Social class inequalities in perinatal outcomes: Scotland 1980–2000

Objective: To examine social class inequalities in adverse perinatal events in Scotland between 1980 and 2000 and how these were influenced by other maternal risk factors. Design: Population based study using routine maternity discharge data. Setting: Scotland. Participants: All women who gave birth to a live singleton baby in Scottish hospitals between 1980 and 2000 (n = 1 282 172). Main outcome measures: Low birth weight (LBW), preterm birth, and small for gestational age (SGA). Results: The distribution of social class changed over time, with the proportion of mothers with undetermined social class increasing from 3.9% in 1980–84 to 14.8% in 1995–2000. The relative index of inequality (RII) decreased during the 1980s for all outcomes. The RII then increased between the early and late 1990s (LBW from 2.09 (95%CI 1.97, 2.22) to 2.43 (2.29, 2.58), preterm from 1.52 (1.44, 1.61) to 1.75 (1.65, 1.86), and SGA from 2.28 (2.14, 2.42) to 2.49 (2.34, 2.66) respectively). Inequalities were greatest in married mothers, mothers aged over 35, mothers taller than 164 cm, and mothers with a parity of one or more. Inequalities were also greater by the end of the 1990s than at the start of the 1980s for women of parity one or more and for mothers who were not married. Conclusion: Despite decreasing during the 1980s, inequalities in adverse perinatal outcomes increased during the 1990s in all strata defined by maternal characteristics

Do differences in the administrative structure of populations confound comparisons of geographic health inequalities?

<p>Background: Geographical health inequalities are naturally described by the variation in health outcomes between areas (e.g. mortality rates). However, comparisons made between countries are hampered by our lack of understanding of the effect of the size of administrative units, and in particular the modifiable areal unit problem. Our objective was to assess how differences in geographic and administrative units used for disseminating data affect the description of health inequalities.</p> <p>Methods: Retrospective study of standard populations and deaths aggregated by administrative regions within 20 European countries, 1990-1991. Estimated populations and deaths in males aged 0-64 were in 5 year age bands. Poisson multilevel modelling was conducted of deaths as standardised mortality ratios. The variation between regions within countries was tested for relationships with the mean region population size and the unequal distribution of populations within each country measured using Gini coefficients.</p> <p>Results: There is evidence that countries whose regions vary more in population size show greater variation and hence greater apparent inequalities in mortality counts. The Gini coefficient, measuring inequalities in population size, ranged from 0.1 to 0.5 between countries; an increase of 0.1 was accompanied by a 12-14% increase in the standard deviation of the mortality rates between regions within a country.</p> <p>Conclusions: Apparently differing health inequalities between two countries may be due to differences in geographical structure per se, rather than having any underlying epidemiological cause. Inequalities may be inherently greater in countries whose regions are more unequally populated.</p&gt

The impact of Sure Start local programmes on seven year olds and their families

This research report presents the findings of a longitudinal study into the impact of Sure Start local programmes (SSLPs) on 7-year-olds and their families. In assessing the impact of SSLPs on child and family functioning over time, the evaluation followed up over 5,000 7-year-olds and their families in 150 SSLP areas who were initially studied when the children were 9 months and 3- and 5-years-old

The impact of Sure Start Local Programmes on five year olds and their families

The ultimate goal of Sure Start Local Programmes (SSLPs) was to enhance the life chances for young children growing up in disadvantaged neighbourhoods. Children in these communities are at risk of doing poorly at school, having trouble with peers and agents of authority (i.e., parents, teachers), and ultimately experiencing compromised life chances. In this report children and families who were seen at 9 months and 3 years of age in the NESS or MCS longitudinal studies are compared to determine whether differences in child and family functioning found at 3 years of age persist until 5 years of age, and whether any other differences emerge

National evaluation of Sure Start local programmes: an economic perspective

The first 524 Sure Start local programmes (SSLPs) were established between 1999 and 2003. They were aimed at families with children up to the age of 4 living in disadvantaged areas. The aim was to bring together early education, childcare, health services and family support to promote the physical, intellectual and social development of babies and children. This report discusses the economic issues arising out of the evaluation of the impact of Sure Start local programmes in England. It takes the outcomes for children and families at the age of five years reported in the National Evaluation of Sure Start and where possible estimates economic values for those outcomes. Where a direct estimation of economic value is not possible at this stage, probable sources of future economic values are discussed. It should be read in conjunction with the impact report, which describes the details of the methodology of the study and the full range of outcomes for children and their families when the children were 5-years-old

The impact of Sure Start local programmes on three-year-olds and their families

This evaluation found that living in a Sure Start Local Programme (SSLP) area was associated with positive impacts on 5 of the 14 outcomes investigated. The analysis of the most recent data shows beneficial effects for almost all children and families living in SSLP areas and provides almost no evidence of adverse effects on population sub-groups such as workless or lone-parent families. These results are in marked contrast to the findings of the initial study published in 2005. Although methodological variations may account for differences in findings across the two phases of the evaluation, the researchers argue that it is eminently possible that the differing results accurately reflect the contrasting experiences of SSLP children and families in the two phases. They argue that the three-year-olds in the latest study have benefited from exposure to more mature and developed local programmes throughout their young lives

Contextual effect on mortality of neighbourhood level education explained by earlier life deprivation

Various aspects of socioeconomic conditions in the neighbourhood have in recent years been found to have an influence on morbidity and mortality even after individual characteristics are taken into account.1 Increasing evidence suggests that to measure fully the impact social conditions may have on mortality risk, the whole life course must be taken into account as mortality risk increases cumulatively over the life course.2 Few studies have combined ecological and life course factors to see if contextual effects may be explained by social conditions earlier in life at the individual level.3,4 Most studies of neighbourhood effects have had a cross sectional design or with short follow up. Effects seen could be a consequence of the fact that people in these areas may have different earlier life experiences that have not been fully taken into account. In this study we examine whether the contextual effect of educational level aggregated to the neighbourhood on mortality risk could be explained by earlier life deprivation

Assessing preventable hospitalisation indicators (APHID): protocol for a data-linkage study using cohort study and administrative data

Introduction Potentially preventable hospitalisation (PPH) has been adopted widely by international health systems as an indicator of the accessibility and overall effectiveness of primary care. The Assessing Preventable Hospitalisation InDicators (APHID) study will validate PPH as a measure of health system performance in Australia and Scotland. APHID will be the first large-scale study internationally to explore longitudinal relationships between primary care and PPH using detailed person-level information about health risk factors, health status and health service use. Methods and analysis APHID will create a new longitudinal data resource by linking together data from a large-scale cohort study (the 45 and Up Study) and prospective administrative data relating to use of general practitioner (GP) services, dispensing of pharmaceuticals, emergency department presentations, hospital admissions and deaths. We will use these linked person-level data to explore relationships between frequency, volume, nature and costs of primary care services, hospital admissions for PPH diagnoses, and health outcomes, and factors that confound and mediate these relationships. Using multilevel modelling techniques, we will quantify the contributions of person-level, geographic-level and service-level factors to variation in PPH rates, including socioeconomic status, country of birth, geographic remoteness, physical and mental health status, availability of GP and other services, and hospital characteristics. Ethics and dissemination Participants have consented to use of their questionnaire data and to data linkage. Ethical approval has been obtained for the study. Dissemination mechanisms include engagement of policy stakeholders through a reference group and policy forum, and production of summary reports for policy audiences in parallel with the scientific papers from the study.</p

Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmö, Sweden, in 2001

Study objective: Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform disorders); and (2) investigating the independent impact of contextual deprivation and neighbourhood social disorganisation on mental health, while assessing both the magnitude and the spatial scale of these effects. Design: Using different spatial techniques, the study investigated mental disorders due to psychoactive substance use, and neurotic disorders. Participants: All 89 285 persons aged 40–69 years residing in Malmö, Sweden, in 2001, geolocated to their place of residence. Main results: The spatial scan statistic identified a large cluster of increased prevalence in a similar location for the two mental disorders in the northern part of Malmö. However, hierarchical geostatistical models showed that the two groups of disorders exhibited a different spatial distribution, in terms of both magnitude and spatial scale. Mental disorders due to substance consumption showed larger neighbourhood variations, and varied in space on a larger scale, than neurotic disorders. After adjustment for individual factors, the risk of substance related disorders increased with neighbourhood deprivation and neighbourhood social disorganisation. The risk of neurotic disorders only increased with contextual deprivation. Measuring contextual factors across continuous space, it was found that these associations operated on a local scale. Conclusions: Taking space into account in the analyses permitted deeper insight into the contextual determinants of mental disorders