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Abstract Background Obstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. Traditionally, decisions regarding site selection are based on desire to complete trials on target in ‘tried and tested’ research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK. Method Using routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard. Results The dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented. Conclusion The NIHR equality, diversity and inclusion strategy states studies must widen participation, facilitating individuals from all backgrounds to engage. The development of this novel interactive dashboard demonstrates an innovative way of achieving this. National Health Service (NHS) maternity researchers should consider using this tool to enhance diversity in research, address health disparities and improve generalisability of findings. This approach could be applied to healthcare settings beyond maternity care and across different global populations. Trial registration ISRCTN 17679951. Registered on August 30, 2023.

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]

Background: Obstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. Traditionally, decisions regarding site selection are based on desire to complete trials on target in 'tried and tested' research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK. Method: Using routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard. Results: The dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented. Conclusion: The NIHR equality, diversity and inclusion strategy states studies must widen participation, facilitating individuals from all backgrounds to engage. The development of this novel interactive dashboard demonstrates an innovative way of achieving this. National Health Service (NHS) maternity researchers should consider using this tool to enhance diversity in research, address health disparities and improve generalisability of findings. This approach could be applied to healthcare settings beyond maternity care and across different global populations. Trial registration: ISRCTN 17679951. Registered on August 30, 2023. [ABSTRACT FROM AUTHOR]

• Impact of socio-economic deprivation on post-ACDF length of stay is unknown. • A total of 2033 patients who had undergone ACDF at our institution were analysed. • Index of multiple deprivation decile significantly predicted post-op length of stay. • The XGBoost model had 80.95 % accuracy, 71.52 % sensitivity and 85.76 % specificity. • Non-clinical pre-operative comorbidities and patient factors can predict length of stay. Post-operative length of hospital stay (LOS) is a valuable measure for monitoring quality of care provision, patient recovery, and guiding hospital resource management. But the impact of patient ethnicity, socio-economic deprivation as measured by the indices of multiple deprivation (IMD), and pre-existing health conditions on LOS post-anterior cervical decompression and fusion (ACDF) is under-researched in public healthcare settings. From 2013 to 2023, a retrospective study at a single center reviewed all ACDF procedures. We analyzed 14 non-clinical predictors—including demographics, comorbidities, and socio-economic status—to forecast a categorized LOS: short (≤2 days), medium (2–3 days), or long (>3 days). Three machine learning (ML) models were developed and assessed for their prediction reliability. 2033 ACDF patients were analyzed; 79.44 % had a LOS ≤ 2 days. Significant predictors of LOS included patient sex (HR:0.81[0.74–0.88], p < 0.005), IMD decile (HR:1.38[1.24–1.53], p < 0.005), smoking (HR:1.24[1.12–1.38], p < 0.005), DM (HR:0.70[0.59–0.84], p < 0.005), and COPD (HR:0.66, p = 0.01). Asian patients had the highest mean LOS (p = 0.003). Testing on 407 patients, the XGBoost model achieved 80.95 % accuracy, 71.52 % sensitivity, 85.76 % specificity, 71.52 % positive predictive value, and a micro F1 score of 0.715. This model is available at: https://acdflos.streamlit.app. Utilizing non-clinical pre-operative parameters such as patient ethnicity, socio-economic deprivation index, and baseline comorbidities, our ML model effectively predicts postoperative LOS for patient undergoing ACDF surgeries. Yet, as the healthcare landscape evolves, such tools will require further refinement to integrate peri and post-operative variables, ensuring a holistic decision support tool. [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. [ABSTRACT FROM AUTHOR]

This study explores the correlation between residents' subjective assessments of urban neighbourhoods, obtained through virtual walkthroughs, and objective measures of deprivation. Our study was set within a specific city in the United Kingdom, with neighbourhoods selected based on Indices of Multiple Deprivation (IMD). We invited residents in the UK through Prolific, a crowdsourcing platform. Employing complete case analysis, TF-IDF keyword extraction, the Kruskal–Wallis test, and Spearman's rank-order correlation, our study examines the alignment between subjective assessments and existing deprivation measures (IMD). The results reveal a nuanced relationship, suggesting potential subjective biases influencing residents' perceptions. Despite these complexities, the study highlights the value of virtual walkthroughs in offering a holistic overview of neighbourhoods. While acknowledging the limitations posed by subjective biases, we argue that virtual walkthroughs provide insights into residents' experiences that potentially complement traditional objective measures of deprivation. By capturing the intricacies of residents' perceptions, virtual walkthroughs contribute to a more comprehensive understanding of neighbourhood deprivation. This research informs future endeavours to integrate subjective assessments with objective measures for robust neighbourhood evaluations. [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]

Objective To investigate the association between socioeconomic deprivation and outcomes following TNF inhibitor (TNFi) treatment. Methods Individuals commencing their first TNFi in the British Society for Rheumatology Biologics Register for RA (BSRBR-RA) and Biologics in RA Genetics and Genomics Study Syndicate (BRAGGSS) cohort were included. Socioeconomic deprivation was proxied using the Index of Multiple Deprivation and categorized as 20% most deprived, middle 40% or 40% least deprived. DAS28-derived outcomes at 6 months (BSRBR-RA) and 3 months (BRAGGSS) were compared using regression models with the least deprived as referent. Risks of all-cause and cause-specific drug discontinuation were compared using Cox models in the BSRBR-RA. Additional analyses adjusted for lifestyle factors (e.g. smoking, BMI) as potential mediators. Results 16 085 individuals in the BSRBR-RA were included (mean age 56 years, 76% female), of whom 18%, 41% and 41% were in the most, middle and least deprived groups, respectively. Of 3459 included in BRAGGSS (mean age 57, 77% female), proportions were 22%, 36% and 41%, respectively. The most deprived group had 0.3-unit higher 6-month DAS28 (95% CI 0.22, 0.37) and were less likely to achieve low disease activity (odds ratio [OR] 0.76; 95% CI 0.68, 0.84) in unadjusted models. Results were similar for 3-month DAS28 (β = 0.23; 95% CI 0.11, 0.36) and low disease activity (OR 0.77; 95% CI 0.63, 0.94). The most deprived were more likely to discontinue treatment (hazard ratio 1.18; 95% CI 1.12, 1.25), driven by ineffectiveness rather than adverse events. Adjusted estimates were generally attenuated. Conclusion Socioeconomic deprivation is associated with reduced response to TNFi. Improvements in determinants of health other than lifestyle factors are needed to address socioeconomic inequities. [ABSTRACT FROM AUTHOR]

Summary: Background: Lower socioeconomic status, as measured by the Index of Multiple Deprivation (IMD), is associated with higher rates of smoking-related disease mortality, and with poor uptake of cancer screening. Here we explore whether socioeconomic status impacts the effectiveness of a single round of low-dose-CT screening, or impacts other causes of death, in the UKLS LDCT screening trial. Methods: IMD quintiles were defined according to UK-wide data, with the deprived group defined as the lower two quintiles (Q1-2) and the less deprived as Q3-5. Follow-up data was obtained for lung cancer diagnosis (median follow-up 9.1 years) and cause of death (median follow-up 9.9 years). Outcomes were compared based on IMD group and trial arm (CT or control). Findings: More deprived quintiles were less likely to respond to the questionnaire, but this population was more likely to be selected for screening by the LLP risk model. Lower IMD quintiles benefitted from low-dose-CT screening in terms of lung cancer survival (HR 1.89, 95% CI 1.16–3.08) to the same extent as upper quintiles (HR 1.87, 95% CI 1.07–3.26). However, there was a bigger impact on deaths due to COPD and emphysema in more deprived quintiles. Interpretation: Whilst LDCT screening benefit for lung cancer was similar, significant impact on the rates of death from other smoking-related diseases, notably COPD and emphysema, was seen primarily in lower socioeconomic groups. Future research is required to confirm how lung cancer screening benefits other disease outcomes. Funding: NIHR Health Technology Assessment Programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.

This study explores the correlation between residents’ subjective assessments of urban neighbourhoods, obtained through virtual walkthroughs, and objective measures of deprivation. Our study was set within a specific city in the United Kingdom, with neighbourhoods selected based on Indices of Multiple Deprivation (IMD). We invited residents in the UK through Prolific, a crowdsourcing platform. Employing complete case analysis, TF-IDF keyword extraction, the Kruskal–Wallis test, and Spearman’s rank-order correlation, our study examines the alignment between subjective assessments and existing deprivation measures (IMD). The results reveal a nuanced relationship, suggesting potential subjective biases influencing residents’ perceptions. Despite these complexities, the study highlights the value of virtual walkthroughs in offering a holistic overview of neighbourhoods. While acknowledging the limitations posed by subjective biases, we argue that virtual walkthroughs provide insights into residents’ experiences that potentially complement traditional objective measures of deprivation. By capturing the intricacies of residents’ perceptions, virtual walkthroughs contribute to a more comprehensive understanding of neighbourhood deprivation. This research informs future endeavours to integrate subjective assessments with objective measures for robust neighbourhood evaluations.

Objectives: To estimate the risk of Long COVID by socioeconomic deprivation and to further examine the inequality by sex and occupation. Design: We conducted a retrospective population-based cohort study using data from the ONS COVID-19 Infection Survey between 26 April 2020 and 31 January 2022. This is the largest nationally representative survey of COVID-19 in the UK with longitudinal data on occupation, COVID-19 exposure and Long COVID. Setting: Community-based survey in the UK. Participants: A total of 201,799 participants aged 16 to 64 years and with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Main outcome measures: The risk of Long COVID at least 4 weeks after SARS-CoV-2 infection by index of multiple deprivation (IMD) and the modifying effects of socioeconomic deprivation by sex and occupation. Results: Nearly 10% (n = 19,315) of participants reported having Long COVID. Multivariable logistic regression models, adjusted for a range of variables (demographic, co-morbidity and time), showed that participants in the most deprived decile had a higher risk of Long COVID (11.4% vs. 8.2%; adjusted odds ratio (aOR): 1.46; 95% confidence interval (CI): 1.34, 1.59) compared to the least deprived decile. Significantly higher inequalities (most vs. least deprived decile) in Long COVID existed in healthcare and patient-facing roles (aOR: 1.76; 95% CI: 1.27, 2.44), in the education sector (aOR: 1.68; 95% CI: 1.31, 2.16) and in women (aOR: 1.56; 95% CI: 1.40, 1.73) than men (aOR: 1.32; 95% CI: 1.15, 1.51). Conclusions: This study provides insights into the heterogeneous degree of inequality in Long COVID by deprivation, sex and occupation. These findings will help inform public health policies and interventions in incorporating a social justice and health inequality lens. [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]

The metabolic syndrome is common in older adults and may be modified by the diet. The aim of this study was to examine associations between a posteriori dietary patterns and the metabolic syndrome in an older New Zealand population. The REACH study (Researching Eating, Activity, and Cognitive Health) included 366 participants (aged 65–74 years, 36 % male) living independently in Auckland, New Zealand. Dietary data were collected using a 109-item FFQ with demonstrated validity and reproducibility for assessing dietary patterns using principal component analysis. The metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III. Associations between dietary patterns and the metabolic syndrome, adjusted for age, sex, index of multiple deprivation, physical activity, and energy intake were analysed using logistic regression analysis. Three dietary patterns explained 18 % of dietary intake variation – 'Mediterranean style' (salad/leafy cruciferous/other vegetables, avocados/olives, alliums, nuts/seeds, shellfish and white/oily fish, berries), 'prudent' (dried/fresh/frozen legumes, soya-based foods, whole grains and carrots) and 'Western' (processed meat/fish, sauces/condiments, cakes/biscuits/puddings and meat pies/hot chips). No associations were seen between 'Mediterranean style' (OR = 0·75 (95 % CI 0·53, 1·06), P = 0·11) or 'prudent' (OR = 1·17 (95 % CI 0·83, 1·59), P = 0·35) patterns and the metabolic syndrome after co-variate adjustment. The 'Western' pattern was positively associated with the metabolic syndrome (OR = 1·67 (95 % CI 1·08, 2·63), P = 0·02). There was also a small association between an index of multiple deprivation (OR = 1·04 (95 % CI 1·02, 1·06), P < 0·001) and the metabolic syndrome. This cross-sectional study provides further support for a Western dietary pattern being a risk factor for the metabolic syndrome in an older population. [ABSTRACT FROM AUTHOR]

Objectives This research links, for the first time, individual level entire GB population census data for 1851-1911 to present day individual level population registers. Precise georeferencing of individual records using AddressBase Premium and further linkage to Indices of Multiple Deprivation (IMDs) enables family group analysis of inter-generational social mobility outcomes. Approach Present-day individual names and addresses taken from Electoral Registers and consumer data are georeferenced and linked to IMD data using AddressBase. This enables calculation of average IMD scores for every family group (surname). Individual level names and addresses from 1851-1911 censuses are assigned to harmonised historical parishes. The present day surname IMD scores are attributed to every resident in the historical censuses. Parish average ‘future IMD’ scores are calculated to show which areas have bequeathed the highest and lowest IMD scores on their residents’ descendants. This is a measure of how ‘north – south divides’ shape inter-generational social mobility. Results A linked data website, apps.cdrc.ac.uk/gbnames, profiles social mobility outcomes for 13,000+ family names, according to average neighbourhood quality experienced by family name bearers. There are clear and enduring regional divides in “future deprivation” inherited from ancestors by the present-day GB population. The research traces the origins of a north-south divide in England. Family roots in northern industrial cities are associated with unfavourable outcomes today. In Scotland, an east-west divide identifies eastern areas sharing similarly high levels of hardship to nineteenth-century industrial cities such as Liverpool and Manchester. Migration partially mitigates these inequalities, but most family groups remain concentrated in their ancestral heartlands, and continue to experience the long-term disadvantages bestowed by geographical location. Conclusion Surnames provide an under-exploited way of linking precisely georeferenced geographies of entire historical populations to their descendants today. Additional linkage to areal deprivation measures makes it possible to evaluate how social and spatial inequalities both endure and are promulgated through the generations. Geography is destiny for much of the population.

We propose a general framework that can be used to analyse the mortality experience of a large portfolio of lives. The objective of the framework is to provide a firm evidence base to support the setting of future mortality assumptions for the portfolio as a whole or subgroup-by-subgroup. The framework is developed in tandem with an analysis of the mortality of pensioners in the Universities Superannuation Scheme (USS), the largest funded pension scheme in the UK and one with a highly educated and very homogeneous membership. The USS experience was compared with English mortality subdivided into deprivation deciles using the Index of Multiple Deprivation (IMD). USS was found to have significantly lower mortality rates than even IMD-10 (the least deprived of the English deciles), but with similar mortality improvement rates to that decile over the period 2005–2016. Higher pensions were found to predict lower mortality, but only weakly so, and only for persons who retired on the first day of a month (mostly from active service). We found that other potential covariates derived from an individual's post/zip code (geographical region and the IMD associated with their local area) typically had no explanatory power. This lack of dependence is an important conclusion of the USS-specific analysis and contrasts with others that consider the mortality of more heterogeneous scheme memberships. Although the key findings are likely to be particular to USS, we argue that our analytical framework will be useful for other large pension schemes and life annuity providers. [ABSTRACT FROM AUTHOR]

Poor diet is associated with an increased risk of metabolic syndrome and poor cognitive function. This study uses the Eating Index in Older Adults (the index) to measure adherence to New Zealand’s dietary guidelines in older adults and associations with metabolic syndrome and cognitive function. This cross-sectional study uses data from the Researching Eating, Activity, and Cognitive Health (REACH) study, 371 adults (65–74 years, 36% male) living in Auckland, New Zealand. A validated 109-item food frequency questionnaire was used to collect dietary data. Adherence to the dietary guidelines was scored using the index, which comprises a total score (maximum = 100) and two sub-scores based on adequacy (60) and moderation (40). Higher scores indicate better adherence to guidelines. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Six cognitive domains were tested using COMPASS (Computerised Mental Performance Assessment System). Regression analyses were performed, adjusted for age, sex, index of multiple deprivation, education (cognitive function only), physical activity, Apolipoprotein E-ε4 genotype (cognitive function only) and energy intake. Because of the number of tests, p ≤ 0.001 was considered statistically significant. The mean [standard deviation] index scores, for males and females, were 62 [9] and 64 [10] for total (p = 0.03); 42 [8] and 43 [7] for adequacy (p = 0.03) and 21 [5] and 21 [6] (p = 0.54) for moderation scores. Adherence to the index was not associated with metabolic syndrome (total score p = 0.55) nor cognitive function (total score and global p = 0.50; attention p = 0.32; executive function p = 0.46; episodic memory p = 0.68; working memory p = 0.04; spatial memory p = 0.17). Higher deprivation was positively associated with metabolic syndrome, while higher education was positively associated with cognitive function (both, p < 0.001). In this population, deprivation and education rather than adherence to the index were more influential factors affecting metabolic syndrome and cognitive function.

Recent studies have sought to explore the relationship between environmental and financial performance, in particular the relationship between the energy efficiency level of a building and its financial value. The present real estate dataset contains 43 variables of repeat sales transactions, energy performance certificate (EPC) rating, index of multiple deprivation (IMD), and geographical location of properties in England and Wales involved in a total of 4,201 transactions from 1995 to 2012. This dataset enables researchers and practitioners to further explore important questions regarding the nexus between the real estate industry, sustainability levels, and socio-economic aspects. Due to the scarcity of publicly available quality real estate data, the dataset detailed in this article may play a relevant role by becoming easily discoverable, clearly explained, and structured to be ready to be used by researchers, analysts, and policymakers. The empirical analysis of the economic case for energy-efficient dwellings in the UK private rental market performed in Fuerst, et al. [1] is based on this dataset.

Zahlreiche internationale Studien zeigen, dass Indizes Multipler Deprivation ein geeignetes Instrument zur Messung sozialräumlicher Effekte auf die Gesundheit der Bevölkerung und damit zur Sichtbarmachung sozialer Ungleichheiten darstellen. Auch für Deutschland liegt mit dem German Index of Multiple Deprivation ein derartiges etabliertes Werkzeug vor. Zukünftig sollten entsprechend fundierte Ergebnisse stärkere Berücksichtigung bei der Ressourcenallokation und medizinischen Bedarfsplanung finden. Numerous international studies show that Indices of Multiple Deprivation are a suitable instrument to determine socio-spatial effects on the health of the population and, thereby, to display social inequalities. For Germany, the German Index of Multiple Deprivation is such an established instrument. In the future, corresponding well-founded results should receive more attention when it comes to the allocation of resources or the planning of medical requirements. [ABSTRACT FROM AUTHOR]

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]

Purpose: To establish how much uveitis patients know about their own condition and to investigate the contribution of demographic factors to that knowledge.Methods: A self-designed questionnaire, comprising 20 questions about uveitis, was distributed to 200 consecutive patients attending a uveitis clinic. The questionnaire requested demographic details and required responses to uveitis-specific knowledge questions. Postcode was used to determine level of social deprivation using Index of Multiple Deprivation 2007. Univariate analyses with the Mann-Whitney test and Kruskal-Wallis test were utilized. Multivariable logistic regression was performed to simultaneously measure the independent influence of demographic variables on the level of patients' understanding of their condition.Results: Of the respondents, 62% were female, 71% aged >40 years and 67% of white ethnic origin, with 41% having been under the care of a uveitis specialist for >10 years and 72% attending ≥3 clinic appointments in the preceding 12 months. Median questionnaire score (out of 60) was 27 (interquartile range, IQR 15). Females scored significantly higher than males (30 vs 24; p = 0.001), but there was no difference according to age, ethnicity, or social deprivation quintile, nor the duration patients had been under ophthalmic review or number of clinic attendances in the preceding 12 months. Multivariable analyses determined no independent influence of any of the factors on the uveitis questionnaire score.Conclusions: Uveitis patients' understanding of their condition is poor. This has relevance for adherence to treatment, follow-up clinic attendance, and eventual outcomes in these patients. [ABSTRACT FROM AUTHOR]

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Background UK National Institute for Health and Care Excellence (NICE) clinical guidelines (CG) 168, published in July 2013, aimed to improve the management of lower limb venous disease by newly recommending interventional treatment for all people affected by symptomatic varicose veins (VV) and specialist vascular referral for all people suffering from a leg ulcer (LU) that had been present for ≥2 weeks. This study aims to determine if CG168 has increased access to vascular services, particularly for the socially deprived, who might be expected to have greater need for such services. Methods The study was performed in a highly multi-cultural, socio-economically diverse, mixed urban/suburban population of approximately 1.2 million people living in and around East Birmingham, UK. Index of multiple deprivation quintile (IMD-Q) was used as a measure of social deprivation to compare levels of social deprivation of people undergoing interventions for symptomatic VV or referred with an LU during 18-month periods before and after the publication of CG168. The referring general practitioner practices (GPPs) were also recorded. Results There was no change in overall IMD-Q distribution before and after CG168 in terms of VV interventions. However, there was a non-significant increase in proportions of people classified as IMD-Q5 (the most deprived quintile). After CG168, fewer IMD-Q5 people with LU were referred, with a shift in referrals towards those from less socially deprived areas. More GPP referred people with both VV and LU after CG168, and those that referred patients before and after CG168 tended to refer more after CG168. Conclusions CG168 has increased VV interventions as well as the number referred with LU. However, this improvement in access to treatment and referral may have disproportionately favoured the more socio-economic privileged. Professional and public education is required to ensure that the beneficial impact of the CG168 recommendations are maximised and that those with the greatest health needs have equal access to evidence-based management of their venous disease. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote)., Objective: This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities., Methods: We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time., Results: Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived., Conclusions: The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas., (©Emma Maria Vestesson, Kaat Lieve An De Corte, Elizabeth Crellin, Jean Ledger, Minal Bakhai, Geraldine M Clarke. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 02.05.2023.)

In this work we present a statistical approach to distinguish and interpret the complex relationship between several predictors and a response variable at the small area level, in the presence of (i) high correlation between the predictors and (ii) spatial correlation for the response. Covariates which are highly correlated create collinearity problems when used in a standard multiple regression model. Many methods have been proposed in the literature to address this issue. A very common approach is to create an index which aggregates all the highly correlated variables of interest. For example, it is well known that there is a relationship between social deprivation measured through the Multiple Deprivation Index (IMD) and air pollution; this index is then used as a confounder in assessing the effect of air pollution on health outcomes (e.g. respiratory hospital admissions or mortality). However it would be more informative to look specifically at each domain of the IMD and at its relationship with air pollution to better understand its role as a confounder in the epidemiological analyses. In this paper we illustrate how the complex relationships between the domains of IMD and air pollution can be deconstructed and analysed using profile regression, a Bayesian non-parametric model for clustering responses and covariates simultaneously. Moreover, we include an intrinsic spatial conditional autoregressive (ICAR) term to account for the spatial correlation of the response variable. [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]

Objective To determine whether there was an association between the coverage of booster immunisation of Diphtheria, Tetanus, acellular Pertussis and Polio (DTaP/IPV) and second Measles, Mumps and Rubella (MMR) dose by age 5 in accordance with the English national immunisation schedule by area-level socioeconomic deprivation and whether this changed between 2007/08 and 2010/11. Design Ecological study. Data Routinely collected national Cover of Vaccination Evaluated Rapidly data on immunisation coverage for DTaP/IPV booster and second MMR dose by age 5 and the Index of Multiple Deprivation (IMD). Setting Primary Care Trust (PCT) areas in England between 2007/08 and 2010/11. Outcome Measures Population coverage (%) of DTaP/IPV booster and second MMR immunisation by age 5. Results Over the 4 years among the 9,457,600 children there was an increase in the mean proportion of children being immunised for DTaP/IPV booster and second MMR across England, increasing from 79% (standard deviation (SD12%)) to 86% (SD8%) for DTaP/IPV and 75% (SD10%) to 84% (SD6%) for second MMR between 2007/08 and 2010/11. In 2007/08 the area with lowest DTaP/IPV booster coverage was 31% compared to 54.4% in 2010/11 and for the second MMR in 2007/08 was 39% compared to 64.8% in 2010/11. A weak negative correlation was observed between average IMD score and immunisation coverage for the DTaP/IPV booster which reduced but remained statistically significant over the study period ( r = −0.298, p < 0.001 in 2007/08 and r = −0.179, p = 0.028 in 2010/11). This was similar for the second MMR in 2007/08 ( r = −0.225, p = 0.008) and 2008/09 ( r = −0.216, p = 0.008) but there was no statistically significant correlation in 2009/10 ( r = −0.108, p = 0.186) or 2010/11 ( r = −0.078, p = 0.343). Conclusion Lower immunisation coverage of DTaP/IPV booster and second MMR dose was associated with higher area-level socioeconomic deprivation, although this inequality reduced between 2007/08 and 2010/11 as proportions of children being immunised increased at PCT level, particularly for the most deprived areas. However, coverage is still below the World Health Organisation recommended 95% threshold for Europe. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine whether social deprivation is a risk factor for late presentation of patients with proliferative diabetic retinopathy and whether it affects their access to urgent laser treatment. Methods: Using a 2:1 case: control design, 102 patients referred to a UK teaching hospital as part of the UK Diabetic Retinopathy National Screening Programme were identified for the period between 1 June 2010 to 1 June 2013. Social deprivation was scored using the Index of Multiple Deprivation 2010. Additional variables considered included age, duration of disease, ethnicity, and HbA1c at time of referral. Results: The cases comprised 34 patients referred with proliferative (grade R3) retinopathy with a control group of 68 patients with lower retinopathy grades; two control patients were excluded due to incomplete data. On univariate analysis, R3 retinopathy was associated with higher social deprivation (P,0.001, Mann-Whitney U-test), and with higher HbA1c (11.5% vs 8.4%; P,0.001, Mann-Whitney U-test). Forward stepwise multivariable analysis showed that the association of R3 retinopathy with deprivation was significant even after adjusting for HbA1c (P=0.016). On univariate analysis South Asian ethnicity was also identified as being a risk factor for presentation with R3 retinopathy, but this was no longer significant when HbA1c was adjusted for in a forward stepwise logistic regression analysis. Conclusion: In our cohort social deprivation appears to be associated with late presentation of proliferative diabetic retinopathy. Our study supports the need to target these groups to reduce preventable blindness and to identify strategies which overcome barriers to care. [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]

Limited studies have been conducted to explore the interaction effects of social environmental and genetic factors on the risks of common psychiatric disorders. 56,613–106,695 individuals were collected from the UK Biobank cohort. Logistic or liner regression models were first used to evaluate the associations of index of multiple deprivation (IMD) with bipolar disorder (BD), depression and anxiety in UK Biobank cohort. Then, for the significant IMD associated with BD, depression and anxiety, genome-wide gene-environment interaction study (GWEIS) was performed by PLINK 2.0. Totally, the higher levels of IMD were significantly associated with higher risks of BD, depression and anxiety. For BD, GWEIS identified multiple significant SNPs interacting with IMD, such as rs75182167 for income and rs111841503 for education. For depression and anxiety, GWEIS found significant SNPs interacting with income and education, such as rs147013419 for income and rs142366753 for education. Social environmental deprivations contributed to the risks of psychiatric disorders. Besides, we reported multiple candidate genetic loci interacting with IMD, providing novel insights into the biological mechanism. • The higher levels of IMD were significantly associated with higher risks of BD, depression and anxiety. • GWEIS identified multiple significant SNPs interacting with IMD, such as rs75182167, rs111841503 and rs12257534. • For depression and anxiety, GWEIS found significant SNPs interacting with education, such as rs142366753 and rs35610560. [ABSTRACT FROM AUTHOR]

This paper presents a spatial analysis of multiple deprivation in South Africa and demonstrates that the most deprived areas in the country are located in the rural former homeland areas. The analysis is undertaken using the datazone level South African Index of Multiple Deprivation which was constructed from the 2001 Census. Datazones are a new statistical geography designed especially for this Index using techniques developed in the United Kingdom. They are smaller in population size than wards, enabling fine-grained spatial analysis of deprivation across the whole of South Africa. The spatial scale used is the smallest to be used in a developing country to date. Levels of deprivation are compared between former homeland areas as a whole, the rest of South Africa and a case-study township, as well as between each former homeland. Individual dimensions of deprivation and an overall composite measure are presented. Municipality-level analysis shows that this spatial pattern of multiple deprivation continued to persist in 2007, demonstrating the ongoing spatial legacy of apartheid. [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]

Aims To examine the relationship between social deprivation, intensification of insulin therapy (⩾ three injections per day) and diabetes control in children and adolescents. Methods We performed a longitudinal observational study of 283 children and adolescents with Type 1 diabetes from three UK paediatric centres from 2005 to 2007. We used linear mixed modelling to identify the contribution of the Index of Multiple Deprivation 2004, insulin regimen and demographic factors in explaining longitudinal differences in HbA1c levels. Results Overall mean HbA1c levels were 8.9% [SD 1.4, 74 mmol/ mol (8 mmol / mol)]. Prescribing of intensive therapy increased from 49.2 to 70.1% (X2 = 32.9, P < 0.001), but there was no corresponding improvement in HbA1c levels. Those from more educationally deprived backgrounds were less likely to be started on intensive therapy (P = 0.04). In linear mixed modelling, factors independently associated with poor metabolic control were greater social deprivation (P = 0.01), particularly lower educational levels (P = 0.006), and non-White ethnicity (P = 0.04). Nested terms analysis showed that increased deprivation interacted with non-White ethnicity (P = 0.009) and with intensive insulin therapy (P = 0.03) to result in poorer metabolic control. In a subgroup intensified from conventional regimens during follow-up (n = 75), greater social deprivation was associated with least success of intensive therapy (P = 0.02). Conclusions Social deprivation was associated with low uptake and poor success of insulin intensification and this appeared to be largely mediated via lower educational levels. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Poorer surgical outcomes in patients with low socioeconomic status have previously been reported, but the mechanisms underlying this pattern are unknown. Lower socioeconomic status may be a proxy marker for the limited economic opportunities associated with compromised cognitive function. The aim of this study was to examine the preoperative neuropsychological characteristics of patients with unilateral hippocampal sclerosis (HS) and their relationship to socioeconomic status. Methods: Two hundred ninety-two patients with medically intractable temporal lobe epilepsy and unilateral HS completed tests of memory and intellectual function prior to surgery. One hundred thirty-one had right HS (RHS), and 161 had left HS (LHS). The socioeconomic status of each participant was determined via the Index of Multiple Deprivation (IMD) associated with their postcode. Results: The IMD was not associated with age at the time of assessment, age at onset of epilepsy, or duration of active epilepsy. The RHS and LHS groups did not differ on the IMD. The IMD was negatively correlated with all neuropsychological test scores in the LHS group. In the RHS group, the IMD was not significantly correlated with any of the neuropsychological measures. There were no significant correlations in the RHS group. Regression analyses suggested that IMD score explained 3% of variance in the measures of intellect, but 8% of the variance in verbal learning in the LHS group. The IMD explained 1% or less of the variance in neuropsychological scores in the RHS group. Controlling for overall level of intellectual function, the IMD score explained a small but significant proportion of the variance in verbal learning in the LHS group and visual learning for the RHS group. Conclusions: Our findings suggest that patients living in an area with a high IMD enter surgery with greater focal deficits associated with their epilepsy and more widespread cognitive deficits if they have LHS. Further work is needed to establish the direction of the relationship between low socioeconomic status and the neurocognitive sequelae of epilepsy. [Copyright &y& Elsevier]

Background: To investigate the association between breastfeeding duration and socio-economic status as measured by the English and Welsh Indices of Multiple Deprivation (IMD). Methods: Total 216 multiparous women whose youngest or only child was between 6 and 24 months completed a retrospective questionnaire study of infant feeding between birth and 26 weeks. Measurements included breast-feeding history; socio-economic demography and IMD. Results: Breastfeeding duration was associated with levels of multiple deprivation in both English and Welsh samples. Deprivation level and breastfeeding duration were associated with traditional indicators of socio-economic status. When considered in combination with other socio-economic indicators of breastfeeding duration, the deprivation level remained a strong predictor of breastfeeding duration over and above other socio-economic measures. Conclusions: Deprivation, as assessed by the IMD is predictive of breastfeeding duration. Postcode and thus deprivation level can be used as a non-intrusive way to identify women most at risk of low breastfeeding rates. Service provision can be targeted directly at women in areas recognized at being high in deprivation. [ABSTRACT FROM AUTHOR]

The access domain of the UK index of multiple deprivation (IMD) 2000 was designed to identify populations in small areas with poor geographical access to certain local key services. The measure is a composite of straight line distances to post offices, large food shops, primary schools and general practice surgeries for population sub-groups. Using the region of East Anglia as a case study area, this research evaluated the utility of the IMD2000 as an indicator of access to primary care. IMD2000 access scores for electoral wards were compared with a range of more detailed indicators of travel times and bus availability for visiting a general practitioner generated in a geographical information system (GIS). A range of easy-to-calculate surrogate variables was developed and tested as possible candidates to improve the explanatory power of the IMD2000 access score. The access domain was negatively correlated with the other five deprivation domains that comprise the overall index, suggesting that access should not be combined with the other measures of deprivation into a composite single score. The access domain was also found to predict access to primary care only with moderate accuracy. Two additional indicators of accessibility calculated in a GIS (road kilometres per thousand population and the presence of a major road in each ward) were found to add slightly to the power of the index. The predictive power of the index was best in urban areas, although it is in rural areas that access to primary care is a more important public health issue. The IMD2000 should be therefore used with caution as a measure of health service accessibility in rural areas. [ABSTRACT FROM AUTHOR]

Background: Internationally, researchers have called for evidence to support tackling health inequalities during the severe acute respiratory syndrome coronavirus 2 (COVID19) pandemic. Despite the 2020 Marmot review highlighting growing health gaps between wealthy and deprived areas, studies have not explored social determinants of health (ethnicity, frailty, comorbidities, household overcrowding, housing quality, air pollution) as modulators of presentation, intensive care unit (ITU) admissions and outcomes among COVID19 patients. There is an urgent need for studies examining social determinants of health including socioenvironmental risk factors in urban areas to inform the national and international landscape., Methods: An in-depth retrospective cohort study of 408 hospitalized COVID19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Quantitative data analyses including a two-step cluster analysis were applied to explore the role of social determinants of health as modulators of presentation, ITU admission and outcomes., Results: Patients admitted from highest Living Environment deprivation indices were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission whilst patients admitted from highest Barriers to Housing and Services (BHS) deprivation Indies were at increased risk of ITU admission. Black, Asian and Minority Ethnic (BAME) patients were more likely, than Caucasians, to be admitted from regions of highest Living Environment and BHS deprivation, present with multi-lobar pneumonia and require ITU admission., Conclusion: Household overcrowding deprivation and presentation with multi-lobar pneumonia are potential modulators of ITU admission. Air pollution and housing quality deprivation are potential modulators of presentation with multi-lobar pneumonia. BAME patients are demographically at increased risk of exposure to household overcrowding, air pollution and housing quality deprivation, are more likely to present with multi-lobar pneumonia and require ITU admission. Irrespective of deprivation, consideration of the Charlson Comorbidity Score and the Clinical Frailty Score supports clinicians in stratifying high risk patients.