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Background: Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds., Methods: Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number of acute presentations and hospitalisations stratified by index of multiple deprivation (IMD) and ethnicity; and factors associated with treatment non-escalation, and hospitalisation rates using multivariable logistic and Poisson regression models., Results: 194 291 preschool children were included. In children not trialled on asthma preventer medications, children from the most deprived IMD quintile (adjusted OR 1.67; 95% CI 1.53 to 1.83) and South Asian (1.77; 1.64 to 1.91) children were more likely to have high reliever usage and where specialist referral had not occurred, the odds of referral being indicated was higher in the most deprived quintile (1.39; 1.28 to 1.52) and South Asian (1.86; 1.72 to 2.01) children compared with the least deprived quintile and white children, respectively.Hospitalisation rates for wheeze/asthma were significantly higher in children from the most deprived quintile (adjusted IRR 1.20; 95% CI 1.13 to 1.27) compared with the least, and in South Asian (1.57; 1.44 to 1.70) and black (1.32; 1.22 to 1.42) compared with white children., Conclusions: We identified inequalities in wheeze/asthma treatment and morbidity in preschool children from more deprived, and non-white backgrounds. A multifaceted approach to tackle health inequality at both the national and local levels, which includes a more integrated and standardised approach to treatment, is needed to improve health outcomes in children with preschool wheeze/asthma., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare the following: DL and CL receive support from the National Institute for Health and Care Research (NIHR). DL has also received an institutional research grant from the Midlands Asthma and Allergy Research Association (MAARA). HP holds institutional research grants from NIHR and Asthma UK unrelated to this publication and has received personal fees from Teva Pharmaceuticals and Sandoz UK. Additionally, HP has received travel expense payments from the European Respiratory Society (ERS). JKQ has received institutional grants from the Industrial Strategy Challenge Fund, the Medical Research Council, Health Data Research, GlaxoSmithKline (GSK), Boehringer Ingelheim (BI), Asthma+Lung UK, and Astra Zeneca (AZ); and personal fees from GSK, Evidera, Chiesi, AZ, and Insmed. EAG has received institutional grants from Gilead, Circassia, Chiesi, Propellar Health, Helicon Health, Adherium Ltd, and AZ; and personal fees from Circassia and Sanofi. SS and CG had no competing interests to declare., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: A third of children born in England have at least one parent born outside the United Kingdom (UK), yet family migration history is infrequently studied as a social determinant of child health. We describe rates of hospital admissions in children aged up to 5 years by parental migration and socioeconomic group., Methods: Birth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age 5 years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group., Results: Overall, children whose parents were both born abroad had lower emergency admission rates than children with parents both born in the UK. Children of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4-171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1-156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4-188.2). A socioeconomic gradient in emergency admissions was present across all maternal regions of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42-1.44, high vs. low IMD group). Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia., Conclusions: Overall, we found the highest emergency admission rates among children of UK-born parents from the most deprived backgrounds. However, patterns differed when decomposing maternal place of birth and admission reason, highlighting the importance of a nuanced approach to research on migration and health., (© 2024. The Author(s).)

Background: Early detection of intermediate hyperglycaemia, otherwise known as non-diabetic hyperglycaemia (NDH) is crucial to identify people at high risk of developing type 2 diabetes mellitus (T2DM) who could benefit from preventative interventions. Failure to identify NDH may also increase the risks of T2DM-related complications at the time of T2DM diagnosis. We investigate sociodemographic inequalities in identification of NDH in England., Methods: We used nationwide data from the English National Health Service (NHS) National Diabetes Audit, which includes all people who were newly identified with NDH (N = 469,910) or diagnosed with T2DM (N = 222,795) between 1st April 2019 and 31st March 2020. We used regression models to explore inequalities in the under identification of NDH by area-level deprivation and age group., Results: Of those with a new T2DM diagnosis, 67.3% had no previous record of NDH. The odds of no previous NDH being recorded were higher amongst people living in more deprived areas (Odds ratio (OR) 1.15 (95% confidence intervals (CI) [1.12, 1.19]) most deprived (Q1) compared to least deprived (Q5) quintile) and younger individuals (OR 4.02 (95% CI [3.79, 4.27] under 35s compared to age 75-84)). Deprivation-related inequalities persisted after stratification by age group, with the largest inequalities amongst middle and older age groups. People living in more deprived areas and younger people also had shorter recorded NDH duration before progression to T2DM, and higher T2DM severity at the time of diagnosis., Conclusions: There is under identification of NDH relative to diagnosis of T2DM amongst people living in more deprived areas and particularly amongst younger people, resulting in missed opportunities for targeted T2DM prevention efforts and potentially contributing to inequalities in T2DM prevalence and severity. More active NDH case-finding amongst these groups may be an important first step in helping to reduce inequalities in T2DM., (© 2024. The Author(s).)

Background: In the United Kingdom, pregnant women who live in the most deprived areas have two times the risk of dying than those who live in the least deprived areas. There are even greater disparities between women from different ethnic groups. The aim of this study was to investigate the role of area-based deprivation and ethnicity in the increased risk of severe maternal morbidity (SMM), in primiparous women in England., Methods: A retrospective nationwide population study was conducted using English National Hospital Episode Statistics Admitted Patient Care database. All primiparous women were included if they gave birth in an National Healthcare Service (NHS) hospital in England between 1 January 2016 and 31 December 2021. Logistic regression was used to examine the relative odds of SMM by Index of Multiple Deprivation and ethnicity, adjusting for age and health behaviours, medical and psychological factors., Results: The study population comprised 1 178 756 primiparous women. Neighbourhood deprivation increased the risk of SMM at the time of childbirth. In the fully adjusted model, there was a linear trend (p=0.001) between deprivation quintile and the odds of SMM. Being from a minoritised ethnic group also independently increased the risk of SMM, with black or black British African women having the highest risk, adjusted OR 1.84 (95% CI 1.70 to 2.00) compared with white women. There was no interaction between deprivation and ethnicity (p=0.49)., Conclusion: This study has highlighted that neighbourhood deprivation and ethnicity are important, independently associated risk factors for SMM., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: To examine the association between being born into relative deprivation and hospital costs during childhood., Design: Retrospective cohort study., Methods: We created a birth cohort using Hospital Episode Statistics for children born in NHS hospitals in 2003/2004. The Index of Multiple Deprivation (IMD) rank at birth was missing from 75% of the baby records, so we linked mother and baby records to obtain the IMD decile from the mother's record. We aggregated and costed each child's hospital inpatient admissions, and outpatient and emergency department (ED) attendances up to 15 years of age. We used 2019/2020 NHS tariffs to assign costs. We constructed an additional cohort, all children born in 2013/2014, to explore any changes over time, comparing the utilisation and costs up to 5 years of age., Results: Our main cohort comprised 567 347 babies born in 2003/2004, of which we could include 91%. Up to the age of 15 years, children born into the most deprived areas used more hospital services than those born in the least deprived, reflected in higher costs of inpatient, outpatient and ED care. The highest costs and greatest differences are in the year following birth. Comparing this with the later cohort (up to age 5 years), the average cost per child increased across all deprivation deciles, but differences between the most and least deprived deciles appeared to narrow slightly., Conclusions: Healthcare utilisation and costs are consistently higher for children who are born into the most deprived areas compared with the least., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objectives: To assess the association between risk factors, including socioeconomic deprivation, and mortality, recurrence and chemo‐ or radiation toxicity in cervical cancer patients. Methods: Retrospective study of cervical cancer patients diagnosed between January 2007 and July 2018. Patient characteristics and mortality data, including recurrence, were assessed, together with socioeconomic deprivation measures evaluated using the English Indices of Multiple Deprivation. Markov multi‐state models were used to model mortality and recurrence, and logistic regression models were used to model chemo‐ or radiation toxicity. Results: Included were 243 women with a median age of 49 years. A total of 57 patients died (23%), of which 41 due to cervical cancer, and 21 (9%) had recurrent disease. Hazard ratios (HR) showed no evidence of association between socioeconomic deprivation and cancer‐specific hazard of mortality from diagnosis or recurrence, hazard of mortality due to other causes or hazard of cancer recurrence. Furthermore, there was no evidence of association between socioeconomic deprivation and chemo‐ or radiation toxicity (bowel, bladder or vaginal stenosis). Conclusions: No associations were found between socioeconomic deprivation and cancer mortality or recurrence in cervical cancer patients in the population of Cornwall. In addition, no association was found between socioeconomic deprivation and chemo‐ or radiation toxicity. [ABSTRACT FROM AUTHOR]

Objectives: Many individuals hold different beliefs about the voices that they hear and have distinct relationships with them, the nature of which may determine the distress experienced. Understanding what factors contribute to these beliefs and relationships and consequently the resulting distress is important. The current research examined whether shame and social deprivation, in a sample of adult voice‐hearers, were related to the relationships that individuals had with their voices or the beliefs that they held about them. Design: The study utilized a cross‐sectional, Internet‐based design. Methods: Eighty‐seven adult voice‐hearers from England were recruited to the online survey. Participants completed measures regarding shame, beliefs about voices, and relationships with voices and provided demographic information and postcodes that were used to refer to Index of Multiple Deprivation data. Results: Social deprivation and shame were not associated. Shame was positively associated with variables describing negative voice‐hearing beliefs/relationships but not positive voice‐hearing beliefs/relationships. Principal component analysis on the eight voice‐hearing variables yielded two components related to positive and negative voice‐hearing qualities. A multiple regression conducted on the two components identified that shame was only associated with negative voice‐hearing qualities. Conclusions: The results suggest that therapies that target shame may be helpful when working with negative voice‐hearing beliefs and relationships. Future research should utilize experimental or longitudinal designs to examine the direction of the relationship. Practitioner points: The results contribute to the limited research evidence available regarding the relationship between shame and voice‐hearing.The results suggest the utility of psychological therapies that focus on shame such as compassion‐focused therapy and that conceptualize voices interpersonally such as cognitive analytic therapy.No conclusions can be made regarding causation. The sample size was relatively small, and results cannot be generalized to other areas of the United Kingdom.Future research should utilize experimental and longitudinal designs to examine the impact of shame on voice‐hearing experiences and to examine other factors that may predict shame. [ABSTRACT FROM AUTHOR]

Socioeconomic inequality of access to healthcare is seen across the spectrum of healthcare, including diabetes. Health inequalities are defined as the 'preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness or opportunities to take action and access treatment when ill health occurs' (NHS England; https://www.england.nhs.uk/about/equality/equality-hub/resources/). Access to diabetes technologies has improved glycaemic and quality-of-life outcomes for many users. Inability to access such devices, however, is evidenced in National Diabetes Audit data, with a reported tenfold variation in insulin pump use by people with type 1 diabetes across specialist centres. This variation suggests a lack of access to healthcare systems that should be investigated. This article highlights some of the key issues surrounding healthcare inequalities in the management of diabetes. [ABSTRACT FROM AUTHOR]

Aims: To describe the prevalence of cardiovascular disease (CVD), multiple comorbidities and social deprivation in patients with a potentially curable cancer in 20 English Cancer Alliances., Materials and Methods: This National Registry Dataset Analysis used national cancer registry data and CVD databases to describe rates of CVD, comorbidities and social deprivation in patients diagnosed with a potentially curable malignancy (stage I-III breast cancer, stage I-III colon cancer, stage I-III rectal cancer, stage I-III prostate cancer, stage I-IIIA non-small cell lung cancer, stage I-IV diffuse large B-cell lymphoma, stage I-IV Hodgkin lymphoma) between 2013 and 2018. Outcome measures included observation of CVD prevalence, other comorbidities (evaluated by the Charlson Comorbidity Index) and deprivation (using the Index of Multiple Deprivation) according to tumour site and allocation to Cancer Alliance. Patients were allocated to CVD prevalence tertiles (minimum: <33.3rd percentile; middle: 33.3rd to 66.6th percentile; maximum: >66.6th percentile)., Results: In total, 634 240 patients with a potentially curable malignancy were eligible. The total CVD prevalence for all cancer sites varied between 13.4% (CVD n = 2058; 95% confidence interval 12.8, 13.9) and 19.6% (CVD n = 7818; 95% confidence interval 19.2, 20.0) between Cancer Alliances. CVD prevalence showed regional variation both for male (16-26%) and female patients (8-16%) towards higher CVD prevalence in northern Cancer Alliances. Similar variation was observed for social deprivation, with the proportion of cancer patients being identified as most deprived varying between 3.3% and 32.2%, depending on Cancer Alliance. The variation between Cancer Alliance for total comorbidities was much smaller., Conclusion: Social deprivation, CVD and other comorbidities in patients with a potentially curable malignancy in England show significant regional variations, which may partly contribute to differences observed in treatments and outcomes., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

For those who are connected digitally, the digital health revolution is an enormous opportunity for patient empowerment. However, half the world's population are not online. Those who are least likely to be online are exactly those who experience the greatest burden of ill health. As information about health and illness is increasingly (and often exclusively) available in digital form, we face a new public health challenge – digital health inequality. Libraries are ideally placed to reach these population groups who may be hardest to reach. The IFLA (2017) Statement on Digital Literacy recognises that with libraries' mission to help all their users access and apply the information they need for personal and community development, digital inclusion is an important part of the practice of librarianship. Successful interventions to improve digital inclusion involve targeting connecting, and transforming lives. This article focuses on initiatives to combat digital exclusion in England and Wales. [ABSTRACT FROM AUTHOR]

Objectives: Over half of pedestrians killed and seriously injured in Great Britain in 2015 were involved in crashes at junctions. This study investigates the nature of these crashes. Methods: A study was conducted into pedestrian casualty crashes at priority controlled junctions, roundabouts and signalised junctions in England between 2005 and 2015 using information from the UK STATS19 accident database, the UK National Travel Survey and the UK National Census. Consideration was given to coding frequencies of contributory factors, exposure (in terms of miles walked or driven) as well as age, gender and the resident deprivation index of the road users involved. Results and Conclusions: In terms of indicative blame, the coding frequencies of subjectively determined pedestrian actions and behaviour factors which might have contributed to pedestrian casualty crashes were found to be between 1.6 and 2.8 times the frequencies of driver actions and behavioural factors. Substantial social gradients were found in pedestrian casualty rates per miles walked and in the driver involvement rates per mile driven with those from the most deprived quintile having higher rates. In addition, it was found that female pedestrians, aged 60 years and over, had higher pedestrian casualty rates, per billion miles walked, for all three junction types, when compared with males and females under the age of 60 years, apart from male pedestrians aged 16 years and younger at priority controlled junctions. [ABSTRACT FROM AUTHOR]

Objective: To analyze the general practitioners (GPs) with regard to the degree of urbanization, social deprivation, general health, and disability.Data Sources: Small area population data and GP practice data in England.Study Design: We used a floating catchment area method to measure spatial GP accessibility with regard to the degree of urbanization, social deprivation, general health, and disability.Data Collection: Data were collected from the Office for National Statistics and the general practice census and analyzed using a geographic information system.Principal Findings: In all, 25.8 percent of the population in England lived in areas with a significant low GP accessibility (mean z-score: -4.2); 27.6 percent lived in areas with a significant high GP accessibility (mean z-score: 7.7); 97.8 percent of high GP accessibility areas represented urban areas, and 31.1 percent of low GP accessibility areas represented rural areas (correlation of accessibility and urbanity: r = 0.59; p<.001). Furthermore, a minor negative correlation with social deprivation was present (r = -0.19; p<.001). Results were confirmed by a multivariate analysis.Conclusion: This study showed substantially differing GP accessibility throughout England. However, socially deprived areas did not have poorer spatial access to GPs. [ABSTRACT FROM AUTHOR]

Background: Opioids are a widely prescribed class of drug with potentially harmful short-term and long-term side effects. There are concerns about the amounts of these drugs being prescribed in England given that they are increasingly considered ineffective in the context of long-term non-cancer pain, which is one of the major reasons for their prescription.Aim: To assess the amount and type of opioids prescribed in primary care in England, and patterns of regional variation in prescribing.Design and Setting: Retrospective observational study using publicly available government data from various sources pertaining to opioids prescribed in primary practice in England and Indices of Social Deprivation.Method: Official government data were analysed for opioid prescriptions from August 2010 to February 2014. The total amount of opioid prescribed was calculated and standardised to allow for geographical comparisons.Results: The total amount of opioid prescribed, in equivalent milligrams of morphine, increased (r = 0.48) over the study period. More opioids were prescribed in the north than in the south of England (r = 0.66, P<0.0001), and more opioids were prescribed in areas of greater social deprivation (r = 0.56, P<0.0001).Conclusion: Long-term opioid prescribing is increasing despite poor efficacy for non-cancer pain, potential harm, and incompatibility with best practice. Questions of equality of care arise from higher prescription rates in the north of England and in areas of greater social deprivation. A national registry of patients with high opioid use would improve patient safety for this high-risk demographic, as well as provide more focused epidemiological data regarding patterns of prescribing. [ABSTRACT FROM AUTHOR]

Background: Population factors, including social deprivation and morbidity, predict the use of emergency departments (EDs).Aim: To link patient-level primary and secondary care data to determine whether the association between deprivation and ED attendance is explained by multimorbidity and other clinical factors in the GP record.Design and Setting: Retrospective cohort study based in East London.Method: Primary care demographic, consultation, diagnostic, and clinical data were linked with ED attendance data. GP Patient Survey (GPPS) access questions were linked to practices.Results: Adjusted multilevel analysis for adults showed a progressive rise in ED attendance with increasing numbers of long-term conditions (LTCs). Comparing two LTCs with no conditions, the odds ratio (OR) is 1.28 (95% confidence interval [CI] = 1.25 to 1.31); comparing four or more conditions with no conditions, the OR is 2.55 (95% CI = 2.44 to 2.66). Increasing annual GP consultations predicted ED attendance: comparing zero with more than two consultations, the OR is 2.44 (95% CI = 2.40 to 2.48). Smoking (OR 1.30, 95% CI = 1.28 to 1.32), being housebound (OR 2.01, 95% CI = 1.86 to 2.18), and age also predicted attendance. Patient-reported access scores from the GPPS were not a significant predictor. For children, younger age, male sex, white ethnicity, and higher GP consultation rates predicted attendance.Conclusion: Using patient-level data rather than practice-level data, the authors demonstrate that the burden of multimorbidity is the strongest clinical predictor of ED attendance, which is independently associated with social deprivation. Low use of the GP surgery is associated with low attendance at ED. Unlike other studies, the authors found that adult patient experience of GP access, reported at practice level, did not predict use. [ABSTRACT FROM AUTHOR]

Background: While the United Kingdom National Health Service aimed to reduce social inequalities in the provision of joint replacement, it is unclear whether these gaps have reduced. We describe secular trends in the provision of primary hip and knee replacement surgery between social deprivation groups., Methods and Findings: We used the National Joint Registry to identify all hip and knee replacements performed for osteoarthritis from 2007 to 2017 in England. The Index of Multiple Deprivation (IMD) 2015 was used to identify the relative level of deprivation of the patient living area. Multilevel negative binomial regression models were used to model the differences in rates of joint replacement. Choropleth maps of hip and knee replacement provision were produced to identify the geographical variation in provision by Clinical Commissioning Groups (CCGs). A total of 675,342 primary hip and 834,146 primary knee replacements were studied. The mean age was 70 years old (standard deviation: 9) with 60% and 56% of women undergoing hip and knee replacements, respectively. The overall rate of hip replacement increased from 27 to 36 per 10,000 person-years and knee replacement from 33 to 46. Inequalities of provision between the most (reference) and least affluent areas have remained constant for both joints (hip: rate ratio (RR) = 0.58, 95% confidence interval [0.56, 0.60] in 2007, RR = 0.59 [0.58, 0.61] in 2017; knee: RR = 0.82 [0.80, 0.85] in 2007, RR = 0.81 [0.80, 0.83] in 2017). For hip replacement, CCGs with the highest concentration of deprived areas had lower overall provision rates, and CCGs with very few deprived areas had higher provision rates. There was no clear pattern of provision inequalities between CCGs and deprivation concentration for knee replacement. Study limitations include the lack of publicly available information to explore these inequalities beyond age, sex, and geographical area. Information on clinical need for surgery or patient willingness to access care were unavailable., Conclusions: In this study, we found that there were inequalities, which remained constant over time, especially in the provision of hip replacement, by degree of social deprivation. Providers of healthcare need to take action to reduce this unwarranted variation in provision of surgery., Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following competing interests: EL, MRW and AWB have received grant funds to investigate the outcome of implant bearings surface for total hip replacement (CeramTec GmbH), outside the submitted work. AJ has received consultancy fees from Freshfields Bruckhaus Deringer and has held advisory board positions (which involved receipt of fees) from Anthera Pharmaceuticals, INC, outside the submitted work. AWB and MRW have received grant funds to investigate the outcome of a design of primary total knee replacement (Stryker, Triathlon), outside the submitted work. AR reported receiving grants from the National Institute of Health Research (NIHR), Orthopaedic Research UK, and DePuy Synthes Limited outside the submitted work. MRW conducts teaching on courses sponsored by Heraeus and DePuy for which his institution receives market rate payments. All other authors declare no conflicts of interest. AJ, MW, AWB, were supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol., (Copyright: © 2023 Lenguerrand et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Summary: We used routine hospital data to investigate whether socially deprived patients had an increased risk of dying following hip fracture compared with affluent patients. We found that the most deprived patients had a significantly increased risk of dying at 30, 90 and 365 days compared with the most affluent patients. Introduction: To identify whether social deprivation has any effect on mortality risk after emergency admission with hip fracture and to determine whether any increased mortality observed among deprived groups was associated with patient and hospital-related factors. Methods: We used routine, linked hospital inpatient and mortality data for emergency admissions with a hip fracture in both England and Wales between 2004 and 2011. Mortality rates at 30, 90 and 365 days were reported. Logistic regression was used to identify any significant increases in mortality with higher levels of social deprivation and the influence of other risk factors on any increased mortality among the most deprived group. Results: Mortality rates at 30, 90 and 365 days were 9.3, 17.4 and 29.0 % in England and 8.3, 16.1 and 27.9 % in Wales. Social deprivation was significantly associated with increased mortality in the most deprived quintile compared with the least deprived quintile at 30, 90 and 365 days in England (OR = 1.187, 1.185 and 1.154, respectively) and at 90 and 365 days in Wales (1.135 and 1.203). There was a little interaction between deprivation and other risk factors influencing 30- and 365-day mortality except for patient age, pre-fracture residence and hospital size. Conclusions: We demonstrated a positive association between social deprivation and increased mortality at 30 days post-admission for hip fracture in both England and Wales that was still evident at 90 and 365 days. We found little influence of other factors on social inequalities in mortality risk at 30 and 365 days post-admission. [ABSTRACT FROM AUTHOR]

This article, written by three research-active teachers and their academic partner, registers concerns with the ways the so-called 'achievement gap' is portrayed in policy announcements in England. It charts a challenge to the current view that it is the task of urban nursery and primary schools to train children to be school-ready. It portrays a collective professional judgement that some young children from less affluent backgrounds face a range of barriers to their learning on entry, which hampers their success at primary school. Further, it argues these barriers arise from children's multiple vulnerabilities which cannot be encapsulated by a single category of need such as eligibility for Free School Meals or a Special Educational Need represented in official national-school quantitative data. This article proceeds to report on three inter-linked teacher inquiry projects, which seek to define and identify the range of vulnerabilities faced by some young children and consider intervention measures that will address their academic and social learning needs. The intention is to show that a more refined view of identifying these needs based on a research-informed reading of young children's multiple vulnerabilities, framed by their social context, will lead to more equitable provision of primary schooling experiences. [ABSTRACT FROM AUTHOR]

Introduction: Socioeconomic deprivation has been associated with an increased incidence of infection and poorer clinical outcomes during influenza pandemics and the COVID-19 pandemic. The aim of this study was to determine the relationship between deprivation and adverse clinical outcomes following hospital admission with community-acquired pneumonia (CAP), specifically 30-day all-cause mortality and non-elective hospital readmission., Methods: Data from the British Thoracic Society national CAP audit on patients admitted to hospital with CAP in England between 1 December 2018 and 31 January 2019 were linked to patient-level Hospital Episode Statistics data and Index of Multiple Deprivation (IMD) scores. Multivariable logistic regression models were used to examine the association between deprivation and (a) 30-day mortality and (b) 30-day readmission with p values for trend reported. Age was examined as a potential effect modifier on the effect of IMD quintile on mortality and subsequent subanalysis in those <65 and ≥65 years was performed., Results: Of 9165 adults admitted with CAP, 24.7% (n=2263) were in the most deprived quintile. No significant trend between deprivation and mortality was observed (p trend=0.38); however, the association between deprivation and mortality differed by age group. In adults aged<65 years, 30-day mortality was highest in the most deprived and lowest in the least deprived quintiles (4.4% vs 2.5%, aOR 1.83, 95% CI 0.84 to 4.0) with a significant trend across groups (p trend=0.04). Thirty-day readmission was highest in the most deprived quintile (17.1%) with a significant p trend across groups (p trend 0.003). Age-adjusted odds of readmission were highest in the most deprived compared with the least deprived (aOR 1.41, 95% CI 1.16 to 1.73)., Conclusions: In adults aged<65 years hospitalised with CAP in England, mortality varied inversely with indices of social deprivation. There was also a significant association between deprivation and 30-day readmission. Strategies are required to decrease health inequalities in pneumonia mortality and hospital readmissions associated with deprivation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This article presents the outcomes to a study of the charity donation behavior of 771 low-income people residing in three socially deprived Boroughs in inner-London. It emerged that several variables known to affect (a) levels of charity giving and (b) choices of types of charity supported among the U.K. public as a whole also influenced the donation behavior of the financially poor. In addition, it appeared that a participant’s sense of affinity with other low-income people and the degree to which the individual believed that the poor were unfairly treated by society at large exerted significant impacts on giving behavior. However behavior differed according to whether a low-income person was “better-educated” (i.e., possessed a qualification beyond the level normally obtained at the minimum legal school leaving age) or was less well-educated. The “very poor” did not donate a higher percentage of their incomes than the moderately poor. [ABSTRACT FROM AUTHOR]

Abstract: We describe contemporaneous changes in environmental quality and social deprivation in English local authority districts over four decades, using secondary source GIS modelled data on environmentally intrusive development. The distribution of this development is described with respect to the Townsend material deprivation score, corroborated against the Breadline Britain index. Spatial patterns of environmental intrusion and material deprivation change markedly over the period, although a clear environmental inequality remains throughout. However, it is not the most deprived who experience the greatest decline in their environmental quality, as most of the increase in environmental intrusion occurs in those districts whose population were amongst the most affluent in the early 1960s. We note that the environmental justice implications of these observations are dependent upon conceptions of justice held, and reflect on the challenge of testing, through empirical longitudinal analysis, the notion that environmental sustainability and social justice are incompatible. [Copyright &y& Elsevier]

This article reports on a research project that studied the approaches to leadership adopted by head teachers in one local authority in an area of extreme social deprivation in northern England. Using data from semi-structured interviews which was analysed using three software packages, it examines how far the heads use either transactional or transformational leadership and identifies the factors that lead heads to make leadership choices. It concludes that while heads use both approaches to leadership, they believe that transformational leadership is far more effective in bringing about change which produces successful school development. However, external pressures cause the heads to concentrate far more than they would wish on transactional leadership in spite of the espoused national policy to facilitate school improvement. [ABSTRACT FROM PUBLISHER]

Assessment of sustainable development normally takes place within what can best be termed 'administrative' spaces (cities, regions, nation states etc.), where there is some managerial and policy control. Thus recommendations may be derived from an analysis of this space, for example the derivation of indicators and indices, which can feed more readily into decision-making. They are alternatives to the use of defined 'administrative' spaces such as the ecosystem and landscape. The paper questions the viability of landscape as a viable spatial matrix for assessment of sustainability. Joint Character Areas (JCAs) in England were employed as the landscape space, and data were collected to assess environmental quality (via the creation of a Countryside Quality Index, CQI) and social deprivation (via the Townsend Index of Deprivation, TID) for each JCA, as these represent two dimensions of sustainability. Results suggest that when employing JCAs as the spatial matrix it is possible to derive a statistically significant regression between CQI as the independent variable as TDI as the dependent variable. Therefore landscape does have some viability as a space for assessing sustainability. Copyright © 2009 John Wiley & Sons, Ltd and ERP Environment. [ABSTRACT FROM AUTHOR]

Since their inception in the 1960s, Area-based Initiatives (ABIs) have been inadequately evaluated. It has been argued that there has been too much emphasis on 'outputs' of regeneration programmes, and not enough attention given to 'outcomes', in terms of their impact on the members of the communities they were intended to target. As a result, there is no clear evidence of the effectiveness of ABIs in reducing social exclusion. This paper argues that one of the initial stages of evaluation should involve an estimation of how accurately the regeneration intervention was targeted at the most socially excluded individuals within a given area. It reports an empirical study that uses survey data to investigate the extent to which respondents at various levels of social exclusion had been targeted by regeneration programmes operating within the boundaries of nine local authorities in the North-West of England. [ABSTRACT FROM AUTHOR]

Background The existence of health inequalities between least and most socially deprived areas is now well established. Aim To use Quality and Outcomes Framework (QOF) indicators to explore the characteristics of primary care in deprived communities. Design of study Two-year study. Setting Primary care in England. Method QOF data were obtained for each practice in England in 2004-2005 and 2005-2008 and linked with census derived social deprivation data (Index of Multiple Deprivation scores 2004), national urbanicity scores and a database of practice characteristics. Data were available for 8480 practices in 2004-2005 and 8264 practices in 2005-2006. Comparisons were made between practices in the least and most deprived quintiles. Results The difference in mean total QOF score between practices in least and most deprived quintiles was 64.5 points in 2004-2005 (mean score, all practices, 959.9) and 30.4 in 2005-2006 (mean, 1012.6). In 2005-2006, the QOF indicators displaying the largest differences between least and most deprived quintiles were: recall of patients not attending appointments for injectable neuroleptics (79 versus 58%, respectively), practices opening ≥45 hours/week (90 versus 74%), practices conducting ≥12 significant event audits in previous 3 years (93 versus 81%), proportion of epileptics who were seizure free ≥12 months (77 versus 65%) and proportion of patients taking lithium with serum lithium within therapeutic range (90 versus 78%). Geographical differences were less in group and training practices. Conclusions Overall differences between primary care quality indicators in deprived and prosperous communities were small. However, shortfalls in specific indicators, both clinical and non-clinical, suggest that focused interventions could be applied to improve the quality of primary care in deprived areas. [ABSTRACT FROM AUTHOR]

Background This cross‐sectional study was carried out in a population‐based setting in Worcestershire to investigate the relationship between social deprivation and other potential prognostic factors. [ABSTRACT FROM PUBLISHER]

Identifying which children and young people (CYP) are most vulnerable to serious infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is important to guide protective interventions. To address this question, we used data for all hospitalizations in England among 0-17 year olds from 1 February 2019 to 31 January 2021. We examined how sociodemographic factors and comorbidities might be risk factors for pediatric intensive care unit (PICU) admission among hospitalizations due to the following causes: Coronavirus Disease 2019 (COVID-19) and pediatric inflammatory multi-system syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the first pandemic year (2020-2021); hospitalizations due to all other non-traumatic causes in 2020-2021; hospitalizations due to all non-traumatic causes in 2019-2020; and hospitalizations due to influenza in 2019-2020. Risk of PICU admission and death from COVID-19 or PIMS-TS in CYP was very low. We identified 6,338 hospitalizations with COVID-19, of which 259 were admitted to a PICU and eight CYP died. We identified 712 hospitalizations with PIMS-TS, of which 312 were admitted to a PICU and fewer than five CYP died. Hospitalizations with COVID-19 and PIMS-TS were more common among males, older CYP, those from socioeconomically deprived neighborhoods and those who were of non-White ethnicity (Black, Asian, Mixed or Other). The odds of PICU admission were increased in CYP younger than 1 month old and decreased among 15-17 year olds compared to 1-4 year olds with COVID-19; increased in older CYP and females with PIMS-TS; and increased for Black compared to White ethnicity in patients with COVID-19 and PIMS-TS. Odds of PICU admission in COVID-19 were increased for CYP with comorbidities and highest for CYP with multiple medical problems. Increases in odds of PICU admission associated with different comorbidities in COVID-19 showed a similar pattern to other causes of hospitalization examined and, thus, likely reflect background vulnerabilities. These findings identify distinct risk factors associated with PICU admission among CYP with COVID-19 or PIMS-TS that might aid treatment and prevention strategies., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: To investigate the relation between social disadvantage and family composition on diabetes prevalence and diabetes care outcome.Design: Retrospective audit in the south west of England of 801 children with diabetes mellitus.Main Outcome Measures: Prevalence of diabetes in relation to the Townsend index. Admissions to hospital with diabetes related problems, glycated haemoglobin, time spent in hospital, outpatient attendance rates.Results: There was no association between social status and diabetes prevalence. Social deprivation increased the likelihood of admission for hypoglycaemia. Children living with a single parent were more likely to be admitted to hospital with a diabetes related problem and stay in hospital longer. Having either a parent with diabetes or a single parent increased the rates of clinic non-attendance. No association was identified between medium term diabetes control and either social disadvantage or single parent status.Conclusions: Social disadvantage has no effect on diabetes prevalence and little on diabetes outcome in childhood. Family structure and parental diabetes have adverse effects on some aspects of diabetes outcome. [ABSTRACT FROM AUTHOR]

Background: Studies report an increasing incidence of self-harm in children and adolescents, but the extent to which this is seen in different ethnic groups is unclear. We aimed to investigate rates of emergency department presentations for self-harm in children and adolescents by ethnicity, as well as to examine their demographic characteristics, clinical characteristics, and outcomes., Methods: In this observational cohort study, we used data on hospital emergency department presentations for self-harm in children and adolescents aged 10-19 years between 2000 and 2016 from the Multicentre Study of Self-harm in England. This study collects data from five general hospitals in Manchester, Oxford, and Derby in the UK, and defines self-harm as any act of intentional self-injury or self-poisoning, regardless of intent. All children and adolescents aged 10-19 years for whom ethnicity data were available were included. Mortality follow-up was available through linkage with mortality records from the Office for National Statistics. Rates of self-harm over time, demographic and clinical characteristics, and self-harm methods were investigated by ethnic group. Risk of repeat self-harm and mortality following an initial presentation for self-harm was compared by ethnic group using Kaplan-Meier curves and Cox proportional hazards models., Findings: Of 14 894 individuals who presented at hospitals with self-harm, 11 906 had data for ethnicity, of whom 10 211 (85·8%) were White, 344 (2·9%) were Black, 619 (5·2%) were South Asian, and 732 (6·1%) were other non-White. Rates of self-harm were highest in White children and adolescents but increased between 2009 and 2016 in all ethnicities. Mean annual rates of self-harm per 100 000 population were 574 for White, 225 for Black, 260 for South Asian, and 344 for other non-White groups. Increases in rates of self-harm between 2009 and 2016 appeared slightly greater in Black groups (incidence rate ratio 1·07 [95% CI 1·03-1·11]), South Asian groups (1·05 [1·01-1·09]), and other non-White groups (1·11 [1·06-1·16]) than in White groups (1·02 [1·00-1·03]). Children and adolescents from a minority ethnic background were more likely to live in areas of high deprivation and were less likely to receive a specialist psychosocial assessment than were White children and adolescents. Children and adolescents from minority ethnic groups were also less likely to repeat self-harm. However, there were no differences in suicide mortality by ethnic group, although the numbers were small., Interpretation: Minority ethnic children and adolescents accounted for an increased proportion of self-harm presentations to hospital over time compared with White ethnic groups. The minority ethnic groups also tended to be more socioeconomically disadvantaged and were less likely to receive a psychosocial assessment. Socioeconomic disparities need to be addressed, and equitable access to culturally sensitive comprehensive psychosocial assessments must be ensured., Funding: UK Department of Health and Social Care., Competing Interests: Declaration of interests LA chairs the National Suicide Prevention Strategy Advisory Group of the UK Department of Health and Social Care, which NK and KH are members of. NK reports grants from Department of Health and Social Care, National Institute of Health Research, National Institute of Health and Care Excellence, and Healthcare Quality and Improvement Partnership, outside of the submitted work. NK has chaired the National Institute for Health and Care Excellence (NICE) guidelines for the longer-term management of self-harm, is the clinical topic adviser for the new NICE self-harm guidelines, chairs the guideline committee for the management of depression, and is part of the NICE Topic Expert Group, which developed the quality standards for self-harm services. KW is executive director for STORM UK suicide prevention training. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)