bluuebunny/crossref_metadata_2025 huggingface dataset:
OP29 Examining Inequalities in the uptake of the School-Based HPV Vaccination Programme in England: A Retrospective Cohort Study
Authors: Fisher H , Audrey S , Mytton J , Hickman M , Trotter C
Published: September 2013

Background

Since 2008, in the United Kingdom the HPV vaccine has been made routinely available to young women aged 12 to 13 years. A course of three doses of the vaccine offered protection against HPV 16 and 18, responsible for approximately 70% of cases of cervical cancer. Although uptake of the HPV vaccine is high, it is unknown whether the vaccine is being delivered equitably by ethnicity or deprivation. This study aimed to investigate factors associated with HPV vaccine initiation and completion within the routine HPV vaccination programme in the South West of England.

Methods

Young women eligible for routine HPV vaccination from 2008/09 to 2010/11 from three Primary Care Trusts/local authorities were included in this study. The following data were retrieved: (i) date of birth; (ii) postcode; (iii) ethnicity; (iv) dates of receipt of HPV and Measles, Mumps and Rubella (MMR) vaccinations, and; (v) name and code of school. Deprivation was assigned using the 2010 Index of Multiple Deprivation. Multivariable logistic regression models were developed to examine factors associated with uptake of HPV vaccination.

Results

Of 14,282 eligible young women, 12,658 (88.6%) initiated, of whom 11,725 (92.6%) completed the course. Initiation varied by programme year (86.5 to 89.6%) and Primary Care Trusts/local authorities (84.8 to 91.6%). There was no strong evidence for an overall association between deprivation quintile and initiation (p = 0.48) or completion (p = 0.10). In comparison to White British young women, young women classified as Asian or British Asian (AOR 0.50 [95% CI 0.44, 0.80]), Black or British Black (0.50 [0.32, 0.79]), and Chinese or other (0.48 [0.33, 0.71]), were less likely to initiate HPV vaccination. However, once initiated, were as likely to complete the course. Young women educated in non-mainstream educational settings were less likely to initiate (0.16 [0.11, 0.24]) and, if initiated, less likely to complete (0.27 [0.17, 0.44). Uptake of MMR vaccination was found to be patterned by ethnicity and deprivation (both <0.001). Young women who had received MMR vaccination were more likely to initiate HPV vaccination (OR 3.64 [3.27, 4.04]).

Conclusion

HPV vaccination uptake did not vary markedly by social deprivation. However, associations with ethnicity and substantially lower uptake in non-mainstream educational settings were observed. Research to identify reasons for low vaccine uptake in these population groups is required.
OP30 Exploring Reasons for Different Health Outcomes between Identically Deprived Post-Industrial UK Cities
Authors: Walsh D , McCartney G , McCullough S , Pol M van der , Buchanan D , Jones R
Published: September 2013

Background

Research has shown that Glasgow has an almost identical deprivation profile to Liverpool and Manchester. However, premature mortality is 30% higher, with mortality at all ages almost 15% higher. Many hypotheses have been proposed to explain this phenomenon: for many, however, no data have been available by which their plausibility could be properly assessed.

Methods

A representative population survey of Glasgow, Liverpool and Manchester was undertaken. Data for various hypotheses were collected from 3,600 respondents (1,200 in each city): a 55% response rate was achieved. The hypotheses included: lower ‘sense of coherence’ (SoC) in Glasgow; lower social capital; the effects of historical government policy; different individual ‘values’ (e.g. psychological outlook (optimism, aspirations)), hedonism; lower social mobility. Wherever possible, previously validated questions and scales were used (e.g. Antonovski’s SoC Scale, Schwartz’s Human Values Scale, Life Orientation Test). Multivariate linear and logistic regression analyses were employed to assess whether any differences existed between the cities for these topics (after adjustment for age, gender, ethnicity, social class, area deprivation, education etc).

Results

Aspects of social capital (trust & reciprocity, social participation) were significantly lower in Glasgow. For example: respondents in Liverpool and Manchester were more than twice as likely to have volunteered in the previous year compared to those in Glasgow (fully adjusted ORs Liverpool 2.6 [2.0, 3.4], p<0.0001; Manchester 2.5 [1.9, 3.3], p<0.0001); Liverpool and Manchester respondents were significantly more likely to report that ‘most people in their neighbourhood could be trusted’ (odds ratios: Liverpool 1.71 [1.4, 2.09], p<0.0001; Manchester 1.45 [1.18, 1.78], p<0.0001). However, SoC was shown to be significantly higher in Glasgow: Liverpool and Manchester respondents were associated, respectively, with fully adjusted mean SoC scores of -4.99 (-5.95, -4.03), p<0.0001 and -8.10 (-9.06, -7.14), p<0.0001 compared to those in Glasgow. The Glasgow sample was not associated with more negative individual values (e.g. lower optimism, hedonism), nor by motivations for social mobility. No clear ‘city’ differences emerged from the political effects questions.

Conclusion

These new data suggest that some of the hypotheses proposed to explain higher mortality in Glasgow are plausible (social capital), and others less plausible (e.g. lower ‘sense of coherence’, different ‘values’). Others (e.g. political effects) remain less clear and require different methodological approaches. These analyses add focus to future research needs to help better understand reasons for excess levels of poor health seen in Glasgow compared to these two very similar post-industrial cities.
OP35 Sexual Risk Behaviour Among Young People in Rural Tanzania: Do those in Full-Time Education Practise Safer Sex?
Authors: Doyle A M , Changalucha J , Weiss H A , Watson-Jones D , Hayes R J , Zaba B , Ross D A
Published: September 2013

Background

Being in full-time education is associated with lower risk of HIV and other STIs. We describe sexual partnership histories reported by youth in rural Tanzania, and investigate the association between current attendance at post-primary education, and sexual behaviour and antibody responses to Herpes Simplex Virus Type 2 (HSV-2) infection.

Methods

In 2007/8, sexual partnership histories were collected through a face-to-face questionnaire and biological samples for STIs from 13,814 15–30 year olds in 20 rural communities, of Mwanza Region, Tanzania. We restricted this analysis to the 2683 females and 4402 males aged 15–24 years and not currently married. Partnership patterns of sexually-active participants were described based on reported dates of first and last intercourse with their last 3 partners in the past year. Point prevalence of concurrency was calculated at 6 months prior to the survey. Age-adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) were estimated using conditional logistic regression. Sera were tested for antibodies to HSV-2 using KALON ELISA.

Results

The mean age in the study was 21 years. The great majority of the 30% of females and 38% of males who reported being in full-time education were in secondary school with a few attending vocational or other training. Students were more likely to report being virgins than non-students (females: 32% vs.8%, AOR 3.8 [95% CI 3.0, 4.9]; males: 20% vs. 7%, AOR 2.5 [2.1, 3.1]). Among those who reported being sexually active in the previous year, students were less likely to report 2+ sexual partners in the previous year (females: 7% vs. 25%, AOR 0.16 [0.11, 0.24]; males: 39% vs. 62%, AOR 0.32 [0.27, 0.37]) and concurrent partners (females: 0.4% vs. 4.0%, AOR 0.08 [0.03, 0.27]; males: 3.2% vs. 8.2%, AOR 0.41 [0.3, 0.56]). Reported condom use at last sex was higher among students (females: 78% vs.28%, AOR 7.8 [5.9, 10.3]; males: 69% vs. 41%, AOR 3.2 [2.7, 3.9]). Students had lower levels of HSV2 infection than non-students (females: 15% vs. 39%, AOR 0.37 [0.29, 0.46]; males: 14% vs. 23%, AOR 0.60 [0.50, 0.72]).

Conclusion

Unmarried youth in full-time education reported lower risk behaviours compared to those not in education. Under-reporting of high risk sexual behaviours may have differed by current education status, but the much lower HSV-2 prevalence among students suggests real differences exist. Interventions to encourage youth to stay in education longer may reduce their sexual risk, but potential differences in other social determinants must also be considered, such as access to resources and parental support.
OP37 Declining Inequality in Obesity Among Urbanised Adult Mexican Women, but it is not Good News
Authors: Perez Ferrer C , McMunn A , Brunner E J
Published: September 2013

Background

The objective of this study was to assess the trend in socioeconomic inequalities in obesity from 1988-2012 for adult Mexican women. We hypothesised that education would be inversely associated with obesity in richer urban areas of Mexico but not in rural areas, and that the gradient in urban areas would become steeper as the nutrition transition progressed.

Methods

Data came from four nationally representative surveys carried out in 1988, 1999, 2006 and 2012. Response rate ranged from 80% to 97% and sample size of non-pregnant women age 20 to 49 from 10,318 to 14,531. Weight and height were measured by a nurse and education level (higher education, high school, secondary, primary or less) was self-reported. Analyses were adjusted for survey design. The relative index of inequality (RII) was computed and its trend from 1988-2012 tested.

Results

Nationally, age-standardised obesity prevalence increased from 9.3% to 33.7% over the 25 year period. An inverse association between education and obesity was observed in urban areas. In rural areas, obesity prevalence increased markedly but there was no association with education level. Obesity increased 5.92 fold (95% CI 4.03, 8.70) among urban women with higher education in the period 1988-2012 compared to 3.23 fold (2.88, 3.63) for urban women with primary or no education. The RII in urban areas declined over the period from 2.87 (1.94, 4.25) in 1988 to 1.55 (1.33, 1.80) in 2012, trend p < 0.001.

Discussion

As expected, an inverse association between education and obesity was observed in urban areas of Mexico. However, the stepwise decline in obesity inequalities was because obesity prevalence increased faster among higher educated groups. These findings simulate trends observed in the USA and not in other middle income countries undergoing nutrition transition like Brazil and China. In rural areas there was no association between education level and obesity across the four surveys.
OP04 Airway Obstruction and All-Cause and Respiratory Mortality: Exploring the Relationship between three Definitions of Obstruction, Smoking using Healths Survey for England and Scottish Health Survey Data
Authors: Moody A , Scholes S , Mindell J
Published: September 2013

Background

Debate continues about the predictive value of different spirometry based definitions of chronic obstructive pulmonary disease (COPD). We explored the hazard of death for three overlapping definitions, and any significant interactions with smoking.

Methods

Data from the Health Survey for England (years 1995–1997, 2001) and Scottish Health Survey (1995, 1998, and 2003) were used. 30001 adults aged 45+ were interviewed, had spirometry data, and linked mortality records (HSE extracted in 2011; SHeS in 2008).Cox regression was used to estimate the hazard ratios of those with COPD/airflow obstruction, compared with those without, adjusted for age, socio-economic position, smoking, drinking, body mass index (BMI), and longstanding-illness. Sex-specific models, for all-cause and respiratory mortality, used three definitions: fixed threshold (FT): FEV1/FVC < 0.70 and FEV1< 80% predicted; lower limit of normal (LLN): FEV1/FVC1; self-reported COPD as a longstanding-illness (COPD).

Results

For men meeting FT criteria the hazard ratio (HR) for all-cause mortality was 1.49 (95% CI 1.37, 1.62), compared with those not meeting the criteria. Despite capturing a smaller group, the HR for LLN was not significantly different: 1.60 (1.44, 1.78), nor was the HR for those reporting COPD 1.73 (1.45, 2.05). Similar, overlapping ratios were found for women: FT 1.52 (1.37, 1.68); LLN 1.62 (1.42, 1.85) and COPD 1.76 (1.42, 2.18). The relationship between COPD/obstructed airflow and mortality was stronger for respiratory mortality, with greater differentiation between measures. Among men, FT HR 2.69 (2.16, 3.36) just overlapped with LLN 4.20 (3.30, 5.35), but was lower than reported COPD 5.19 (3.79, 7.10). Among women, the figures were: FT 3.46 (2.68, 4.47), LLN 4.24 (3.17, 5.66), COPD 6.36 (4.31, 9.37). Smoking was a significant risk factor for mortality in all models, independently of airway obstruction, but results showed a significant interaction between cigarette pack-years and COPD. Among adults without COPD, the HR gradually increased to 1.7 (all-cause mortality) for those with 50+ pack-years, relative to never smokers and around 2 for respiratory deaths. Among adults reporting COPD, the HR for pack-years ≥1 was around 3 for all-cause and >6 for respiratory deaths.

Conclusion

Participants mentioning COPD as a longstanding illness had the highest respiratory mortality. The HR for those meeting LLN criteria was higher, but not significantly so, than using FT. Any history of smoking increased mortality dramatically among those reporting COPD, compared with a more graded increase of risk by number of pack-years for those not reporting COPD.
OP40 A New Obesity Measure: Is it a Useful Predictor of Heart Disease and All Cause Mortality?
Authors: Boniface D R
Published: September 2013

Background

Krakauer and Krakauer [2012] have developed an obesity measure, the ABSI (A Body Shape Index), based on waist circumference, height and weight, which has particular sensitivity to abdominal fatness. It is a strong predictor of all cause mortality in the USA population sample of 14,105 adults in the National Health and Nutrition Examination Survey (NHANES) 1999–2004. The ABSI is based on a novel logic. It is in the form of the ratio (waist measured) to (waist predicted from height and weight). It has little correlation with BMI and is designed to identify excess waist size irrespective of BMI.

Methods

ABSI-UK was constructed in the same way as the Krakauer and Krakauer original version but from parameters of height, weight and waist from the Health Survey for England. The usefulness of the ABSI to predict CHD and all cause mortality in the 23 year follow-up of the 9003 men and women participants in the UK Health and Lifestyle Survey was compared with the usefulness of: ABSI-UK, BMI, waist, linear combination of BMI and waist, waist to hip ratio, and waist to height ratio, using Cox survival analysis adjusted for age and sex.

Results

The ABSI indices were found to be the strongest predictors of all cause and CHD mortality in this sample. Differences in the relative distribution of height between the UK and the USA mean that ABSI-UK is a better predictor in the UK sample, but the improved performance may not be sufficient to justify a different measure. For all-cause mortality the rank ordering by effectiveness from best to worst by Wald statistic was ABSI-UK (60.5), ABSI (47.7), linear combination of waist and BMI (24.3), waist to height ratio (21.4), waist to hip ratio (12.8), waist (11.0), and BMI (0.117). BMI did not reach statistical significance whereas ABSI-UK had a HR of 1.50 (95% CI 1.35, 1.66).

Conclusion

Where waist measurement is available in addition to height and weight, ABSI appears to be the preferred choice of obesity measure. Further tests of the ABSI obesity measure should be carried out in different samples. The role of ABSI as a confounder in analyses of the effects of other behaviours such as dietary measures should be investigated.
OP48 Determinants of Active Commuting: Longitudinal Results from the Commuting and Health in Cambridge Study
Authors: Panter J , Dalton A , Griffin S , Ogilvie D
Published: September 2013

Background

Numerous cross-sectional studies have examined the associations between individual, psychological and environmental characteristics and active commuting, but few longitudinal studies exist to support more robust causal inference. Using two complementary approaches to longitudinal analysis, we aimed to build on this evidence by exploring whether (a) individual, psychological, workplace and route environmental characteristics, (b) changes in route environmental characteristics, were associated with changes in active commuting.

Methods

655 adult commuters completed postal questionnaires concerning past-week commuting trips at similar times of year in 2009 and 2010. We computed changes in time spent walking and cycling and the proportion of car trips, and identified those who took up or maintained walking, cycling or alternatives to the car as the usual mode of travel. Using multivariable logistic regression, we assessed the associations between uptake and maintenance of travel behaviours and baseline individual, psychological and perceived and objective environmental characteristics and between changes in active commuting and changes in perceived environmental characteristics of the route to work.

Results

Mean within-participant changes in active commuting were relatively small (walking: +3.0 minutes/week; cycling: -5.3 minutes/week). A lack of free workplace parking predicted uptake of walking and alternatives to the car, while less favourable attitudes towards car use predicted continued use of alternatives to the car. Self-reported and objectively-assessed convenience of public transport respectively predicted uptake of walking (OR 2.47 [95% CI 1.44, 4.25]) and cycling (2.59 [0.99, 6.78]). Those who reported an increase in the convenience of public transport were more likely to take up alternatives to the car (3.24 [1.28, 8.14]) and those who reported convenient cycle routes at baseline were more likely to take up cycling (2.48 [1.04, 5.93]) and alternatives to the car (4.65 [1.45, 14.92]). Those who reported an increase in the perceived danger of cycling reported 8% more car trips, whereas those who reported a decrease were more likely to take up alternatives to the car (2.50 [1.07, 5.86]).

Discussion

Individual, psychological and environmental factors were associated with uptake of active commuting. A few environmental characteristics relating to the convenience and safety of routes for active travel and the convenience of public transport were associated with changes in active commuting both as baseline predictors of change and as dynamic correlates of change, suggesting that these may be suitable targets for interventions to promote walking and cycling to work.
OP49 Socio-Economic Status and Lung Cancer Incidence in Men with type 2 Diabetes in Scotland (2001-2007)
Authors: Walker J , Wild S
Published: September 2013

Background

Diabetes is a chronic disease which affects c. 5% of Scottish men; lung cancer is the second most common cancer among men in Scotland. While both conditions exhibit marked social patterning (specifically, higher prevalence in deprived groups), little research has sought to determine whether the relationship between socio-economic status (SES) and lung cancer differs between men with and without diabetes.

Methods

Data from a population-based national diabetes register and the Scottish Cancer Registry, combined with all-Scotland population totals, were used to investigate associations between Type 2 diabetes (T2DM), SES and lung cancer. SES was represented by quintiles of the Scottish Index of Multiple Deprivation (a composite area-based measure of multiple deprivation). Age-standardised incidence rates for lung cancer at ages 55–79 during the period 2001–2007 were calculated, by quintile of SES, for men with and without T2DM. Generalised linear models (GLMs) were fitted to estimate the relative risk (RR) of lung cancer associated with T2DM in each SES quintile, adjusted for age.

Results

Among men without T2DM, age-standardised incidence of lung cancer (per 100,000 of population) in the least deprived and most deprived quintiles was, respectively, 165.2 (95% CI 155.7, 174.8) and 551.0 (533.4, 568.7). Corresponding rates in men with T2DM were 208.1 (172.4, 243.8) and 363.3 (322.7, 403.8). Relative risk of lung cancer (T2DM vs. no diabetes) ranged from 1.22 (0.98, 1.53) in the least deprived quintile to 0.67 (0.59, 0.76) in the most deprived quintile, decreasing monotonically in intermediate quintiles. Across all SES quintiles combined RR of lung cancer in men with T2DM was 0.81 (0.73, 0.89). The interaction of SES with T2DM was highly significant (p < 0.001).

Conclusion

Marked social gradients for lung cancer incidence were observed both in men with and without T2DM. However, the influence of SES on cancer incidence differed materially by diabetes status: among more deprived men, the risk of lung cancer was attenuated in those with Type 2 diabetes. Possible explanations include lower prevalence of obesity and risk of diabetes among deprived men who smoke, higher prevalence of diabetes among this group, survival bias and more intensive smoking cessation guidance given to deprived men with diabetes in the course of their ongoing clinical management.
OP51 What are the Commonest Symptoms of Cancer and the Risk Factors for Delay in Presentation with Cancer Symptoms?
Authors: Forbes LJL , Warburton F , Richards M A , Ramirez A J
Published: September 2013

Background

One year cancer survival is poor in the UK compared with similar developed countries. Poor one year survival may be due to delay in symptomatic presentation leading to advanced stage at diagnosis. Much of the research to date has focussed on risk factors for delayed presentation for people with specific cancers. To inform public health approaches to promoting early symptomatic presentation of across all cancer types, we aimed to identify the most common symptoms of cancer and risk factors for delay in presentation of those symptoms in a UK population of cancer patients.

Methods

We surveyed 2,923 cancer patients who had been diagnosed after symptomatic presentation, using a self-complete questionnaire asking about nature and duration of symptoms and barriers to symptomatic presentation (response rate 79%). We weighted percentages reporting each symptom by the incidence of each cancer site to ensure representativeness of the general population of cancer patients. We considered patients reporting more than three months from first noticing the symptom to first seeing a doctor to have delayed presentation.

Results

The four commonest symptoms were pain (30%), systemic symptoms (23% [fatigue 17%, weight loss 8%]), bleeding (20%) and lump (17%). 69% had experienced one or more of these symptoms. Delay in presentation was reported by one fifth of cancer patients and was most common among patients with prostate and rectal cancer and malignant melanoma and among more socioeconomically deprived people. Change of bowel habit and urinary symptoms (in men only) were the symptoms most likely to be associated with delay in presentation. Among 48% of the patients who reported that anything had put them off going to the doctor with their cancer symptoms, 58% reported that they had not recognised that their symptom was serious; 32% of these had delayed presentation. Worry about wasting the doctor’s time was reported by 12% of patients; 33% of these had delayed presentation. Worry about what the doctor might find (7%) and embarrassment were less common (3%), but were frequently associated with delay in presentation (47% of those who reported worry about what the doctor might find and 60% of those who reported embarrassment).

Conclusion

These unique data on the nature of the most common symptoms of cancer and risk factors for delayed symptomatic presentation among a representative sample of cancer patients can inform public health approaches to promoting diagnosis of cancer at an early stage and contribute to improving cancer survival.
OP06 Opposing Processes Contingent on Early Smoking: A Cross-Cohort Comparison of Socioeconomic Inequalities in Alcohol use Across the Youth-To-Adult Transition
Authors: Green M J , Leyland A H , Sweeting H , Benzeval M
Published: September 2013

Background

Evidence of associations between socioeconomic position (SEP) and alcohol use in adolescence and young adulthood is inconsistent, possibly because causal mechanisms associated with SEP pull in different directions. For example, more affluent young people may have greater resources for obtaining alcohol, and may drink for pleasure, whilst socioeconomic adversity may increase coping-motivated drinking. Our previous research on adolescents showed disadvantaged SEP was associated with higher levels of drinking in combination with early smoking, but lower levels of drinking without smoking. We investigate whether such opposing processes contingent on early smoking are present in multiple contexts and across the transition into adulthood.

Methods

Data were taken from the British 1970 birth cohort study (BCS70; N = 11,649), 1958 National Child Development Study (NCDS58; N = 15,242), and the youth cohort of the Scottish Twenty-07 Study (T07; N = 1,515). T07 represents experiences in the specific context of Glasgow at the same historical time as BCS70, whilst NCDS58 respondents grew up 12 years earlier. Measures were obtained when respondents were aged approximately 16 years and in young adulthood, when respondents were aged approximately 22–26 years across the three studies. Path analyses tested direct associations between parental social class at age 16 and both weekly drinking at age 16 and heavy drinking in young adulthood (>14/21 units last week for women/men), adjusting for an indirect path via early smoking (defined as daily smoking at age 16).

Results

In all three studies, a manual compared to a non-manual parental social class was associated with a higher likelihood of daily smoking at age 16, and daily smoking at 16 was associated with a higher likelihood of weekly drinking at 16. Adjusting for the indirect relationship via smoking, a manual social class was directly associated with a lower likelihood of weekly drinking at 16 (ORs ranged between 0.51-0.70; p < 0.05). Daily smoking at 16 also exhibited positive associations with young adult drinking. Adjusting for the indirect paths via early smoking and adolescent drinking, a manual parental social class was only associated with a lower likelihood of young adult drinking in BCS70 (OR was 0.64 compared to 1.03 and 1.00 in NCDS and T07). Gender-stratified analyses produced very similar results.

Conclusion

Early smoking may mark out mechanisms related to socioeconomic disadvantage which promote heavier drinking, but there is otherwise a tendency for the more affluent to drink more heavily, which seems consistent in adolescence, but more context dependent in young adulthood.
OP60 Poor Educational Outcomes for Young People with Caring Responsibilities
Authors: Brennan C A , Smith E , Farragher T M
Published: September 2013

Background

Conservative estimates suggest there are 175,000 children and young people in the UK with caring responsibilities for a dependent relative. The level and type of care varies between families but up to 20% may be caring for 20 hours or more a week and up to 7% for over 50 hours a week. Many of these children are from single parent households and so are likely to lack the support of other adult relatives living nearby. Caring roles in young people have been associated with poor health outcomes and disruption to schooling which may limit opportunities in later life. This study explored the association between young people identified as carers and their educational achievement using data from the Longitudinal Study of Young People in England (LSYPE).

Methods

LSYPE is a large-scale nationally representative cohort of young people aged 13 to 14 years in 2004 who were followed annually to explore progress through education and training. Young people were identified as having caring responsibilities or not from three self-report questions. Educational achievement at age 16 years was provided through data linkage with the National Pupil Database. The association between attainment of 5 or more GCSE and equivalents and caring responsibilities was explored using logistic regression and adjusted by other predictor variables which included; demographics, young person’s health, young person’s social behaviour, parental factors and family structure.

Results

Educational data were available on 16,122 of the cohort at aged 16 years and 11,466 also had data on caring responsibilities. The final sample included 2,906 (25%) young carers and 8,560 (75%) young people without caring responsibilities. Young carers had 35% decreased odds of achieving 5 or more GCSE’s or equivalent compared to non carers within the cohort: OR 0.65 [95% CI 0.59, 0.7]). The association remained on controlling for other predictor variables: OR 0.73 [0.64, 0.83]). Detailed exploration of the associations between predictor variables, caring responsibilities and educational attainment will be presented.

Conclusion

The results suggest that a young person’s caring role can have a negative impact on their outcomes in compulsory education. Even given the increased likelihood of disadvantage and health difficulties amongst young carers, they are less likely to achieve a recognised minimum standard of educational attainment and this is likely to impact on future life chances.
OP66 Stress in the City: A Multilevel Analysis of Anxiolytic Uptake in Northern Ireland
Authors: Maguire A , O’Reilly D
Published: September 2013

Background

Half the world’s population now live in cities and by 2030 this proportion will increase to two-thirds. There is growing concern over the negative implications for health associated with living in urban areas. Individuals living in cities are thought to be at an increased risk of cancer, heart attack, stroke and schizophrenia and cities are also associated with increased deprivation and disadvantage. Studies testing the association between urban dwelling and disorders such as depression and anxiety have produced conflicting results. This study aims to discover if living in a city increases your risk of suffering from depression or anxiety, using antidepressant and anxiolytic prescribing as proxy indicators.

Methods

Anxiolytic and antidepressant prescribing data from the national prescribing database was linked to individual level census data from the Northern Ireland longitudinal study. Multilevel regression analyses were carried out to test the association between city dwelling and prescription drug uptake, adjusting for natural clustering of individuals within neighbourhoods. The effect of selective migration was tested by identifying moves to and from city and rural areas.

Results

In the unadjusted model individuals living in cities were 80% more likely than those living in rural areas to receive an anxiolytic (OR 1.80 [95% CI 1.64, 1.96]) 37% more likely to receive an antidepressant (1.37 [1.29, 1.45]). After full adjustment for age, gender, marital status, education, measures of socio-economic disadvantage, limiting long term illness, area deprivation and crime levels individuals living in cities were still 34% more likely to receive anxiolytic medication compared to those living in rural areas (1.34 [1.23, 1.46]). The association between city dwelling and antidepressant uptake attenuated more. Results from the selective migration analysis found that “ever living” in a city increased the likelihood of receiving anxiolytic medication but had no significant effect on antidepressant uptake.

Conclusion

Even after adjustment for known mental health risk factors city living increases the likelihood of receiving anxiolytic medication. Some studies have suggested that the lack of social networks and individualistic society created in cities has a negative impact on mental health. Interestingly though city dwelling appears to impact anxiety disorders more than depression. Further analyses will be carried out adjusting for social fragmentation.
OP69 Occurrence of Liver Cirrhosis in England, A Cohort Study, 1998-2009: A Comparison with Cancer
Authors: Ratib S , West J , Crooks C J , Fleming K M
Published: September 2013

Background

In contrast to cancer there is no routine registration of the occurrence of newly diagnosed cases of cirrhosis across most of the world despite its high associated mortality. To therefore put in context the burden of cirrhosis within England we calculated incidence of disease and trends over time and compared this to the top twenty cancers diagnosed in the UK.

Methods

We used the Clinical Practice Research Datalink and linked English Hospital Episode Statistics to identify adult cases of cirrhosis from 1998 to 2009. We described trends in incidence by sex and aetiology. We applied the age- and sex-specific incidence figures to (i) the 2009 age- and sex-stratified population of the UK, to estimate the number of people being newly diagnosed with cirrhosis, and (ii) the European age- and sex-stratified population, to calculate the change in incidence between 1998 and 2009.

Results

A total of 5118 incident cases of cirrhosis aged 18 or over were identified between 1998 and 2009, 57.9% were male. Over the 12-year period crude incidence increased by 50.6% from 25.8 in 1998 to 37.5 in 2009 per 100,000 person-years. Incidence increased for all aetiology types. We estimated approximately 17,000 people were newly diagnosed with cirrhosis in 2009 in the UK, greater than that of the fifth most common cancer non-Hodgkin’s lymphoma. The percentage change in incidence of cirrhosis between 1998 and 2009 for both men (45.2%) and women (28.4%) was greater than that seen for the top four most commonly diagnosed cancers in the UK (breast, lung, bowel and prostate).

Conclusion

Cirrhosis has increased more than that of the top four cancers during 1998 to 2009 in England. The burden of cirrhosis is continuing to rise for all aetiology types. Many of the aetiologies of cirrhosis are preventable; therefore strategies to monitor and reduce the incidence of this disease are urgently needed.
OP70 Prioritising Outcome Measures for Ambulance Service Care: A Three Stage Consensus Study
Authors: Coster J E , Turner J E , Sirwardena N , Wilson R , Phung V-H
Published: September 2013

Background

Historically ambulance care quality and performance has been measured by response times rather than clinical need or effectiveness. This limits the evidence about the effectiveness of the care the ambulance service provides. The Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) project is a 5 year research programme which aims to develop new ways of measuring the performance, quality and impact of ambulance service care that better reflect the care provided.

Methods

We held a 1 day consensus event with a multi-stakeholder group to identify and prioritise which features of ambulance service care are important and worth further development as measures of performance and quality. The day comprised a series of small group discussions to share opinions about measures identified from literature reviews and the opportunity for participants to add their ideas, together with a live vote to help identify and rank measures for further development. Time measures were considered in a separate online questionnaire. The results from the online questionnaire and Consensus Event were fed into a Delphi study.

Results

43 participants attended the consensus event, representing a range of participant groups including patient and public, ambulance services, commissioners and policy groups. The top 5 outcome measures prioritised by the participants were: accuracy of dispatch decisions; completeness and accuracy of patient records; accuracy of call taker identification of different conditions or needs (e.g. heart attack, stroke, suitable for nurse advice); pain measurement and symptom relief; and patient experience. From the online survey of time measures the top 5 measures were time of call to time of arrival at scene; time symptoms start (e.g. chest pain) to time of treatment with balloon for heart attack; time taken to answer the emergency call; total time spent on scene; and incident or start of symptoms to calling the ambulance service.

Conclusion

Using consensus methods we have identified a set of outcome measures that can potentially be used to measure the performance and quality of ambulance service care. Some of these measures fit with existing government targets, such as response times and time taken to answer the emergency call. However, most measures are new ways of measuring ambulance service care and the importance of these measures and methods of measurement will be assessed as part of an on-going Delphi study.
OP72 Relationship between Age and Deprivation in Emergency Admission for ACS Conditions
Authors: Blunt I
Published: September 2013

Background

Around one fifth of emergency admissions to hospital are for conditions regarded as “ambulatory care sensitive”, that is the need for admission could have potentially been avoided through timely access to primary care. Previous studies have found that age and deprivation have strong influence on the likelihood of hospital admission. The present study examines whether rates of emergency admission for ACS conditions are disproportionately higher for deprived older people.

Methods

An observational study based on routinely collected hospital admission data from April 2011 to March 2012 from NHS hospitals in England. Age-specific emergency admission rates were calculated at the national level using population and deprivation estimates for small area of residence. An admission was categorised as “ambulatory care sensitive” if any of 27 specific ACS conditions were noted in the ICD-10 diagnostic codes associated with the admission.

Results

Rates of ACS admission increase with deprivation in every age band. The inequality is least evident for people aged between 15 and 19, when the least deprived group have 64 ACS admissions per 100,000 while the most deprived group have 104 admission per 100,000 (a rate 1.6 times higher). As rates of admission increase with age, so does the disparity between deprivation groups, reaching a maximum of 3.8-fold difference in the 45-49 age group (49 vs 184 admissions per 100,000). From that point the inequality narrows as age continues to increase, with people aged 85 and over having just a 1.6-fold difference between the least and most deprived groups (993 vs 1,610 admissions per 100,000). Emergency admissions for ACS conditions are more strongly influenced by deprivation than those for non-ACS conditions, and patterns of admission vary by individual ACS condition.

Conclusion

Rates of admission for conditions potentially amenable to primary care increase with both increasing patient age and local levels of deprivation. The degree of increase due to deprivation does not vary linearly with age. This suggests that efforts to prevent hospital admission, which traditionally focus on patients aged 65 and over, may benefit from including adults up to twenty years younger in the most deprived areas.
OP73 How can we Develop More Effective Public Health Interventions?
Authors: Payne N , Goyder E , Kelly M P , Nicholl J
Published: September 2013

Background

A number of recent trials and systematic reviews of public health interventions have had disappointing conclusions despite a major investment in trials. An elegant evaluation design to test a poorly developed intervention is clearly unsatisfactory, so to what extent is the effectiveness of public health compromised by interventions that are poorly developed in the first place? Guidance on the development of complex interventions highlights the need to develop theory-based interventions to the point where they can reasonably be expected to have a worthwhile effect. However, in practice many public health interventions are complex, have arisen from a variety of sources, contain elements the quantity and quality of which arises from chance rather than design, have not been through a pre-intervention development phase, are not theory based, and are relatively poorly defined and described.

Methods

Firstly, a systematic search was conducted to find literature which describe methods for the development of public health interventions (as opposed to how to evaluate them). Secondly, a step-wise comparison was carried out between the development of new drugs and the development and introduction of public health interventions.

Results

There is little literature on the development of public health interventions which suggests that the “science” of intervention development (in public health) is still at an early stage. Recommended stages in intervention development include: identifying the evidence base; identifying and developing appropriate theory – and, while evidence-based guidance on the development of behaviour change interventions in public health has been produced, there may be several competing theories requiring judgement in respect of which is most appropriate. Moreover, the key components of complex public health interventions, including their implementation, need to be better identified and described in terms of their interrelations and replicability. While pharmaceutical products have a distinct development phase which is well planned and appropriately funded, this is not the case for public health interventions although it is clear that there are lessons for public health from drug development. In part the problem arises because of the lack of a champion or sponsor for the development of public health interventions, and also because of the absence of funding to develop those interventions in the first place.

Discussion

For public health interventions to be as successful and effective as they have the potential to be, we must review and revise how such interventions are initially designed and developed. A clear development and sponsorship process for public health interventions of all complexity needs establishing.
OP76 Who Runs Public Health?
Authors: Oliver K , Vocht F de , Money A , Everett M
Published: September 2013

Background

Persistent health inequalities encourage researchers to identify new ways of understanding the policy process. Research shows that informal relationships are implicated in finding evidence and making decisions for public health policy. However, few studies use specialised methods such a network analysis to identify key relationships and actors in the policy process. Furthermore, little is known about the strategies used by these influential individuals to control the policy process. This study aimed to use relational methods to identify important individuals in the public health policy process, and to produce explanations for their influence.

Methods

We combined network and qualitative data to identify the most influential individuals in public health policy in a UK conurbation, and describe strategies they used to influence policy. Network data were collected by asking for nominations of powerful and influential people in public health policy (n = 152, response rate 80%), and 23 semi-structured interviews with a sub-sample of the network population were analysed using a framework approach.

Results

The most influential public health policy makers in this conurbation were identified as public health professionals and mid-level managers in the NHS and local government. However, public health professionals were not influential throughout the policy process, playing only a few roles. Influential managers described four main strategies to influence policy: controlling policy processes through gatekeeping key organisations, providing policy content, and managing selected experts and executives to lead on policies. Public health professionals and academics are indirectly connected to policy via managers, but neither group are described in connection with key strategies.

Conclusion

The most powerful individuals in public health are managers, not usually considered targets for research. As we show, they are highly influential through all stages of the policy process. Understanding the daily activities of influential policy individuals provides a new framework for understanding policy, and providing concrete examples of influence questions current approaches to knowledge translation. The study demonstrates the utility of using network analysis methods and potential applications of the method for researchers who wish to influence policy are suggested.
OP77 Proxy Reporting of Health-Related Quality of Life using the Euroqol-5D in Care Home Residents; how Good is it and how should we Deal with Clustering Effects?
Authors: Devine A M , Taylor SJC , Spencer A , Diaz-Ordaz K , Eldridge S , Underwood M
Published: September 2013

Background

Some care home residents are unable to complete the measures of health utility needed for cost-utility analyses. Proxy measures are an alternative source of data; however, the level of agreement in the EQ-5D between residents and care home staff and the impact of clustering on this agreement has not been investigated previously. Using data nested in a large clinical trial, we aimed to (1) identify inter-rater agreement levels for the reporting of EQ-5D by care home residents and carers, (2) investigate whether proxies have a greater tendency to choose ‘some problems’ at the domain level and (3) investigate factors influencing agreement.

Methods

Kappa statistics were used to examine the level of agreement between proxy and self-completed responses at the domain level and intraclass correlation coefficients (ICCs) were used for EQ-5D index scores, visual analogue scales and total quality-adjusted life-years (QALYs). Importantly, the calculation of the Kappa and ICC relies on the assumption of independence of the observations, so the impact that clustering might have upon our results was also examined. The percentage of residents and proxies choosing each level of each domain was compared to examine whether responders have a consistent preference for one of the levels. Finally, a mixed model was used to consider the extent to which the difference in EQ-5D-S and EQ-5D-P was affected by other variables at baseline.

Results

We found slight to fair agreement at the domain level (cluster-adjusted Kappa 0.02–0.30) and fair agreement at the score level (cluster-adjusted ICC 0.30–0.32) and for QALYs (cluster-adjusted ICC 0.38). Proxies had a greater tendency to use the ‘some problems’ compared to self-report. The random effect mixed model showed that a higher GDS-15 (and likelihood of depression) and lower MMSE score (and lower cognitive impairment) were both associated with greater discrepancy between proxy and self-completed scores.

Conclusion

Proxies appear to be a reliable source of data for QALY scores but may be less reliable if individual domains are considered. As expected, the presence of more severe depression or cognitive impairment in residents reduced their agreement with proxy scores. The frequent reporting of ‘some problems’ by proxies suggests that a 4-level measure would counter this tendency to choose the ‘middle’ option.