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Adjei NK, Samkange-Zeeb F, Boakye D, Saleem M, Christianson L, Kebede MM, Heise TL, Brand T, Esan OB, Taylor-Robinson DC, Agyemang C, Zeeb H. Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09879-9. [PMID: 38598068 DOI: 10.1007/s11154-024-09879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK.
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | | | - Daniel Boakye
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Maham Saleem
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Thomas L Heise
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Oluwaseun B Esan
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Adjei NK, Jonsson KR, Straatmann VS, Melis G, McGovern R, Kaner E, Wolfe I, Taylor-Robinson DC. Impact of poverty and adversity on perceived family support in adolescence: findings from the UK Millennium Cohort Study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02389-8. [PMID: 38353677 DOI: 10.1007/s00787-024-02389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024]
Abstract
Emotional support from family members may have an important effect on adolescent health outcomes, and has been identified as a target for policy to protect against the impacts of poverty and other early life adversities. However, few studies have assessed the extent to which poverty and adversity themselves influence the nature of emotional support that parents can provide to adolescents. We, therefore, aimed to investigate the impact of trajectories of income poverty and family adversities, including parental mental ill health, alcohol misuse and domestic violence across childhood developmental stages on young people's relationships with their families and perceived emotional support received. We analysed longitudinal data on 10,976 children from the nationally representative UK Millennium Cohort study. Exposure trajectories of poverty and family adversities were characterised using group-based multi-trajectory models (age 9 months-14 years). The outcomes were perceived emotional support and quality of family relationships, measured by the three-item Short Social Provisions Scale (SPS-3) and levels of parent-adolescent closeness and conflict, measured at age 14. ORs and 95% CIs were estimated using multivariable logistic regression models, adjusting for potential confounding factors. At age 14, the overall prevalence of low perceived emotional support was 13% (95% CI: 12, 14). Children of mothers with lower socioeconomic status (SES) were more likely to report low emotional support, with a clear social gradient (education-degree plus: 10.3% vs. no qualifications: 15.4%). Compared with children exposed to low levels of poverty and adversity, children in the persistent adversity trajectory groups experienced higher odds of low emotional support and low-quality parent-adolescent relationship; those exposed to both persistent poverty and poor parental mental health were particularly at increased risk of experiencing poor family relationships and low perceived emotional support (adjusted odds ratio 2·2; 95% CI 1·7-2·9). Low perceived emotional support and poor family relationships in adolescence are more prevalent among socially disadvantaged children and adolescents and those experiencing social adversity. Policies to improve levels of family support for UK adolescents should focus on improving modifiable determinants such as child poverty and family mental health.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Kenisha Russell Jonsson
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
| | | | - Gabriella Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, UK
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Adjei NK, Schlüter DK, Melis G, Straatmann VS, Fleming KM, Wickham S, Munford L, McGovern R, Howard LM, Kaner E, Wolfe I, Taylor-Robinson DC. Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study. J Adolesc Health 2024; 74:60-70. [PMID: 37831048 DOI: 10.1016/j.jadohealth.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Exposure to parental mental ill-health and poverty in childhood impact health across the lifecourse. Both maternal and paternal mental health may be important influences, but few studies have unpicked the complex interrelationships between these exposures and family poverty for later health. METHODS We used longitudinal data on 10,500 children from the nationally representative UK millennium cohort study. Trajectories of poverty, maternal mental health, and secondary caregiver mental health were constructed from child age of 9 months through to 14 years. We assessed the associations of these trajectories with mental health outcomes at the age of 17 years. Population-attributable fractions were calculated to quantify the contribution of caregivers' mental health problems and poverty to adverse outcomes at the country level. RESULTS We identified five distinct trajectories. Compared with children with low poverty and good parental mental health, those who experienced poverty and poor primary or secondary caregiver mental health (53%) had worse outcomes. Children exposed to both persistent poverty and poor caregiver mental health were at markedly increased risk of socioemotional behavioural problems (aOR 4.2; 95% CI 2.7-6.7), mental health problems (aOR 2.5; CI 1.6-3.9), and cognitive disability (aOR 1.7; CI 1.1-2.5). We estimate that 40% of socioemotional behavioural problems at the age of 17 were attributable to persistent parental caregivers' mental health problems and poverty. DISCUSSION More than half of children growing up in the UK are persistently exposed to either one or both of poor caregiver mental health and family poverty. The combination of these exposures is strongly associated with adverse health outcomes in the next generation.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom.
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Gabriella Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | | | - Kate M Fleming
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Luke Munford
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Louise M Howard
- Department of Health Service and Population Research, King's College London, London, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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Adjei NK, Schlüter DK, Straatmann VS, Melis G, Fleming KM, McGovern R, Howard LM, Kaner E, Wolfe I, Taylor-Robinson DC. Quantifying the contribution of poverty and family adversity to adverse child outcomes in the UK: evidence from the UK Millennium Cohort Study. Lancet 2022; 400 Suppl 1:S16. [PMID: 36929958 DOI: 10.1016/s0140-6736(22)02226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent health is poor in the UK, with higher prevalence of adverse outcomes in adolescents exposed to family adversities that cluster with poverty from early life. However, little evidence exists to quantify the contribution of these exposures to poor child health in the UK to inform policy. The aim of this study was to estimate the proportion of child physical, mental, cognitive, and behavioural outcomes that could be prevented if exposure to poverty and family adversity during childhood were eliminated. METHODS We used nationally representative birth cohort data from the UK Millennium Cohort Study to calculate population attributable fractions. Exposure trajectories were characterised using previously developed group-based multi-trajectory models of childhood adversities up to age 14 years, including low poverty and family adversity, persistent poverty, persistent parental alcohol use, persistent domestic violence and abuse, and persistent poverty and poor parental mental health trajectory; and we assessed the effect of these trajectories on adolescent outcomes using regression models. These models were used to calculate population attributable fractions by contrasting a hypothetical scenario in which all children were in a low poverty and family adversity trajectory with the real-world scenario. FINDINGS The identified exposure trajectories contributed substantially to the burden of childhood developmental problems. Compared with the low poverty and family adversity trajectory, the overall percentage of socioemotional behavioural problems at age 14 years attributable to persistent poverty and family adversity trajectories was 54% (95% CI 45-60). A percentage of 36·1% (95% CI 21·8-46·2) was reported for drug experimentation, 32·6% (18·8-40·7) for cognitive disability, and 27·4% (12·9-34·9) for obesity (appendix). INTERPRETATION Poverty and family adversity contribute to a substantial burden of adverse child health and developmental outcomes in the UK population. FUNDING The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London at King's College Hospital NHS Foundation Trust, and the UK Medical Research Council.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Gabriella Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Kate M Fleming
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Howard
- Department of Health Service and Population Research, King's College London, London, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, UK
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Russell Jonsson K, Taylor-Robinson DC, Schultz Straatmann V, Melis G, Adjei NK. Health behaviors and subsequent mental health problems during the COVID-19 pandemic: A longitudinal analysis of adults in the UK. Front Public Health 2022; 10:1064677. [PMID: 36711346 PMCID: PMC9877513 DOI: 10.3389/fpubh.2022.1064677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Public health mitigation policies aimed at slowing the spread of COVID-19 led to an increase in mental health problems (MHPs). This study examines the association between multiple pre-pandemic health behaviors and MHPs prior to, and during, the COVID-19 pandemic. Methods We analyzed a representative population sample of 11,256 adults (aged 20-65 years) from Understanding Society-The UK Household Longitudinal Study. Baseline data from participants interviewed in 2017/2019 (wave 9) were linked to web surveys conducted during the COVID-19 pandemic. We used latent class analysis (LCA) to identify mutually exclusive health behavior (physical activity, alcohol consumption, eating habits and smoking tobacco) clusters by gender, and examined the sociodemographic correlates of each cluster. We assessed how pre-pandemic latent classes of health behaviors were associated with changes in MHPs during the pandemic using fixed effects regression models. Results Three health behavior clusters were identified: positive (33%), moderate (24%), and high risk (43%), where similar behaviors clustered within individuals and sociodemographic circumstances. In particular, gender, age, migrant status and ethnicity were found to have strong associations with each cluster. Our results also demonstrated a clear association in MHPs with health behaviors both prior to, and during the pandemic. There were significant increases in MHPs between 2017/2019 and January 2021, with fluctuations coinciding with changes in public health mitigation policies. Assessments across the three clusters showed about 25.2%, 16.9%, and 0.7% increases in MHPs in the positive, moderate and high risk health behavior clusters, respectively. Discussion This study shows that pre-pandemic health behaviors were significantly associated with mental health before and during the pandemic. Holistic policy interventions and promotions targeting multiple health behaviors may be an effective strategy to improve mental health in the pandemic recovery period.
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Affiliation(s)
- Kenisha Russell Jonsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Göteborg, Sweden
| | | | - Viviane Schultz Straatmann
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Gabriella Melis
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Nicholas Kofi Adjei
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom.,Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
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Adjei NK, Schlüter DK, Straatmann VS, Melis G, Fleming KM, McGovern R, Howard LM, Kaner E, Wolfe I, Taylor-Robinson DC. Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study. Lancet Reg Health Eur 2021; 13:100279. [PMID: 35199082 PMCID: PMC8841277 DOI: 10.1016/j.lanepe.2021.100279] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
- Correspondence to: Dr. Nicholas Kofi Adjei, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom Waterhouse Building 2nd Floor Block F, L69 3GL, Liverpool United Kingdom.
| | - Daniela K. Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
| | | | - Gabriella Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
| | - Kate M. Fleming
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle United Kingdom
| | - Louise M. Howard
- Department of Health Service and Population Research, King's College London, London, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle United Kingdom
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - David C. Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
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Rose TC, Adams NL, Whitehead M, Wickham S, O'Brien SJ, Hawker J, Taylor-Robinson DC, Violato M, Barr B. Neighbourhood unemployment and other socio-demographic predictors of emergency hospitalisation for infectious intestinal disease in England: A longitudinal ecological study. J Infect 2020; 81:736-742. [PMID: 32888980 PMCID: PMC7649336 DOI: 10.1016/j.jinf.2020.08.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/22/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
We examined trends in infectious intestinal disease (IID) hospitalisations in England. Overall IID admission rates for children and older adults declined between 2012 & 2017. Increasing unemployment was associated with increasing IID admission rates. Healthcare access, underlying morbidity and ethnicity were also associated with IID rates. Policies should address inequalities in emergency IID hospitalisations.
Background Previous studies have observed that infectious intestinal disease (IID) related hospital admissions are higher in more deprived neighbourhoods. These studies have mainly focused on paediatric populations and are cross-sectional in nature. This study examines recent trends in emergency IID admission rates, and uses longitudinal methods to investigate the effects of unemployment (as a time varying measure of neighbourhood deprivation) and other socio-demographic characteristics on IID admissions for adults and children in England. Methods A longitudinal ecological analysis was performed using Hospital Episode Statistics on emergency hospitalisations for IID, collected over the time period 2012–17 across England. Analysis was conducted at the neighbourhood (Lower-layer Super Output Area) level for three age groups (0–14; 15–64; 65+ years). Mixed-effect Poisson regression models were used to assess the relationship between trends in neighbourhood unemployment and emergency IID admission rates, whilst controlling for measures of primary and secondary care access, underlying morbidity and the ethnic composition of each neighbourhood. Results From 2012–17, declining trends in emergency IID admission rates were observed for children and older adults overall, while rates increased for some sub-groups in the population. Each 1 percentage point increase in unemployment was associated with a 6.3, 2.4 and 4% increase in the rate of IID admissions per year for children [IRR=1.06, 95%CI 1.06–1.07], adults [IRR=1.02, 95%CI 1.02–1.03] and older adults [IRR=1.04, 95%CI 1.036–1.043], respectively. Increases in poor primary care access, the percentage of people from a Pakistani ethnic background, and the prevalence of long-term health problems, in a neighbourhood, were also associated with increases in IID admission rates. Conclusions Increasing trends in neighbourhood deprivation, as measured by unemployment, were associated with increases in emergency IID admission rates for children and adults in England, despite controlling for measures of healthcare access, underlying morbidity and ethnicity. Research is needed to improve understanding of the mechanisms that explain these inequalities, so that effective policies can be developed to reduce the higher emergency IID admission rates experienced by more disadvantaged communities.
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Affiliation(s)
- Tanith C Rose
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK.
| | - Natalie L Adams
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Sarah J O'Brien
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Hawker
- National Infection Service, Public Health England, Birmingham, UK
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Mara Violato
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Benjamin Barr
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
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Affiliation(s)
- Ian Sinha
- Alder Hey Children's Hospital, Liverpool, UK
| | - Davara Bennett
- Department of Public Health and Policy, Farr Institute@HeRC, Liverpool, UK
| | - David C Taylor-Robinson
- Alder Hey Children's Hospital, Liverpool, UK
- Department of Public Health and Policy, Farr Institute@HeRC, Liverpool, UK
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Campbell M, Straatmann VS, Lai ETC, Potier J, Pinto Pereira SM, Wickham SL, Taylor-Robinson DC. Understanding social inequalities in children being bullied: UK Millennium Cohort Study findings. PLoS One 2019; 14:e0217162. [PMID: 31141521 PMCID: PMC6541267 DOI: 10.1371/journal.pone.0217162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Children living in disadvantaged socio-economic circumstances (SEC) are more commonly victims of bullying, but pathways leading to social inequalities in being bullied are unclear. We assess how early life risk factors might mediate the increased risk of being bullied at age seven for children living in disadvantaged circumstances. Material and methods Using data from 5,857 children in the UK Millennium Cohort Study (MCS) we calculate risk ratios (RR) for being bullied at age seven (child-reported), by household income quintile. Socially patterned risk factors for being bullied relating to social networks, family relationships and child characteristics from birth to age five were adjusted for to assess if they mediated any association between SEC and being bullied. Results 48.6% of children reported having been bullied. Children living in the lowest income households were at 20% greater risk of being bullied compared to those from the highest (RR1.20, 95%CI 1.06,1.36). Controlling for social networks, family relationships and child characteristics attenuated the increased risk for children in low income households to aRR 1.19 (95%CI 1.05, 1.35), aRR 1.16 (95%CI 1.02,1.32) and aRR 1.13 (95%CI 1.00,1.28) respectively. Our final model adjusted for risk factors across all domains attenuated the RR by 45% (aRR 1.11,95%CI 0.97,1.26). Conclusions About half of children reported being bullied by age seven with a clear social gradient. The excess risk in children growing up in disadvantaged circumstances was partially explained by differences in their early years relating to their social network, family relationships and the child’s own abilities and behaviours. Policies to reduce inequalities in these risk factors may also reduce inequalities in the risk of being bullied in childhood.
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Affiliation(s)
- Melisa Campbell
- University of Liverpool, Public Health and Policy, Liverpool, United Kingdom
- * E-mail:
| | | | - Eric T. C. Lai
- University of Liverpool, Public Health and Policy, Liverpool, United Kingdom
| | - Joanne Potier
- Alder Hey Children’s NHS Foundation Trust, Liverpool Fresh Child and Adolescent Mental Health Services (CAMHS), Liverpool, England, United Kingdom
| | - Snehal M. Pinto Pereira
- University College London, Institute of Epidemiology and Health Care, London, United Kingdom
| | - Sophie L. Wickham
- University of Liverpool, Public Health and Policy, Liverpool, United Kingdom
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Taylor-Robinson DC, Straatmann VS, Whitehead M. Adverse childhood experiences or adverse childhood socioeconomic conditions? Lancet Public Health 2019; 3:e262-e263. [PMID: 29776799 DOI: 10.1016/s2468-2667(18)30094-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 12/12/2022]
Affiliation(s)
- David C Taylor-Robinson
- Department of Public Health and Policy, The Farr Institute@HeRC, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK.
| | - Viviane S Straatmann
- Department of Public Health and Policy, The Farr Institute@HeRC, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, The Farr Institute@HeRC, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK
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11
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Affiliation(s)
| | - Eric T Lai
- Department of Public Health and Policy, Farr Institute@HeRC, Liverpool, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, Farr Institute@HeRC, Liverpool, UK
| | - Ben Barr
- Department of Public Health and Policy, Farr Institute@HeRC, Liverpool, UK
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12
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Adams NL, Rose TC, Elliot AJ, Smith G, Morbey R, Loveridge P, Lewis J, Studdard G, Violato M, O'Brien SJ, Whitehead M, Taylor-Robinson DC, Hawker JI, Barr B. Social patterning of telephone health-advice for diarrhoea and vomiting: analysis of 24 million telehealth calls in England. J Infect 2018; 78:95-100. [PMID: 30267800 PMCID: PMC6428660 DOI: 10.1016/j.jinf.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Gastrointestinal (GI) infections are common and most people do not see a physician. There is conflicting evidence of the impact of socioeconomic status (SES) on risk of GI infections. We assessed the relationship between SES and GI calls to two National Health Service (NHS) telephone advice services in England. METHODS Over 24 million calls to NHS Direct (2010-13) and NHS 111 (2013-15) were extracted from Public Health England (PHE) syndromic surveillance systems. The relationship between SES and GI calls was assessed using generalised linear models (GLM). RESULTS Adjusting for rurality and age-sex interactions, in NHS Direct, children in disadvantaged areas were at lower risk of GI calls; in NHS 111 there was a higher risk of GI calls in disadvantaged areas for all ages (0-4 years RR 1.27, 95% CI 1.25-1.29; 5-9 years RR 1.43, 95% CI 1.36-1.51; 10-14 years RR 1.36, 95% CI 1.26-1.41; 15-19 years RR 1.59, 95% CI 1.52-1.67; 20-59 years RR 1.50, 95% CI 1.47-1.53, 60 years and over RR 1.12, 95% CI 1.09-1.14). CONCLUSIONS Disadvantaged areas had higher risk of GI calls in NHS 111. This may relate to differences in exposure or vulnerability to GI infections, or propensity to call about GI infections.
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Affiliation(s)
- Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK; National Infection Service, Public Health England, London, UK.
| | - Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Paul Loveridge
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - James Lewis
- Emergency Response Department, Science and Technology, Health Protection Directorate, Public Health England, Porton Down, Salisbury, UK
| | - Gareth Studdard
- NHS England, West Midlands Integrated Urgent Care, Birmingham, UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Jeremy I Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; National Infection Service, Field Service, Public Health England, Birmingham, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
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Adams NL, Rose TC, Hawker J, Violato M, O’Brien SJ, Whitehead M, Barr B, Taylor-Robinson DC. Socioeconomic status and infectious intestinal disease in the community: a longitudinal study (IID2 study). Eur J Public Health 2018; 28:134-138. [PMID: 29016791 PMCID: PMC5965370 DOI: 10.1093/eurpub/ckx091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Infectious intestinal diseases (IID) are common, affecting around 25% of people in UK each year at an estimated annual cost to the economy, individuals and the NHS of £1.5 billion. While there is evidence of higher IID hospital admissions in more disadvantaged groups, the association between socioeconomic status (SES) and risk of IID remains unclear. This study aims to investigate the relationship between SES and IID in a large community cohort. Methods Longitudinal analysis of a prospective community cohort in the UK following 6836 participants of all ages was undertaken. Hazard ratios for IID by SES were estimated using Cox proportional hazard, adjusting for follow-up time and potential confounding factors. Results In the fully adjusted analysis, hazard ratio of IID was significantly lower among routine/manual occupations compared with managerial/professional occupations (HR 0.74, 95% CI 0.61-0.90). Conclusion In this large community cohort, lower SES was associated with lower IID risk. This may be partially explained by the low response rate which varied by SES. However, it may be related to differences in exposure or recognition of IID symptoms by SES. Higher hospital admissions associated with lower SES observed in some studies could relate to more severe consequences, rather than increased infection risk.
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Affiliation(s)
- Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
- National Infection Service, Public Health England, London/Birmingham,
UK
| | - Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- National Infection Service, Public Health England, London/Birmingham,
UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah J O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
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Adams NL, Rose TC, Hawker J, Violato M, O’Brien SJ, Barr B, Howard VJK, Whitehead M, Harris R, Taylor-Robinson DC. Relationship between socioeconomic status and gastrointestinal infections in developed countries: A systematic review and meta-analysis. PLoS One 2018; 13:e0191633. [PMID: 29360884 PMCID: PMC5779704 DOI: 10.1371/journal.pone.0191633] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 12/26/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The association between socioeconomic status (SES) and health is well-documented; however limited evidence on the relationship between SES and gastrointestinal (GI) infections exists, with published studies producing conflicting results. This systematic review aimed to assess the association between SES and GI infection risk, and explore possible sources of heterogeneity in effect estimates reported in the literature. METHODS MEDLINE, Scopus, Web of Science and grey literature were searched from 1980 to October 2015 for studies reporting an association between GI infections and SES in a representative population sample from a member-country of the Organisation for Economic Co-operation and Development. Harvest plots and meta-regression were used to investigate potential sources of heterogeneity such as age; level of SES variable; GI infection measurement; and predominant mode of transmission. The protocol was registered on PROSPERO: CRD42015027231. RESULTS In total, 6021 studies were identified; 102 met the inclusion criteria. Age was identified as the only statistically significant potential effect modifier of the association between SES and GI infection risk. For children, GI infection risk was higher for those of lower SES versus high (RR 1.51, 95% CI;1.26-1.83), but there was no association for adults (RR 0.79, 95% CI;0.58-1.06). In univariate analysis, the increased risk comparing low and high SES groups was significantly higher for pathogens spread by person-to-person transmission, but lower for environmental pathogens, as compared to foodborne pathogens. CONCLUSIONS Disadvantaged children, but not adults, have greater risk of GI infection compared to their more advantaged counterparts. There was high heterogeneity and many studies were of low quality. More high quality studies are needed to investigate the association between SES and GI infection risk, and future research should stratify analyses by age and pathogen type. Gaining further insight into this relationship will help inform policies to reduce inequalities in GI illness in children.
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Affiliation(s)
- Natalie L. Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- National Infection Service, Public Health England, London, United Kingdom
| | - Tanith C. Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- National Infection Service, Public Health England, London, United Kingdom
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
| | - Sarah J. O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Victoria J. K. Howard
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Ross Harris
- National Infection Service, Public Health England, London, United Kingdom
| | - David C. Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
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Taylor-Robinson DC, Stanojevic S. Low lung function in early adulthood: morbidity and death. The Lancet Respiratory Medicine 2017; 5:910-911. [DOI: 10.1016/s2213-2600(17)30437-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
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Rose TC, Adams NL, Barr B, Hawker J, O'Brien SJ, Violato M, Whitehead M, Taylor-Robinson DC. Socioeconomic status is associated with symptom severity and sickness absence in people with infectious intestinal disease in the UK. BMC Infect Dis 2017. [PMID: 28645256 PMCID: PMC5481911 DOI: 10.1186/s12879-017-2551-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of infectious intestinal disease (IID) in the UK is substantial. Negative consequences including sickness absence are common, but little is known about the social patterning of these outcomes, or the extent to which they relate to disease severity. METHODS We performed a cross-sectional analysis using IID cases identified from a large population-based survey, to explore the association between socioeconomic status (SES) and symptom severity and sickness absence; and to assess the role of symptom severity on the relationship between SES and absence. Regression modelling was used to investigate these associations, whilst controlling for potential confounders such as age, sex and ethnicity. RESULTS Among 1164 cases, those of lower SES versus high had twice the odds of experiencing severe symptoms (OR 2.2, 95%CI;1.66-2.87). Lower SES was associated with higher odds of sickness absence (OR 1.8, 95%CI;1.26-2.69), however this association was attenuated after adjusting for symptom severity (OR 1.4, 95%CI;0.92-2.07). CONCLUSIONS In a large sample of IID cases, those of low SES versus high were more likely to report severe symptoms, and sickness absence; with greater severity largely explaining the higher absence. Public health interventions are needed to address the unequal consequences of IID identified.
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Affiliation(s)
- Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK. .,Department of Public Health and Policy, University of Liverpool, Liverpool, UK. .,Department of Public Health and Policy Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK.
| | - Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK.,National Infection Service, Public Health England, London/Birmingham, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,National Infection Service, Public Health England, London/Birmingham, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Taylor-Robinson DC, Williams H, Pearce A, Law C, Hope S. Do early-life exposures explain why more advantaged children get eczema? Findings from the U.K. Millennium Cohort Study. Br J Dermatol 2016; 174:569-78. [PMID: 26595368 PMCID: PMC4949701 DOI: 10.1111/bjd.14310] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Abstract
Background Atopic dermatitis (eczema) in childhood is socially patterned, with higher incidence in more advantaged populations. However, it is unclear what factors explain the social differences. Objectives To identify early‐life risk factors for eczema, and to explore how early‐life risk factors explain any differences in eczema. Methods We estimated odds ratios (ORs) for ever having had eczema by age 5 years in 14 499 children from the U.K. Millennium Cohort Study (MCS), with a focus on maternal, antenatal and early‐life risk factors and socioeconomic circumstances (SECs). Risk factors were explored to assess whether they attenuated associations between SECs and eczema. Results Overall 35·1% of children had ever had eczema by age 5 years. Children of mothers with degree‐level qualifications vs. no educational qualifications were more likely to have eczema (OR 1·52, 95% confidence interval 1·31–1·76), and there was a gradient across the socioeconomic spectrum. Maternal atopy, breastfeeding (1–6 weeks and ≥ 6 months), introduction of solids under 4 months or cow's milk under 9 months, antibiotic exposure in the first year of life and grime exposure were associated with an increased odds of having eczema. Female sex, Pakistani and Bangladeshi ethnicity, smoking during pregnancy, exposure to environmental tobacco smoke and having more siblings were associated with reduced odds for eczema. Controlling for maternal, antenatal and early‐life characteristics (particularly maternal smoking during pregnancy, breastfeeding and number of siblings) reduced the OR for eczema to 1·26 (95% confidence interval 1·03–1·50) in the group with the highest educational qualifications compared with the least. Conclusions In a representative U.K. child cohort, eczema was more common in more advantaged children. This was explained partially by early‐life factors including not smoking during pregnancy, breastfeeding and having fewer siblings. What's already known about this topic? Previous studies have suggested that atopic dermatitis (eczema) in childhood is socially patterned, with higher incidence in more advantaged populations. It is unclear what explains these differences.
What does this study add? This large longitudinal study confirmed a significant excess of atopic dermatitis in more advantaged children born in 2000. This could be explained partially by maternal and early‐life factors including less maternal smoking in pregnancy, prolonged breastfeeding and fewer siblings.
Plain language summary available online
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Affiliation(s)
- D C Taylor-Robinson
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, L69 3GB, U.K.,UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, U.K
| | - H Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - A Pearce
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, U.K
| | - C Law
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, U.K
| | - S Hope
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, U.K
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18
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Rose TC, Adams N, Taylor-Robinson DC, Barr B, Hawker J, O'Brien S, Violato M, Whitehead M. Relationship between socioeconomic status and gastrointestinal infections in developed countries: a systematic review protocol. Syst Rev 2016; 5:13. [PMID: 26791956 PMCID: PMC4721014 DOI: 10.1186/s13643-016-0187-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/12/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The association between low socioeconomic status (SES) and poor health is well documented in the existing literature. Nonetheless, evidence on the relationship between SES and gastrointestinal (GI) infections is limited, and the mechanisms underlying this relationship are not well understood with published studies pointing to conflicting results. This review aims to identify studies that investigate the relationship between SES and GI infections in developed countries, in order to assess the direction of the association and explore possible explanations for any differences in the risk, incidence or prevalence of GI infections across socioeconomic groups. METHODS Three systematic methods will be used to identify relevant literature: electronic database, reference list and grey literature searching. The databases MEDLINE, Scopus and Web of Science Core Collection will be searched using a broad range of search terms. Screening of the results will be performed by two reviewers using pre-defined inclusion and exclusion criteria. The reference lists of included studies will be searched, and Google will be used to identify grey literature. Observational studies reporting quantitative results on the prevalence or incidence of any symptomatic GI infections by SES, in a representative population sample from a member country of the Organisation for Economic Co-operation and Development (OECD), will be included. Data will be extracted using a standardised form. Study quality will be assessed using the Liverpool University Quality Assessment Tools (LQAT). A narrative synthesis will be performed including tabulation of studies for comparison. DISCUSSION This systematic review will consolidate the existing knowledge on the relationship between SES and GI infections. The results will help to identify gaps in the literature and will therefore provide an evidence base for future empirical studies to deepen the understanding of the relationship, including effective study design and appropriate data analysis methods. Ultimately, gaining insight into this relationship will help to inform policies to reduce any health inequalities identified. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015027231.
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Affiliation(s)
- Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK. .,Department of Public Health and Policy, University of Liverpool, Liverpool, UK. .,Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK.
| | - Natalie Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK. .,Department of Public Health and Policy, University of Liverpool, Liverpool, UK. .,Public Health England, London, UK.
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK. .,Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK. .,Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK. .,Public Health England, London, UK.
| | - Sarah O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK. .,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
| | - Mara Violato
- NIHR Health Protections Research Unit in Gastrointestinal Infections, University of Oxford, Oxford, UK. .,Health Economics Research Centre, University of Oxford, Oxford, UK.
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, L69 7BE, UK. .,Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
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Taylor-Robinson DC, Pearce A, Whitehead M, Smyth R, Law C. Social inequalities in wheezing in children: findings from the UK Millennium Cohort Study. Eur Respir J 2015; 47:818-28. [PMID: 26677938 PMCID: PMC4771620 DOI: 10.1183/13993003.01117-2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/13/2015] [Indexed: 01/31/2023]
Abstract
Wheezing in childhood is socially patterned, but it is unclear what factors explain the social differences.Regression analysis of the UK Millennium Cohort Study, based on 11 141 singleton children who participated at ages 9 months and 3, 5 and 7 years. Relative risk ratios (RRR) for early and persistent/relapsing wheeze were estimated using multinomial regression, according to measures of socioeconomic circumstances. Maternal, antenatal and early-life characteristics were assessed as potential mediators.Children of mothers with no educational qualifications were more likely to have both wheeze types, compared to children of mothers with degree-level qualifications (RRR 1.53, 95% CI 1.26-1.86 for early wheeze; 1.32 95% CI 1.04-1.67 for persistent/relapsing wheeze). Controlling for maternal age, smoking during pregnancy and breastfeeding removed the elevated risk of wheezing. Male sex, maternal age, body mass index, atopy, smoking during pregnancy, preterm birth, breastfeeding, exposure to other children and furry pets were independently associated with wheezing, but the pattern of association varied between wheezing types.In this representative UK cohort, adjustment for maternal smoking during pregnancy and breastfeeding removed the socioeconomic inequalities in common wheezing phenotypes. Policies to reduce the social gradient in these risk factors may reduce inequalities in wheezing and asthma.
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Affiliation(s)
- David C Taylor-Robinson
- Dept of Public Health and Policy, University of Liverpool, Liverpool, UK UCL Institute of Child Health, London, UK
| | | | - Margaret Whitehead
- Dept of Public Health and Policy, University of Liverpool, Liverpool, UK
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20
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Taylor-Robinson DC, Williams H, Pearce A, Law C, Hope S. OP56 Do early life exposures explain why more advantaged children get eczema? findings from the UK millennium cohort study. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Taylor-Robinson DC, Southern KW, Winstanley C. Social network analysis of Pseudomonas aeruginosa in cystic fibrosis. Lancet Respir Med 2015. [PMID: 26208995 DOI: 10.1016/s2213-2600(15)00250-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Kevin W Southern
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GB, UK
| | - Craig Winstanley
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3GB, UK
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Taylor-Robinson DC, Thielen K, Pressler T, Olesen HV, Diggle PJ. Low socioeconomic status and lung function. Eur Respir J 2015; 45:857-8. [PMID: 25726542 DOI: 10.1183/09031936.00232014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Karsten Thielen
- Dept of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tania Pressler
- Cystic Fibrosis Center, Rigshospitalet, Copenhagen, Denmark
| | - Hanne V Olesen
- Pediatric Dept A, Cystic Fibrosis Center, Aarhus University Hospital, Aarhus, Denmark
| | - Peter J Diggle
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Affiliation(s)
- David C Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK UCL Institute of Child Health, London, UK
| | - Michael S Schechter
- Department of Pediatrics, Division of Pulmonary Medicine, Virginia Commonwealth University, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
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Taylor-Robinson DC, Thielen K, Pressler T, Olesen HV, Diderichsen F, Diggle PJ, Smyth R, Whitehead M. Low socioeconomic status is associated with worse lung function in the Danish cystic fibrosis population. Eur Respir J 2014; 44:1363-6. [PMID: 25186272 PMCID: PMC4216452 DOI: 10.1183/09031936.00063714] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Karsten Thielen
- Dept of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tania Pressler
- Cystic Fibrosis Center, Rigshospitalet, Copenhagen, Denmark
| | - Hanne V Olesen
- Paediatric Dept A, Cystic Fibrosis Center, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Diderichsen
- Dept of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter J Diggle
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Margaret Whitehead
- Dept of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, UK
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25
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R M, Anwar E, Orton L, Taylor-Robinson DC, Bromley H, Lloyd-Williams F, Calder N, O’Flaherty M, Castillo MG, White M, Petticrew M, White MM, Capewell S. PP09 Assessing the Potential Effect of Healthy Eating Policy Interventions on Socioeconomic Inequalities: Systematic Review. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Orton LC, Lloyd-Williams F, Bromley H, Hawkes C, Taylor-Robinson DC, O’Flaherty M, Moonan M, Rayner M, Capewell S. PP11 Using the “4Ps” Marketing Approach to Evaluate Health-Promoting Food Policies. A Rapid Scoping Review. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Taylor-Robinson DC, Smyth R, Diggle PJ, Whitehead M. A longitudinal study of the impact of social deprivation and disease severity on employment status in the UK cystic fibrosis population. PLoS One 2013; 8:e73322. [PMID: 24009747 PMCID: PMC3751887 DOI: 10.1371/journal.pone.0073322] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/18/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND People with Cystic Fibrosis (CF) in the UK and elsewhere are increasingly surviving into adulthood, yet there is little research on the employment consequences of having CF. We investigated, for the first time in a UK-wide cohort, longitudinal employment status, and its association with deprivation, disease severity, and time in hospital. METHODS We did a longitudinal registry study of adults with CF in the UK aged 20 to 40 (3458 people with 15,572 observations between 1996 and 2010), using mixed effects models. RESULTS Around 50% of adults with CF were in employment. Male sex, higher lung function and body mass index, and less time in hospital were associated with improved employment chances. All other things being equal, being in the most deprived quintile was associated with a reduction of employment prevalence of 17.6 percentage points compared to the prevalence in the least deprived quintile. Having poor lung function was associated with a reduced employment prevalence of 7.2 percentage points compared to the prevalence for people with relatively good lung function. Acting synergistically, deprivation modifies the effect of lung function on employment chances - poor lung function in the least deprived group was associated with a 3 percentage point reduction in employment chances, while poor lung function in the most deprived quintile was associated with a 7.7 point reduction in employment chances. CONCLUSIONS Greater deprivation, disease severity, and time in hospital are all associated with employment chances in adults with CF. Furthermore, our analysis suggests that deprivation amplifies the harmful association of disease severity on employment. Future studies should focus on understanding and mitigating the barriers to employment faced by people with CF.
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Taylor-Robinson DC, Smyth RL, Diggle PJ, Whitehead M. The effect of social deprivation on clinical outcomes and the use of treatments in the UK cystic fibrosis population: a longitudinal study. Lancet Respir Med 2013; 1:121-8. [PMID: 24429092 PMCID: PMC3878382 DOI: 10.1016/s2213-2600(13)70002-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Poorer socioeconomic circumstances have been linked with worse outcomes in cystic fibrosis. We assessed whether a relation exists between social deprivation and individual's clinical and health-care outcomes. Methods We did a longitudinal registry study of the UK cystic fibrosis population younger than 40 years (8055 people with 49 337 observations for weight, the most commonly collected outcome, between Jan 1, 1996, and Dec 31, 2009). We assessed data for weight, height, body-mass index, percent predicted forced expiratory volume in 1 s (%FEV1), risk of Pseudomonas aeruginosa colonisation, and the use of major cystic fibrosis treatment modalities. We used mixed effects models to assess the association between small-area deprivation and clinical and health-care outcomes, adjusting for clinically important covariates. We give continuous outcomes as mean differences, and binary outcomes as odds ratios, comparing extremes of deprivation quintile. Findings Compared with the least deprived areas, children from the most deprived areas weighed less (standard deviation [SD] score −0·28, 95% CI −0·38 to −0·18), were shorter (–0·31, −0·40 to −0·21, and had a lower body-mass index (–0·13, −0·22 to −0·04), were more likely to have chronic P aeruginosa infection (odds ratio 1·89, 95% CI 1·34 to 2·66), and have a lower %FEV1 (–4·12 percentage points, 95% CI −5·01 to −3·19). These inequalities were apparent very early in life and did not widen thereafter. On a population level, after adjustment for disease severity, children in the most deprived quintile were more likely to receive intravenous antibiotics (odds ratio 2·52, 95% CI 1·92 to 3·17) and nutritional treatments (1·78, 1·44 to 2·20) compared with individuals in the least deprived quintile. Patients from the most disadvantaged areas were less likely to receive DNase or inhaled antibiotic treatment. Interpretation In the UK, children with cystic fibrosis from more disadvantaged areas have worse growth and lung function compared with children from more affluent areas, but these inequalities do not widen with advancing age. Clinicians consider deprivation status, as well as disease status, when making decisions about treatments, and this might mitigate some effects of social disadvantage. Funding Medical Research Council (UK).
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Affiliation(s)
| | | | - Peter J Diggle
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P. Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance. Cochrane Database Syst Rev 2012; 11:CD000371. [PMID: 23152203 DOI: 10.1002/14651858.cd000371.pub5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common. The WHO state this will improve nutritional status, haemoglobin, and cognition and thus will improve health, intellect, and school attendance. Consequently, it is claimed that school performance will improve, child mortality will decline, and economic productivity will increase. Given the important health and societal benefits attributed to this intervention, we sought to determine whether they are based on reliable evidence. OBJECTIVES To summarize the effects of giving deworming drugs to children to treat soil-transmitted intestinal worms (nematode geohelminths) on weight, haemoglobin, and cognition; and the evidence of impact on physical well being, school attendance, school performance, and mortality. SEARCH METHODS In February 2012, we searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, EMBASE, LILACS, mRCT, and reference lists, and registers of ongoing and completed trials. SELECTION CRITERIA We selected randomized controlled trials (RCTs) and quasi-RCTs comparing deworming drugs for geohelminth worms with placebo or no treatment in children aged 16 years or less, reporting on weight, haemoglobin, and formal test of intellectual development. In cluster-RCTs treating communities or schools, we also sought data on school attendance, school performance, and mortality. We included trials that included health education with deworming. DATA COLLECTION AND ANALYSIS At least two authors independently assessed the trials, evaluated risk of bias, and extracted data. Continuous data were analysed using the mean difference (MD) with 95% confidence intervals (CI). Where data were missing, we contacted trial authors. We used GRADE to assess evidence quality, and this is reflected in the wording we used: high quality ("deworming improves...."); moderate quality ("deworming probably improves..."); low quality ("deworming may improve...."); and very low quality ("we don't know if deworming improves...."). MAIN RESULTS We identified 42 trials, including eight cluster trials, that met the inclusion criteria. Excluding one trial where data are awaited, the 41 trials include 65,168 participants.Screening then treatingFor children known to be infected with worms (by screening), a single dose of deworming drugs may increase weight (0.58 kg, 95% CI 0.40 to 0.76, three trials, 139 participants; low quality evidence) and may increase haemoglobin (0.37 g/dL, 95% CI 0.1 to 0.64, two trials, 108 participants; low quality evidence), but we do not know if there is an effect on cognitive functioning (two trials, very low quality evidence).Single dose deworming for all childrenIn trials treating all children, a single dose of deworming drugs gave mixed effects on weight, with no effects evident in seven trials, but large effects in two (nine trials, 3058 participants, very low quality evidence). The two trials with a positive effect were from the same very high prevalence setting and may not be easily generalised elsewhere. Single dose deworming probably made little or no effect on haemoglobin (mean difference (MD) 0.06 g/dL, 95% CI -0.06 to 0.17, three trials, 1005 participants; moderate evidence), and may have little or no effect on cognition (two trials, low quality evidence).Mulitple dose deworming for all childrenOver the first year of follow up, multiple doses of deworming drugs given to all children may have little or no effect on weight (MD 0.06 kg, 95% CI -0.17 to 0.30; seven trials, 2460 participants; low quality evidence); haemoglobin, (mean 0.01 g/dL lower; 95% CI 0.14 lower to 0.13 higher; four trials, 807 participants; low quality evidence); cognition (three trials, 30,571 participants, low quality evidence); or school attendance (4% higher attendance; 95% CI -6 to 14; two trials, 30,243 participants; low quality evidence);For time periods beyond a year, there were five trials with weight measures. One cluster-RCT of 3712 children in a low prevalence area showed a large effect (average gain of 0.98 kg), whilst the other four trials did not show an effect, including a cluster-RCT of 27,995 children in a moderate prevalence area (five trials, 37,306 participants; low quality evidence). For height, we are uncertain whether there is an effect of deworming (-0.26 cm; 95% CI -0.84 to 0.31, three trials, 6652 participants; very low quality evidence). Deworming may have little or no effect on haemoglobin (0.00 g/dL, 95%CI -0.08 to 0.08, two trials, 1365 participants, low quality evidence); cognition (two trials, 3720 participants; moderate quality evidence). For school attendance, we are uncertain if there is an effect (mean attendance 5% higher, 95% CI -0.5 to 10.5, approximately 20,000 participants, very low quality evidence).Stratified analysis to seek subgroup effects into low, medium and high helminth endemicity areas did not demonstrate any pattern of effect. In a sensitivity analysis that only included trials with adequate allocation concealment, we detected no significant effects for any primary outcomes.One million children were randomized in a deworming trial from India with mortality as the primary outcome. This was completed in 2005 but the authors have not published the results. AUTHORS' CONCLUSIONS Screening children for intestinal helminths and then treating infected children appears promising, but the evidence base is small. Routine deworming drugs given to school children has been more extensively investigated, and has not shown benefit on weight in most studies, except for substantial weight changes in three trials conducted 15 years ago or more. Two of these trials were carried out in the same high prevalence setting. For haemoglobin and cognition, community deworming seems to have little or no effect, and the evidence in relation to school attendance, and school performance is generally poor, with no obvious or consistent effect. Our interpretation of this data is that it is probably misleading to justify contemporary deworming programmes based on evidence of consistent benefit on nutrition, haemoglobin, school attendance or school performance as there is simply insufficient reliable information to know whether this is so.
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Orton LC, Bromley H, Hawkes C, Taylor-Robinson DC, Moonan M, O’Flaherty M, Lloyd-Williams F, Rayner M, Capewell S. PS15 Policy Actions to Reduce Dietary Salt Intake: Price, Product, Place or Promotion? A Review of the Evidence. Br J Soc Med 2012. [DOI: 10.1136/jech-2012-201753.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P. Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance. Cochrane Database Syst Rev 2012:CD000371. [PMID: 22786473 DOI: 10.1002/14651858.cd000371.pub4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common. The WHO state this will improve nutritional status, haemoglobin, and cognition and thus will improve health, intellect, and school attendance. Consequently, it is claimed that school performance will improve, child mortality will decline, and economic productivity will increase. Given the important health and societal benefits attributed to this intervention, we sought to determine whether they are based on reliable evidence. OBJECTIVES To summarize the effects of giving deworming drugs to children to treat soil-transmitted intestinal worms (nematode geohelminths) on weight, haemoglobin, and cognition; and the evidence of impact on physical well being, school attendance, school performance, and mortality. SEARCH METHODS In February 2012, we searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, EMBASE, LILACS, mRCT, and reference lists, and registers of ongoing and completed trials. SELECTION CRITERIA We selected randomized controlled trials (RCTs) and quasi-RCTs comparing deworming drugs for geohelminth worms with placebo or no treatment in children aged 16 years or less, reporting on weight, haemoglobin, and formal test of intellectual development. In cluster-RCTs treating communities or schools, we also sought data on school attendance, school performance, and mortality. We included trials that included health education with deworming. DATA COLLECTION AND ANALYSIS At least two authors independently assessed the trials, evaluated risk of bias, and extracted data. Continuous data were analysed using the mean difference (MD) with 95% confidence intervals (CI). Where data were missing, we contacted trial authors. We used GRADE to assess evidence quality, and this is reflected in the wording we used: high quality ("deworming improves...."); moderate quality ("deworming probably improves..."); low quality ("deworming may improve...."); and very low quality ("we don't know if deworming improves...."). MAIN RESULTS We identified 42 trials, including eight cluster trials, that met the inclusion criteria. Excluding one trial where data are awaited, the 41 trials include 65,168 participants.For programmes that treat only children detected as infected (by screening), a single dose of deworming drugs probably increased weight (0.58 kg, 95% CI 0.40 to 0.76, three trials, 139 participants; moderate quality evidence) and may have increased haemoglobin (0.37 g/dL, 95% CI 0.1 to 0.64, two trials, 108 participants; low quality evidence), but we do not know if there is an effect on cognitive functioning (two trials, very low quality evidence).For a single dose of deworming drugs given to all children in endemic areas, there were mixed effects on weight, with no effects evident in seven trials, but large effects in two. Overall our analysis indicated that we are uncertain whether there was an effect on weight (nine trials, 3058 participants; very low quality evidence). For haemoglobin, deworming made little or no difference (0.02 g/dL, 95% CI -0.05 to 0.09, four trials, 1992 participants; low quality evidence), and we don't know if it improves cognition (one trial, very low quality evidence).For multiple doses of deworming drugs with follow up for up to one year given to all children in endemic areas, we are uncertain if there is an effect on weight (0.06 kg, 95% CI -0.17 to 0.30; seven trials, 2460 participants; very low quality evidence); cognition (three trials, very low quality evidence); or school attendance (4% higher attendance; 95% CI -6 to 14; two trials, 75 clusters and 143 individually randomized participants, very low quality evidence). For haemoglobin, the intervention may have little or no effect (mean 0.01 g/dL lower; 95% CI 0.14 lower to 0.13 higher; four trials, 807 participants; low quality evidence).For multiple doses of deworming drugs with follow up beyond one year given to all children in endemic areas there were five trials with weight measures. One cluster-RCT of 3712 children in a low prevalence area showed a large effect (average gain of 0.98kg), whilst the other four trials did not show an effect, including a cluster-RCT of 27,995 children in a moderate prevalence area. Overall, we are uncertain if there is an effect for weight (five trials, 302 clusters and 1045 individually randomized participants; very low quality evidence). For other outcomes, we are uncertain whether deworming affects height (-0.26 cm; 95%CI -0.84 to 0.31, three trials, 1219 participants); haemoglobin (0.02 g/dL, 95%CI 0.3 to 0.27, two trials, 1365 participants); cognition (two trials), or school attendance (mean attendance 5% higher, 95% CI -0.5 to 10.5, one trial, 50 clusters).Stratified analysis to seek subgroup effects into low, medium and high helminth endemicity areas did not demonstrate any pattern of effect. We did not detect any significant effects for any primary outcomes in a sensitivity analysis only including trials with adequate allocation concealment.One million children were randomized in a deworming trial from India with mortality as the primary outcome. This was completed in 2005 but the authors have not published the results. AUTHORS' CONCLUSIONS Screening children for intestinal helminths and then treating infected children appears promising, but the evidence base is small. Routine deworming drugs given to school children has been more extensively investigated, and has not shown benefit on weight in most studies, except for substantial weight changes in three trials conducted 15 years ago or more. Two of these trials were carried out in the same high prevalence setting. For haemoglobin, community deworming seems to have little or no effect, and the evidence in relation to cognition, school attendance, and school performance is generally poor, with no obvious or consistent effect. Our interpretation of this data is that it is probably misleading to justify contemporary deworming programmes based on evidence of consistent benefit on nutrition, haemoglobin, school attendance or school performance as there is simply insufficient reliable information to know whether this is so.
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Orton LC, Lloyd-Williams F, Taylor-Robinson DC, Moonan M, O'Flaherty M, Capewell S. Prioritising public health: a qualitative study of decision making to reduce health inequalities. BMC Public Health 2011; 11:821. [PMID: 22014291 PMCID: PMC3206485 DOI: 10.1186/1471-2458-11-821] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 10/20/2011] [Indexed: 12/03/2022] Open
Abstract
Background The public health system in England is currently facing dramatic change. Renewed attention has recently been paid to the best approaches for tackling the health inequalities which remain entrenched within British society and across the globe. In order to consider the opportunities and challenges facing the new public health system in England, we explored the current experiences of those involved in decision making to reduce health inequalities, taking cardiovascular disease (CVD) as a case study. Methods We conducted an in-depth qualitative study employing 40 semi-structured interviews and three focus group discussions. Participants were public health policy makers and planners in CVD in the UK, including: Primary Care Trust and Local Authority staff (in various roles); General Practice commissioners; public health academics; consultant cardiologists; national guideline managers; members of guideline development groups, civil servants; and CVD third sector staff. Results The short term target- and outcome-led culture of the NHS and the drive to achieve "more for less", combined with the need to address public demand for acute services often lead to investment in "downstream" public health intervention, rather than the "upstream" approaches that are most effective at reducing inequalities. Despite most public health decision makers wishing to redress this imbalance, they felt constrained due to difficulties in partnership working and the over-riding influence of other stakeholders in decision making processes. The proposed public health reforms in England present an opportunity for public health to move away from the medical paradigm of the NHS. However, they also reveal a reluctance of central government to contribute to shifting social norms. Conclusions It is vital that the effectiveness and cost effectiveness of all new and existing policies and services affecting public health are measured in terms of their impact on the social determinants of health and health inequalities. Researchers have a vital role to play in providing the complex evidence required to compare different models of prevention and service delivery. Those working in public health must develop leadership to raise the profile of health inequalities as an issue that merits attention, resources and workforce capacity; and advocate for central government to play a key role in shifting social norms.
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Affiliation(s)
- Lois C Orton
- University of Liverpool, Public Health and Policy, Psychology, Health and Society, 2nd Floor Block B Waterhouse Buildings, Liverpool L69 3GL, UK.
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Semple MG, Taylor-Robinson DC, Lane S, Smyth RL. Household tobacco smoke and admission weight predict severe bronchiolitis in infants independent of deprivation: prospective cohort study. PLoS One 2011; 6:e22425. [PMID: 21811609 PMCID: PMC3139660 DOI: 10.1371/journal.pone.0022425] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 06/23/2011] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine demographic, environmental and clinical factors associated with severe bronchiolitis in infants admitted to hospital and quantify the independent effects of these factors. DESIGN Prospective cohort study. SETTING Alder Hey Children's Hospital, Liverpool, United Kingdom. PARTICIPANTS 378 infants admitted to hospital with a diagnosis of bronchiolitis, of whom 299 (79%) were antigen positive to respiratory syncytial virus (RSV). OUTCOME Severity of disease during admission, defined as "no need for supplemental oxygen" (reference group), "any need for supplemental oxygen" and "any need for mechanical ventilation". RESULTS Univariate analysis found male sex (p = 0.035) and tobacco smoking by a household member (p<0.001) were associated with need for both supplemental oxygen and mechanical ventilation. Premature birth, low gestation, low birth weight, low admission weight and low corrected age on admission were also associated with need for mechanical ventilation (all p≤0.002). Deprivation scores (IMD 2004) were significantly higher in households where a member smoked compared to non-smoking households (p<0.001). The odds of smoking predicted by deprivation were 7 times higher (95%CI (3.59, 14.03)), when comparing the least and most deprived quintiles of the study population. Family history of atopic disease and deprivation score were not associated with severe disease. Multivariate multinomial logistic regression which initially included all covariates, found household tobacco smoking (adjusted OR = 2.45, 95%CI (1.60, 3.74) predicted need for oxygen supplementation. Household tobacco smoking (adjusted OR = 5.49, (2.78, 10.83)) and weight (kg) on admission (adjusted OR = 0.51, (0.40, 0.65)) were both significant predictors in the final model for mechanical ventilation. The same associations and similar size of effects were found when only children with proven RSV infection were included in analysis. CONCLUSIONS Low admission weight and householder tobacco smoking increased the risk of severe bronchiolitis in infants admitted to hospital. These effects were independent of a standard deprivation measure. NIHR Study Ref. DHCS/G121/10.
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Affiliation(s)
- Malcolm G Semple
- Department of Women's and Children's Health, University of Liverpool, Liverpool, United Kingdom.
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Taylor-Robinson DC, Milton B, Lloyd-Williams F, O'Flaherty M, Capewell S. Planning ahead in public health? A qualitative study of the time horizons used in public health decision-making. BMC Public Health 2008; 8:415. [PMID: 19094194 PMCID: PMC2649072 DOI: 10.1186/1471-2458-8-415] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 12/18/2008] [Indexed: 12/03/2022] Open
Abstract
Background In order to better understand factors that influence decisions for public health, we undertook a qualitative study to explore issues relating to the time horizons used in decision-making. Methods Qualitative study using semi-structured interviews. 33 individuals involved in the decision making process around coronary heart disease were purposively sampled from the UK National Health Service (national, regional and local levels), academia and voluntary organizations. Analysis was based on the framework method using N-VIVO software. Interviews were transcribed, coded and emergent themes identified. Results Many participants suggested that the timescales for public health decision-making are too short. Commissioners and some practitioners working at the national level particularly felt constrained in terms of planning for the long-term. Furthermore respondents felt that longer term planning was needed to address the wider determinants of health and to achieve societal level changes. Three prominent 'systems' issues were identified as important drivers of short term thinking: the need to demonstrate impact within the 4 year political cycle; the requirement to 'balance the books' within the annual commissioning cycle and the disruption caused by frequent re-organisations within the health service. In addition respondents suggested that the tools and evidence base for longer term planning were not well established. Conclusion Many public health decision and policy makers feel that the timescales for decision-making are too short. Substantial systemic barriers to longer-term planning exist. Policy makers need to look beyond short-term targets and budget cycles to secure investment for long-term improvement in public health.
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Taylor-Robinson DC, Jones AP, Garner P. Deworming drugs for treating soil-transmitted intestinal worms in children: effects on growth and school performance. Cochrane Database Syst Rev 2007:CD000371. [PMID: 17943740 DOI: 10.1002/14651858.cd000371.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In areas where intestinal worm infections occur, the World Health Organization recommends treating all school children at regular intervals with deworming drugs to improve growth and school performance. The evidence base for this policy needs to be established for countries to commit resources to implement these programmes. OBJECTIVES To summarize the effects of deworming drugs used to treat soil-transmitted intestinal worms (nematode geohelminths) on growth and school performance in children. SEARCH STRATEGY In May 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, mRCT, and reference lists. SELECTION CRITERIA Randomized and quasi-randomized controlled trials (RCTs) comparing deworming drugs for geohelminth worms with placebo or no treatment in children aged 16 years or less, reporting on growth, nutritional status, school performance, or cognition tests. DATA COLLECTION AND ANALYSIS Two authors independently assessed the trials and evaluated methodological quality; one author extracted data, and another checked a sample. Continuous data were analysed using the weighted mean difference (WMD) with 95% confidence intervals (CI). The random-effects model (RE model) was used in the presence of statistically significant heterogeneity. MAIN RESULTS Thirty-four RCTs, including six cluster-RCTs, met the inclusion criteria. Four trials had adequate allocation concealment, and three cluster-RCTs failed to take design effects into account in their analysis. Weight increased after one dose of a deworming drug (WMD 0.34 kg, 95% CI 0.05 to 0.64, RE model; 2448 children, 9 trials); however, there was considerable heterogeneity between trials that was not explained by background intestinal worm infection or intensity. A meta-analysis of multiple dose trials reporting on outcomes within a year of starting treatment showed no significant difference in weight gain (1714 children, 6 trials); however, one cluster-RCT did show effects on weight at one year in a subgroup analysis. In the seven multiple dose trials with follow up beyond 12 months, only one showed a significant increase in weight. Six of seven trials reported clear data on cognitive tests and school performance: five reported no significant effects, and one showed some improvements in three out of 10 cognitive tests. AUTHORS' CONCLUSIONS Deworming drugs used in targeted community programmes may be effective in relation to weight gain in some circumstances but not in others. No effect on cognition or school performance has been demonstrated.
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Affiliation(s)
- D C Taylor-Robinson
- Liverpool School of Tropical Medicine, International Health Group, Pembroke Place, Liverpool, Merseyside, UK, L3 5QA.
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