUTHOR]

While social and spatial determinants of biomarkers have been reported, no previous study has examined both together within an intersectional perspective. We present a novel extension of quantitative intersectional analyses using cross-classified multilevel models to explore how intersectional positions and neighbourhood deprivation are associated with biomarkers, using baseline UK Biobank data (collected from 2006 to 2010). Our results suggest intersectional inequalities in biomarkers of healthy ageing are mostly established by age 40-49, but different intersections show different relationships with deprivation. Our study suggests that certain biosocial pathways are more strongly implicated in how neighbourhoods and intersectional positions affect healthy ageing than others. [ABSTRACT FROM AUTHOR]

This article seeks to provide evidence on whether ‘league table’ orderings for the economic performance of local areas are robust to the use of spatial units other than the Local Authority. We concentrate primarily on the overall index from the recently published Index of Multiple Deprivation for England. In addition to compiling league tables for administrative Local Authority areas and functional Travel-To-Work Areas, we also develop a concentric banding approach which allows a range of definitions for any local area. Our results demonstrate that local economic performance league table standings can exhibit marked sensitivity to the adopted definition of local area. We offer some particular focus on the case of Hull, but also demonstrate that this is not a unique example. [ABSTRACT FROM PUBLISHER]

Background: Deprivation can impact the access to health interventions in publicly funded health systems where cost is not the dominant barrier. In this study we examined whether deprivation affected the access to disease modifying therapies (DMTs) for multiple sclerosis (MS)., Methods: All English adults on the UK MS register with relapsing remitting MS who were diagnosed between 2010 and 2017, and after the age of 29 years were included. Deprivation was measured using postcode-based 2015 English index of multiple deprivation (IMD), which was divided into quintiles., Results: A total of 1449 participants were eligible and 531/1449 (36.6%) received DMTs. Participants who lived in more deprived areas, based on their IMD scores, were significantly less likely to receive DMTs (odds ratio = 0.69, 95% Confidence interval = 0.49 to 0.98); barriers to housing and services contributed to this disparity. The Nagelkerke R 2 value of these models showed that 2% of variation in accessing DMTs were dependant on deprivation., Conclusions: Deprivation, as measured by IMD, negatively influences the access to DMTs in England. Our findings also suggest that the lack of access to local MS DMT clinics in deprived areas may contribute to this disparity., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: At a low geographical level, little is known about the associations between population characteristics and deprivation, and their trends, which would be directly affected by the house market, labour pressures and government policies. We describe temporal trends in health and overall deprivation in England by age, sex, urbanity and ethnicity., Methods: Repeated cross-sectional whole population study for England, 2004-2015, at a low geographical level (average 1500 residents). We calculated weighted medians of the Index of Multiple Deprivation (IMD) for each subgroup of interest., Results: Over time, we observed increases in relative deprivation for people aged under 30, and aged 30-59, while median deprivation decreased for those aged 60 or over. Subgroup analyses indicated that relative overall deprivation was consistently higher for young adults (aged 20-29) and infants (aged 0-4), with increases in deprivation for the latter. Levels of overall deprivation in 2004 greatly varied by ethnicity, with the lowest levels observed for White British and the highest for Blacks. Over time, small reductions were observed in the deprivation gap between White British and all other ethnic groups. Findings were consistent across overall IMD and its health and disability subdomain, but large regional variability was also observed., Conclusions: Government policies, the financial crisis of 2008, education funding and the increasing cost of houses relative to real wages are important parameters in interpreting our findings. Socioeconomic deprivation is an important determinant of health and the inequalities this work highlights may have significant implications for future fiscal and healthcare policy., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: There is strong evidence to suggest that social deprivation is linked to health inequalities. In the UK, concerns have been raised regarding disparities in the outcomes of acute cardiac services within the National Health Service (NHS). This study explored whether differences exist in (a) elective hospital presentation time (b) indicators of severity and disease burden and (c) treatment outcomes (hospital stay and mortality) on the basis of the index of multiple deprivation (IMD) status., Design: This study was a retrospective analysis of data from NHS databases for 13,758 patients that had undergone cardiac revascularisation interventions at the Liverpool Heart and Chest Hospital between April 2007-March 2012., Methods: The data was analysed by descriptive, univariate and multivariate statistics to explore the association between the IMD quintiles (Q1-Q5) and revascularisation type, elective presentation time, hospital length of stay and mortality., Results and Conclusions: Univariate analysis indicated that there were significant differences between patients from the most deprived areas (Q5) compared with patients from the least deprived areas (Q1), these included admission volumes, time before presentation to hospital and proportion of non-elective cases. After risk-adjustments, percutaneous coronary intervention patients from Q5 compared with Q1 had significantly greater length of hospital stay and risk of in-hospital major acute cardiovascular events. After multivariate adjustment for baseline risk factors, patients from Q5 were associated with significantly worse five-year survival as compared with Q1 (hazard ratio (HR) 1.52, 95% confidence interval (CI): 1.36-1.71; p < 0.001). In conclusion, there is evidence to suggest that inequalities in cardiac revascularisation choices and outcomes in the UK may be associated with social deprivation., (© The European Society of Cardiology 2015.)