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Fong WLE, Nguyen VG, Burns R, Boukari Y, Beale S, Braithwaite I, Byrne TE, Geismar C, Fragaszy E, Hoskins S, Kovar J, Navaratnam AMD, Oskrochi Y, Patel P, Tweed S, Yavlinsky A, Hayward AC, Aldridge RW. The incidence of COVID-19-related hospitalisation in migrants in the UK: Findings from the Virus Watch prospective community cohort study. J Migr Health 2024; 9:100218. [PMID: 38559897 PMCID: PMC10978526 DOI: 10.1016/j.jmh.2024.100218] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/11/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Background Migrants in the United Kingdom (UK) may be at higher risk of SARS-CoV-2 exposure; however, little is known about their risk of COVID-19-related hospitalisation during waves 1-3 of the pandemic. Methods We analysed secondary care data linked to Virus Watch study data for adults and estimated COVID-19-related hospitalisation incidence rates by migration status. To estimate the total effect of migration status on COVID-19 hospitalisation rates, we ran mixed-effect Poisson regression for wave 1 (01/03/2020-31/08/2020; wildtype), and mixed-effect negative binomial regressions for waves 2 (01/09/2020-31/05/2021; Alpha) and 3 (01/06/2020-31/11/2021; Delta). Results of all models were then meta-analysed. Results Of 30,276 adults in the analyses, 26,492 (87.5 %) were UK-born and 3,784 (12.5 %) were migrants. COVID-19-related hospitalisation incidence rates for UK-born and migrant individuals across waves 1-3 were 2.7 [95 % CI 2.2-3.2], and 4.6 [3.1-6.7] per 1,000 person-years, respectively. Pooled incidence rate ratios across waves suggested increased rate of COVID-19-related hospitalisation in migrants compared to UK-born individuals in unadjusted 1.68 [1.08-2.60] and adjusted analyses 1.35 [0.71-2.60]. Conclusion Our findings suggest migration populations in the UK have excess risk of COVID-19-related hospitalisations and underscore the need for more equitable interventions particularly aimed at COVID-19 vaccination uptake among migrants.
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Affiliation(s)
- Wing Lam Erica Fong
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Vincent G Nguyen
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Sarah Beale
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Isobel Braithwaite
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Thomas E Byrne
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Ellen Fragaszy
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Jana Kovar
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Annalan MD Navaratnam
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Youssof Oskrochi
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Parth Patel
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Sam Tweed
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London NW1 2DA, UK
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Boukari Y, Kadir A, Waterston T, Jarrett P, Harkensee C, Dexter E, Cinar EN, Blackett K, Nacer H, Stevens A, Devakumar D. Gaza, armed conflict and child health. BMJ Paediatr Open 2024; 8:e002407. [PMID: 38350977 PMCID: PMC10868171 DOI: 10.1136/bmjpo-2023-002407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
- Yamina Boukari
- Institute of Health Informatics, University College London, London, UK
| | | | - Tony Waterston
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Burns R, Wyke S, Eyre MT, Boukari Y, Sørensen TB, Tsang C, Campbell CNJ, Beale S, Zenner D, Hargreaves S, Campos-Matos I, Harron K, Aldridge RW. COVID-19 vaccination coverage for half a million non-EU migrants and refugees in England. Nat Hum Behav 2024; 8:288-299. [PMID: 38049560 PMCID: PMC10896718 DOI: 10.1038/s41562-023-01768-6] [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] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/23/2023] [Indexed: 12/06/2023]
Abstract
Despite evidence suggesting that some migrants are at risk of under-immunization and have experienced severe health inequities during the pandemic, data are limited on migrants' COVID-19 vaccine coverage globally. Here we linked data from non-European Union migrants and resettled refugees to the national COVID-19 vaccination dataset in England. We estimated patterns in second and third dose delays and overdue doses between 12 December 2020 and 20 April 2022 by age, visa type and ethnicity. Of the 465,470 linked records, 91.8% (427,073/465,470) of migrants received a second dose and 51.3% (238,721/465,470) received a third. Refugees had the highest risk of delayed second (adjusted odds ratio 1.66; 95% confidence interval 1.55-1.79) and third dose (1.55; 1.43-1.69). Black migrants were twice as likely to have a second dose delayed (2.37; 2.23-2.54) than white migrants, but this trend reversed for the third dose. Older migrants (>65 years) were four times less likely to have received their second or third dose compared with the general population in England aged >65 or older. Policymakers, researchers and practitioners should work to understand and address personal and structural barriers to vaccination for diverse migrant populations.
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Affiliation(s)
- Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.
| | - Sacha Wyke
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Max T Eyre
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Tina B Sørensen
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Camille Tsang
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Colin N J Campbell
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Infection and Population Health Department, Institute of Global Health, University College London, London, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace London, London, UK
| | - Ines Campos-Matos
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
- UK Health Security Agency, London, UK
| | - Katie Harron
- UCL Great Ormond Street, Institute of Child Health, University College London, London, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
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Burns R, Wyke S, Eyre MT, Boukari Y, Sørensen TB, Tsang C, Campbell CNJ, Beale S, Zenner D, Hargreaves S, Campos-Matos I, Harron K, Aldridge RW. Author Correction: COVID-19 vaccination coverage for half a million non-EU migrants and refugees in England. Nat Hum Behav 2024; 8:399. [PMID: 38374444 PMCID: PMC10896711 DOI: 10.1038/s41562-024-01845-4] [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: 02/21/2024]
Affiliation(s)
- Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.
| | - Sacha Wyke
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Max T Eyre
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Tina B Sørensen
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Camille Tsang
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Colin N J Campbell
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Infection and Population Health Department, Institute of Global Health, University College London, London, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace London, London, UK
| | - Ines Campos-Matos
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
- UK Health Security Agency, London, UK
| | - Katie Harron
- UCL Great Ormond Street, Institute of Child Health, University College London, London, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
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Burns R, Wyke S, Boukari Y, Katikireddi SV, Zenner D, Campos-Matos I, Harron K, Aldridge RW. Linking migration and hospital data in England: linkage process and evaluation of bias. Int J Popul Data Sci 2024; 9:2181. [PMID: 38476270 PMCID: PMC10929707 DOI: 10.23889/ijpds.v9i1.2181] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Introduction Difficulties ascertaining migrant status in national data sources such as hospital records have limited large-scale evaluation of migrant healthcare needs in many countries, including England. Linkage of immigration data for migrants and refugees, with National Health Service (NHS) hospital care data enables research into the relationship between migration and health for a large cohort of international migrants. Objectives We aimed to describe the linkage process and compare linkage rates between migrant sub-groups to evaluate for potential bias for data on non-EU migrants and resettled refugees linked to Hospital Episode Statistics (HES) in England. Methods We used stepwise deterministic linkage to match records from migrants and refugees to a unique healthcare identifier indicating interaction with the NHS (linkage stage 1 to NHS Personal Demographic Services, PDS), and then to hospital records (linkage stage 2 to HES). We calculated linkage rates and compared linked and unlinked migrant characteristics for each linkage stage. Results Of the 1,799,307 unique migrant records, 1,134,007 (63%) linked to PDS and 451,689 (25%) linked to at least one hospital record between 01/01/2005 and 23/03/2020. Individuals on work, student, or working holiday visas were less likely to link to a hospital record than those on settlement and dependent visas and refugees. Migrants from the Middle East and North Africa and South Asia were four times more likely to link to at least one hospital record, compared to those from East Asia and the Pacific. Differences in age, sex, visa type, and region of origin between linked and unlinked samples were small to moderate. Conclusion This linked dataset represents a unique opportunity to explore healthcare use in migrants. However, lower linkage rates disproportionately affected individuals on shorter-term visas so future studies of these groups may be more biased as a result. Increasing the quality and completeness of identifiers recorded in administrative data could improve data linkage quality.
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Affiliation(s)
- Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Sacha Wyke
- UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ United Kingdom
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Sirinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, United Kingdom
| | - Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, United Kingdom
- Infection and Population Health Department, Institute of Global Health, University College London
| | - Ines Campos-Matos
- UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ United Kingdom
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom
| | - Katie Harron
- UCL Great Ormond Street, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
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Pathak N, Zhang CX, Boukari Y, Burns R, Menezes D, Hugenholtz G, French RS, Gonzalez-Izquierdo A, Mathur R, Denaxas S, Hayward A, Sonnenberg P, Aldridge RW. Sexual and reproductive health and rights of migrant women attending primary care in England: A population-based cohort study of 1.2 million individuals of reproductive age (2009-2018). J Migr Health 2024; 9:100214. [PMID: 38327760 PMCID: PMC10847991 DOI: 10.1016/j.jmh.2024.100214] [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: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
Background Evidence on the sexual and reproductive health and rights (SRHR) of migrants is lacking globally. We describe SRHR healthcare resource use and long-acting reversible contraceptives (LARCs) prescriptions for migrant versus non-migrant women attending primary care in England (2009-2018). Methods This population-based observational cohort study, using Clinical Practice Research Datalink (CPRD) GOLD, included females living in England aged 15 to 49. Migration was defined using a validated codelist. Rates per 100 person years at risk (pyar) and adjusted rate ratios (RRs) were measured in migrants versus non-migrants for consultations related to all-causes, six exemplar SRHR outcomes, and LARC prescriptions. Proportions of migrants and non-migrants ever prescribed LARC were calculated. Findings There were 25,112,116 consultations across 1,246,353 eligible individuals. 98,214 (7.9 %) individuals were migrants. All-cause consultation rates were lower in migrants versus non-migrants (509 vs 583/100pyar;RR 0.9;95 %CI 0.9-0.9), as were consultations rates for emergency contraception (RR 0.7;95 %CI 0.7-0.7) and cervical screening (RR 0.96;95 %CI 0.95-0.97). Higher rates of consultations were found in migrants for abortion (RR 1.2;95 %CI 1.1-1.2) and management of fertility problems (RR 1.39;95 %CI 1.08-1.79). No significant difference was observed for chlamydia testing and domestic violence. Of 1,205,258 individuals eligible for contraception, the proportion of non-migrants ever prescribed LARC (12.2 %;135,047/1,107,894) was almost double that of migrants (6.91 %;6,728/97,364). Higher copper intrauterine devices prescription rates were found in migrants (RR 1.53;95 %CI 1.45-1.61), whilst hormonal LARC rates were lower for migrants: levonorgestrel intrauterine device (RR 0.63;95 %CI 0.60-0.66), subdermal implant (RR 0.72;95 %CI 0.69-0.75), and progesterone-only injection (RR 0.35;95 %CI 0.34-0.36). Interpretation Healthcare resource use differs between migrant and non-migrant women of reproductive age. Opportunities identified for tailored interventions include access to primary care, LARCs, emergency contraception and cervical screening. An inclusive approach to examining health needs is essential to actualise sexual and reproductive health as a human right.
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Affiliation(s)
- Neha Pathak
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute for Global Health, University College London, London, WC1E 6JB, UK
- Guy's & St Thomas's NHS Foundation Trust, London, SE1 9RT, UK
| | - Claire X. Zhang
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Dee Menezes
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Gregory Hugenholtz
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Rebecca S French
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- BHF Data Science Center, Health Data Research UK, London, NW1 2DA, UK
| | - Andrew Hayward
- Inclusion Health, UK Health Security Agency, London, UK
- Institute of Epidemiology and Healthcare, University College London, London, WC1E 7HB, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, WC1E 6JB, UK
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Faddoul A, Shannon G, Asghar K, Boukari Y, Smith J, Neilson A. The health dimensions of violence in Palestine: a call to prevent genocide. Lancet 2024; 403:25-26. [PMID: 38128558 DOI: 10.1016/s0140-6736(23)02751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Alix Faddoul
- Heidelberg Institute for Global Health, Heidelberg 69120, Germany.
| | | | - Khudejha Asghar
- University of Edinburgh School of Social and Political Science, Edinburgh, United Kingdom
| | | | - James Smith
- University College London, London, United Kingdom
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Boukari Y, Beale S, Nguyen V, Fong WLE, Burns R, Yavlinsky A, Hoskins S, Lewis K, Geismar C, Navaratnam AM, Braithwaite I, Byrne TE, Oskrochi Y, Tweed S, Kovar J, Patel P, Hayward A, Aldridge R. SARS-CoV-2 infections in migrants and the role of household overcrowding: a causal mediation analysis of Virus Watch data. J Epidemiol Community Health 2023; 77:649-655. [PMID: 37463770 PMCID: PMC10511992 DOI: 10.1136/jech-2022-220251] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Migrants are over-represented in SARS-CoV-2 infections globally; however, evidence is limited for migrants in England and Wales. Household overcrowding is a risk factor for SARS-CoV-2 infection, with migrants more likely to live in overcrowded households than UK-born individuals. We aimed to estimate the total effect of migration status on SARS-CoV-2 infection and to what extent household overcrowding mediated this effect. METHODS We included a subcohort of individuals from the Virus Watch prospective cohort study during the second SARS-CoV-2 wave (1 September 2020-30 April 2021) who were aged ≥18 years, self-reported the number of rooms in their household and had no evidence of SARS-CoV-2 infection pre-September 2020. We estimated total, indirect and direct effects using Buis' logistic decomposition regression controlling for age, sex, ethnicity, clinical vulnerability, occupation, income and whether they lived with children. RESULTS In total, 23 478 individuals were included. 9.07% (187/2062) of migrants had evidence of infection during the study period vs 6.27% (1342/21 416) of UK-born individuals. Migrants had 22% higher odds of infection during the second wave (total effect; OR 1.22, 95% CI 1.01 to 1.47). Household overcrowding accounted for approximately 36% (95% CI -4% to 77%) of these increased odds (indirect effect, OR 1.07, 95% CI 1.03 to 1.12; proportion accounted for: indirect effect on log odds scale/total effect on log odds scale=0.36). CONCLUSION Migrants had higher odds of SARS-CoV-2 infection during the second wave compared with UK-born individuals and household overcrowding explained 36% of these increased odds. Policy interventions to reduce household overcrowding for migrants are needed as part of efforts to tackle health inequalities during the pandemic and beyond.
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Affiliation(s)
- Yamina Boukari
- Institute of Health Informatics, University College London, London, UK
| | - Sarah Beale
- Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Vincent Nguyen
- Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Burns
- Institute of Health Informatics, University College London, London, UK
| | - Alexei Yavlinsky
- Institute of Health Informatics, University College London, London, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Kate Lewis
- Population, Policy and Practice Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Annalan Md Navaratnam
- Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Thomas E Byrne
- Institute of Health Informatics, University College London, London, UK
| | - Youssof Oskrochi
- Institute of Health Informatics, University College London, London, UK
| | - Sam Tweed
- Institute of Health Informatics, University College London, London, UK
| | - Jana Kovar
- Institute of Health Informatics, University College London, London, UK
| | - Parth Patel
- Institute of Health Informatics, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London, UK
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9
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Hoskins S, Beale S, Nguyen V, Boukari Y, Yavlinsky A, Kovar J, Byrne T, Fong WLE, Geismar C, Patel P, Johnson AM, Aldridge RW, Hayward A. Deprivation, essential and non-essential activities and SARS-CoV-2 infection following the lifting of national public health restrictions in England and Wales. NIHR Open Res 2023; 3:46. [PMID: 37994319 PMCID: PMC10663878 DOI: 10.3310/nihropenres.13445.1] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 11/24/2023]
Abstract
Background Individuals living in deprived areas in England and Wales undertook essential activities more frequently and experienced higher rates of SARS-CoV-2 infection than less deprived communities during periods of restrictions aimed at controlling the Alpha (B.1.1.7) variant. We aimed to understand whether these deprivation-related differences changed once restrictions were lifted. Methods Among 11,231 adult Virus Watch Community Cohort Study participants multivariable logistic regressions were used to estimate the relationships between deprivation and self-reported activities and deprivation and infection (self-reported lateral flow or PCR tests and linkage to National Testing data and Second Generation Surveillance System (SGSS)) between August - December 2021, following the lifting of national public health restrictions. Results Those living in areas of greatest deprivation were more likely to undertake essential activities (leaving home for work (aOR 1.56 (1.33 - 1.83)), using public transport (aOR 1.33 (1.13 - 1.57)) but less likely to undertake non-essential activities (indoor hospitality (aOR 0.82 (0.70 - 0.96)), outdoor hospitality (aOR 0.56 (0.48 - 0.66)), indoor leisure (aOR 0.63 (0.54 - 0.74)), outdoor leisure (aOR 0.64 (0.46 - 0.88)), or visit a hairdresser (aOR 0.72 (0.61 - 0.85))). No statistical association was observed between deprivation and infection (P=0.5745), with those living in areas of greatest deprivation no more likely to become infected with SARS-CoV-2 (aOR 1.25 (0.87 - 1.79). Conclusion The lack of association between deprivation and infection is likely due to the increased engagement in non-essential activities among the least deprived balancing the increased work-related exposure among the most deprived. The differences in activities highlight stark disparities in an individuals' ability to choose how to limit infection exposure.
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Affiliation(s)
- Susan Hoskins
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Sarah Beale
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
| | - Yamina Boukari
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Anne M. Johnson
- Institute for Global Health, University College London, London, England, WC1N 1EH, UK
| | - Robert W. Aldridge
- Centre for Public Health Data Science, University College London, London, England, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, England, WC1E 7HB, UK
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Serisier A, Beale S, Boukari Y, Hoskins S, Nguyen V, Byrne T, Fong WLE, Fragaszy E, Geismar C, Kovar J, Yavlinsky A, Hayward A, Aldridge RW. A case-crossover study of the effect of vaccination on SARS-CoV-2 transmission relevant behaviours during a period of national lockdown in England and Wales. Vaccine 2023; 41:511-518. [PMID: 36496282 PMCID: PMC9721283 DOI: 10.1016/j.vaccine.2022.11.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies of COVID-19 vaccine effectiveness show increases in COVID-19 cases within 14 days of a first dose, potentially reflecting post-vaccination behaviour changes associated with SARS-CoV-2 transmission before vaccine protection. However, direct evidence for a relationship between vaccination and behaviour is lacking. We aimed to examine the association between vaccination status and self-reported non-household contacts and non-essential activities during a national lockdown in England and Wales. METHODS Participants (n = 1154) who had received the first dose of a COVID-19 vaccine reported non-household contacts and non-essential activities from February to March 2021 in monthly surveys during a national lockdown in England and Wales. We used a case-crossover study design and conditional logistic regression to examine the association between vaccination status (pre-vaccination vs 14 days post-vaccination) and self-reported contacts and activities within individuals. Stratified subgroup analyses examined potential effect heterogeneity by sociodemographic characteristics such as sex, household income or age group. RESULTS 457/1154 (39.60 %) participants reported non-household contacts post-vaccination compared with 371/1154 (32.15 %) participants pre-vaccination. 100/1154 (8.67 %) participants reported use of non-essential shops or services post-vaccination compared with 74/1154 (6.41 %) participants pre-vaccination. Post-vaccination status was associated with increased odds of reporting non-household contacts (OR 1.65, 95 % CI 1.31-2.06, p < 0.001) and use of non-essential shops or services (OR 1.50, 95 % CI 1.03-2.17, p = 0.032). This effect varied between men and women and different age groups. CONCLUSION Participants had higher odds of reporting non-household contacts and use of non-essential shops or services within 14 days of their first COVID-19 vaccine compared to pre-vaccination. Public health emphasis on maintaining protective behaviours during this post-vaccination time period when individuals have yet to develop full protection from vaccination could reduce risk of SARS-CoV-2 infection.
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Affiliation(s)
- Aimee Serisier
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Sarah Beale
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK; Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK.
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Susan Hoskins
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Vincent Nguyen
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK; Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Cyril Geismar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK; Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
| | - Robert W Aldridge
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
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Hoskins S, Beale S, Nguyen V, Boukari Y, Yavlinsky A, Kovar J, Byrne T, Fragaszy E, Fong WLE, Geismar C, Patel P, Navaratnam AMD, van Tongeren M, Johnson AM, Aldridge RW, Hayward A. Relative contribution of essential and non-essential activities to SARS-CoV-2 transmission following the lifting of public health restrictions in England and Wales. Epidemiol Infect 2022; 151:e3. [PMID: 36475452 PMCID: PMC9990391 DOI: 10.1017/s0950268822001832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE We aimed to understand which non-household activities increased infection odds and contributed greatest to SARS-CoV-2 infections following the lifting of public health restrictions in England and Wales. PROCEDURES We undertook multivariable logistic regressions assessing the contribution to infections of activities reported by adult Virus Watch Community Cohort Study participants. We calculated adjusted weighted population attributable fractions (aPAF) estimating which activity contributed greatest to infections. FINDINGS Among 11 413 participants (493 infections), infection was associated with: leaving home for work (aOR 1.35 (1.11-1.64), aPAF 17%), public transport (aOR 1.27 (1.04-1.57), aPAF 12%), shopping once (aOR 1.83 (1.36-2.45)) vs. more than three times a week, indoor leisure (aOR 1.24 (1.02-1.51), aPAF 10%) and indoor hospitality (aOR 1.21 (0.98-1.48), aPAF 7%). We found no association for outdoor hospitality (1.14 (0.94-1.39), aPAF 5%) or outdoor leisure (1.14 (0.82-1.59), aPAF 1%). CONCLUSION Essential activities (work and public transport) carried the greatest risk and were the dominant contributors to infections. Non-essential indoor activities (hospitality and leisure) increased risk but contributed less. Outdoor activities carried no statistical risk and contributed to fewer infections. As countries aim to 'live with COVID', mitigating transmission in essential and indoor venues becomes increasingly relevant.
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Affiliation(s)
- Susan Hoskins
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Vincent Nguyen
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Alexei Yavlinsky
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Jana Kovar
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Thomas Byrne
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Ellen Fragaszy
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Wing Lam Erica Fong
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Cyril Geismar
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Parth Patel
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Annalan M. D. Navaratnam
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK
| | - Anne M. Johnson
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, WC1E 7HB, UK
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Zhang CX, Boukari Y, Pathak N, Mathur R, Katikireddi SV, Patel P, Campos-Matos I, Lewer D, Nguyen V, Hugenholtz GC, Burns R, Mulick A, Henderson A, Aldridge RW. Migrants' primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis. Lancet Reg Health Eur 2022; 20:100455. [PMID: 35789753 PMCID: PMC9243519 DOI: 10.1016/j.lanepe.2022.100455] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background How international migrants access and use primary care in England is poorly understood. We aimed to compare primary care consultation rates between international migrants and non-migrants in England before and during the COVID-19 pandemic (2015-2020). Methods Using data from the Clinical Practice Research Datalink (CPRD) GOLD, we identified migrants using country-of-birth, visa-status or other codes indicating international migration. We linked CPRD to Office for National Statistics deprivation data and ran a controlled interrupted time series (ITS) using negative binomial regression to compare rates before and during the pandemic. Findings In 262,644 individuals, pre-pandemic consultation rates per person-year were 4.35 (4.34-4.36) for migrants and 4.60 (4.59-4.60) for non-migrants (RR:0.94 [0.92-0.96]). Between 29 March and 26 December 2020, rates reduced to 3.54 (3.52-3.57) for migrants and 4.2 (4.17-4.23) for non-migrants (RR:0.84 [0.8-0.88]). The first year of the pandemic was associated with a widening of the gap in consultation rates between migrants and non-migrants to 0.89 (95% CI 0.84-0.94) times the ratio before the pandemic. This widening in ratios was greater for children, individuals whose first language was not English, and individuals of White British, White non-British and Black/African/Caribbean/Black British ethnicities. It was also greater in the case of telephone consultations, particularly in London. Interpretation Migrants were less likely to use primary care than non-migrants before the pandemic and the first year of the pandemic exacerbated this difference. As GP practices retain remote and hybrid models of service delivery, they must improve services and ensure primary care is accessible and responsive to migrants' healthcare needs. Funding This study was funded by the Medical Research Council (MC_PC 19070 and MR/V028375/1) and a Wellcome Clinical Research Career Development Fellowship (206602).
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Affiliation(s)
- Claire X. Zhang
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom
| | - Yamina Boukari
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom
| | - Neha Pathak
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
- Guy's & St Thomas's NHS Foundation Trust, London SE1 9RT, United Kingdom
| | - Rohini Mathur
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, United Kingdom
| | - Parth Patel
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
| | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom
- UK Health Security Agency, Wellington House, 133–155, Waterloo Road, London SE1 8UG, United Kingdom
| | - Dan Lewer
- Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Vincent Nguyen
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
- Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Greg C.G. Hugenholtz
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
| | - Rachel Burns
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
| | - Amy Mulick
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Alasdair Henderson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Robert W. Aldridge
- Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom
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13
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Pathak N, Zhang CX, Boukari Y, Burns R, Mathur R, Gonzalez-Izquierdo A, Denaxas S, Sonnenberg P, Hayward A, Aldridge RW. Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK. Int J Environ Res Public Health 2021; 18:13304. [PMID: 34948912 PMCID: PMC8707886 DOI: 10.3390/ijerph182413304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Abstract
International migrants comprised 14% of the UK's population in 2020; however, their health is rarely studied at a population level using primary care electronic health records due to difficulties in their identification. We developed a migration phenotype using country of birth, visa status, non-English main/first language and non-UK-origin codes and applied it to the Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country-of-birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997 to 2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified: 178,749 (1.11%) had foreign-country-of-birth or visa -status codes, 216,731 (1.35%) non-English-main/first-language codes, and 8288 (0.05%) non-UK-origin codes. The cohort was similarly distributed versus ONS data by sex and region of birth. Migration recording improved over time and younger migrants were better represented than those aged ≥50. The validated phenotype identified a large migrant cohort for use in migration health research in CPRD GOLD to inform healthcare policy and practice. The under-recording of migration status in earlier years and older ages necessitates cautious interpretation of future studies in these groups.
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Affiliation(s)
- Neha Pathak
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Guy’s & St. Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Claire X. Zhang
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Health Data Research UK, London NW1 2BF, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Health Data Research UK, London NW1 2BF, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK;
| | - Andrew Hayward
- Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Robert W. Aldridge
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
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Pathak N, Patel P, Burns R, Haim L, Zhang CX, Boukari Y, Gonzales-Izquierdo A, Mathur R, Minassian C, Pitman A, Denaxas S, Hemingway H, Hayward A, Sonnenberg P, Aldridge RW. Healthcare resource utilisation and mortality outcomes in international migrants to the UK: analysis protocol for a linked population-based cohort study using Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and the Office for National Statistics (ONS). Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15931.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An estimated 14.2% (9.34 million people) of people living in the UK in 2019 were international migrants. Despite this, there are no large-scale national studies of their healthcare resource utilisation and little is known about how migrants access and use healthcare services. One ongoing study of migration health in the UK, the Million Migrants study, links electronic health records (EHRs) from hospital-based data, national death records and Public Health England migrant and refugee data. However, the Million Migrants study cannot provide a complete picture of migration health resource utilisation as it lacks data on migrants from Europe and utilisation of primary care for all international migrants. Our study seeks to address this limitation by using primary care EHR data linked to hospital-based EHRs and national death records. Our study is split into a feasibility study and a main study. The feasibility study will assess the validity of a migration phenotype, a transparent reproducible algorithm using clinical terminology codes to determine migration status in Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR. If the migration phenotype is found to be valid, the main study will involve using the phenotype in the linked dataset to describe primary care and hospital-based healthcare resource utilisation and mortality in migrants compared to non-migrants. All outcomes will be explored according to sub-conditions identified as research priorities through patient and public involvement, including preventable causes of inpatient admission, sexual and reproductive health conditions/interventions and mental health conditions. The results will generate evidence to inform policies that aim to improve migration health and universal health coverage.
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Boukari Y, Qutachi O, Scurr DJ, Morris AP, Doughty SW, Billa N. A dual-application poly (dl-lactic-co-glycolic) acid (PLGA)-chitosan composite scaffold for potential use in bone tissue engineering. J Biomater Sci Polym Ed 2017; 28:1966-1983. [PMID: 28777694 DOI: 10.1080/09205063.2017.1364100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The development of patient-friendly alternatives to bone-graft procedures is the driving force for new frontiers in bone tissue engineering. Poly (dl-lactic-co-glycolic acid) (PLGA) and chitosan are well-studied and easy-to-process polymers from which scaffolds can be fabricated. In this study, a novel dual-application scaffold system was formulated from porous PLGA and protein-loaded PLGA/chitosan microspheres. Physicochemical and in vitro protein release attributes were established. The therapeutic relevance, cytocompatibility with primary human mesenchymal stem cells (hMSCs) and osteogenic properties were tested. There was a significant reduction in burst release from the composite PLGA/chitosan microspheres compared with PLGA alone. Scaffolds sintered from porous microspheres at 37 °C were significantly stronger than the PLGA control, with compressive strengths of 0.846 ± 0.272 MPa and 0.406 ± 0.265 MPa, respectively (p < 0.05). The formulation also sintered at 37 °C following injection through a needle, demonstrating its injectable potential. The scaffolds demonstrated cytocompatibility, with increased cell numbers observed over an 8-day study period. Von Kossa and immunostaining of the hMSC-scaffolds confirmed their osteogenic potential with the ability to sinter at 37 °C in situ.
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Affiliation(s)
- Yamina Boukari
- a School of Pharmacy , The University of Nottingham Malaysia Campus , Semenyih , Malaysia
| | - Omar Qutachi
- b School of Pharmacy , The University of Nottingham, Park Campus , Nottingham , UK
| | - David J Scurr
- b School of Pharmacy , The University of Nottingham, Park Campus , Nottingham , UK
| | - Andrew P Morris
- a School of Pharmacy , The University of Nottingham Malaysia Campus , Semenyih , Malaysia
| | | | - Nashiru Billa
- a School of Pharmacy , The University of Nottingham Malaysia Campus , Semenyih , Malaysia
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Gupta M, Aina A, Boukari Y, Doughty S, Morris A, Billa N. Effect of volume of porogens on the porosity of PLGA scaffolds in pH-controlled environment. Pharm Dev Technol 2017; 23:207-210. [DOI: 10.1080/10837450.2017.1304415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Manish Gupta
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Malaysia
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Adeyinka Aina
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Malaysia
- Pharmaceutical Manufacturing Technology Centre, University of Limerick, Limerick, Ireland
| | - Yamina Boukari
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Malaysia
| | - Stephen Doughty
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Malaysia
- Penang Medical College, George Town, Malaysia
| | - Andrew Morris
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Malaysia
| | - Nashiru Billa
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Malaysia
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Aina A, Gupta M, Boukari Y, Morris A, Billa N, Doughty S. Monitoring model drug microencapsulation in PLGA scaffolds using X-ray powder diffraction. Saudi Pharm J 2016; 24:227-31. [PMID: 27013917 PMCID: PMC4792904 DOI: 10.1016/j.jsps.2015.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/15/2015] [Indexed: 11/29/2022] Open
Abstract
The microencapsulation of three model drugs; metronidazole, paracetamol and sulphapyridine into Poly (dl-Lactide-Co-Glycolide) (PLGA) scaffolds were probed using X-ray Powder Diffraction (XRPD). Changes in the diffraction patterns of the PLGA scaffolds after encapsulation was suggestive of a chemical interaction between the pure drugs and the scaffolds and not a physical intermixture.
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Affiliation(s)
- Adeyinka Aina
- Department of Mathematics and Natural Science, American University of Iraq, Kirkuk Main Road, Raparin, Sulaimani, Iraq
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia
| | - Manish Gupta
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia
- School of Pharmacy, Monash University Malaysia Campus, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Yamina Boukari
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia
| | - Andrew Morris
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia
| | - Nashiru Billa
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia
| | - Stephen Doughty
- Drug Delivery Laboratory, School of Pharmacy, University of Nottingham Malaysia Campus, Jalan Broga, 43500 Semenyih, Selangor Darul Ehsan, Malaysia
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Boukari Y, Scurr DJ, Qutachi O, Morris AP, Doughty SW, Rahman CV, Billa N. Physicomechanical properties of sintered scaffolds formed from porous and protein-loaded poly(DL-lactic-co-glycolic acid) microspheres for potential use in bone tissue engineering. Journal of Biomaterials Science, Polymer Edition 2015; 26:796-811. [DOI: 10.1080/09205063.2015.1058696] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Debrix I, Fillon J, Boukari Y, Selle F, Casagrande T, Lotz JP, Herve C. Évaluation des pratiques de prescription de chimiothérapies anticancéreuses à des stades métastatiques avancés : résultats d’une étude pilote. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2262-1] [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: 11/28/2022]
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Boukari Y, Busnot A, Busnot F, Leclaire A, Bernard MA. Structure du di-μ-acétato-bis[acétatobis(méthyl-1 imidazole)cuivre(II)] hexahydraté. ACTA ACUST UNITED AC 1982. [DOI: 10.1107/s0567740882009030] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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