Ethnic Differences in Self-Poisoning Across South London

Crisis ◽  
2014 ◽  
Vol 35 (4) ◽  
pp. 268-272
Author(s):  
Sean Cross ◽  
Dinesh Bhugra ◽  
Paul I. Dargan ◽  
David M. Wood ◽  
Shaun L. Greene ◽  
...  
Keyword(s):  
Black Women ◽  
Data Collection ◽  
White Women ◽  
Population Based ◽  
Care Services ◽  
Self Harm ◽  
Managing Risk ◽  
The Uk ◽  
Incident Cases ◽  
Minority Ethnic

Background: Self-poisoning (overdose) is the commonest form of self-harm cases presenting to acute secondary care services in the UK, where there has been limited investigation of self-harm in black and minority ethnic communities. London has the UK’s most ethnically diverse areas but presents challenges in resident-based data collection due to the large number of hospitals. Aims: To investigate the rates and characteristics of self-poisoning presentations in two central London boroughs. Method: All incident cases of self-poisoning presentations of residents of Lambeth and Southwark were identified over a 12-month period through comprehensive acute and mental health trust data collection systems at multiple hospitals. Analysis was done using STATA 12.1. Results: A rate of 121.4/100,000 was recorded across a population of more than half a million residents. Women exceeded men in all measured ethnic groups. Black women presented 1.5 times more than white women. Gender ratios within ethnicities were marked. Among those aged younger than 24 years, black women were almost 7 times more likely to present than black men were. Conclusion: Self-poisoning is the commonest form of self-harm presentation to UK hospitals but population-based rates are rare. These results have implications for formulating and managing risk in clinical services for both minority ethnic women and men.

scholarly journals Differences in estimates for ten-year risk of cardiovascular disease in Black versus white persons with identical risk factor profiles using pooled cohort equations

2021 ◽  
Author(s):  
Ramachandran S. Vasan ◽  
Edwin van den Heuvel
Keyword(s):  
Cardiovascular Disease ◽  
Black Women ◽  
White Women ◽  
Absolute Risk ◽  
Density Lipoprotein ◽  
Clinical Decision ◽  
Population Based ◽  
Decision Threshold ◽  
Cvd Risk ◽  
Risk Profiles

AbstractBackgroundSex- and race-specific pooled cohort equations (PCE) are recommended for estimating the 10-year risk of cardiovascular disease (CVD), with an absolute risk >7.5% indicating a clinical decision threshold.MethodsWe generated in silico 30,565 risk profiles in men and 29,515 in women by combining numerical (age, total and high-density lipoprotein cholesterol, systolic blood pressure) and binary risk factors (smoking, diabetes, antihypertensive treatment). We compared PCE-estimated 10-year CVD risk in Black versus white individuals with identical risk profiles. We performed similar comparisons in participants in the Framingham Third Generation cohort and the National Health and Nutrition Examination Survey 2017-2018.ResultsThere were 6357 risk profiles associated with 10-year CVD risk >7.5% for Black but not for white men (median risk difference [RD] 6.25%, range 0.15-22.8%; median relative risk [RR] 2.40, range 1.02-12.6). There were 391 profiles with 10-year CVD risk >7.5% for white but not for Black men (median RD 2.68%, range 0.07-16.9%; median RR 1.42, range 1.01-3.57). There were 6543 risk profiles associated with 10-year estimated CVD risk >7.5% for Black but not for white women (median RD 6.14%, range 0.35-26.8%; median RR 2.29, range 1.05-12.6). There were 318 profiles with 10-year CVD risk >7.5% for white but not for Black women (median RD 3.71%, range 0.22-20.1%; median RR 1.66, range 1.03-5.46). The population-based samples demonstrated similar risk differences.ConclusionsThe PCE may generate substantially divergent CVD risk estimates for Black versus white individuals with identical risk profiles, which could introduce race-related variations in clinical recommendations for CVD prevention.

scholarly journals Examining the risk of depression or self-harm associated with incretin-based therapies used to manage hyperglycaemia in patients with type 2 diabetes: a cohort study using the UK Clinical Practice Research Datalink

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023830 ◽  
Author(s):  
John-Michael Gamble ◽  
Eugene Chibrikov ◽  
William K Midodzi ◽  
Laurie K Twells ◽  
Sumit R Majumdar
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Population Based ◽  
Practice Research ◽  
Primary Study ◽  
Clinical Practice Research Datalink ◽  
Glucose Lowering ◽  
Self Harm ◽  
The Uk ◽  
New Onset

ObjectivesTo compare population-based incidence rates of new-onset depression or self-harm in patients initiating incretin-based therapies with that of sulfonylureas (SU) and other glucose-lowering agents.DesignPopulation-based cohort study.SettingPatients attending primary care practices registered with the UK-based Clinical Practice Research Datalink (CPRD).ParticipantsUsing the UK-based CPRD, we identified two incretin-based therapies cohorts: (1) dipeptidyl peptidase-4 inhibitor (DPP-4i)-cohort, consisting of new users of DPP-4i and SU and (2) glucagon-like peptide-1 receptor agonists (GLP-1RA)-cohort, consisting of new users of GLP-1RA and SU, between January 2007 and January 2016. Patients with a prior history of depression, self-harm and other serious psychiatric conditions were excluded.Main outcome measuresThe primary study outcome comprised a composite of new-onset depression or self-harm. Unadjusted and adjusted Cox proportional hazards regression was used to quantify the association between incretin-based therapies and depression or self-harm. Deciles of High-Dimensional Propensity Scores and concurrent number of glucose-lowering agents were used to adjust for potential confounding.ResultsWe identified new users of 6206 DPP-4i and 22 128 SU in the DPP-4i-cohort, and 501 GLP-1RA and 16 409 SU new users in the GLP-1RA-cohort. The incidence of depression or self-harm was 8.2 vs 11.7 events/1000 person-years in the DPP-4i-cohort and 18.2 vs 13.6 events/1000 person-years in the GLP-1RA-cohort for incretin-based therapies versus SU, respectively. Incretin-based therapies were not associated with an increased or decreased incidence of depression or self-harm compared with SU (DPP-4i-cohort: unadjusted HR 0.70, 95% CI 0.51 to 0.96; adjusted HR 0.80, 95% CI 0.57 to 1.13; GLP-1RA-cohort: unadjusted HR 1.36, 95% CI 0.72 to 2.58; adjusted HR 1.25, 95% CI 0.63 to 2.50). Consistent results were observed for other glucose-lowering comparators including insulin and thiazolidinediones.ConclusionsOur findings suggest that the two incretin-based therapies are not associated with an increased or decreased risk of depression or self-harm.

Strategies for preventing suicide

1997 ◽  
Vol 171 (4) ◽  
pp. 351-354 ◽  
Author(s):  
Glyn Lewis ◽  
Keith Hawton ◽  
Peter Jones
Keyword(s):  
High Risk ◽  
Population Attributable Fraction ◽  
Population Based ◽  
Number Needed To Treat ◽  
Deliberate Self Harm ◽  
Suicide Rates ◽  
Population Attributable Fractions ◽  
Effective Interventions ◽  
Self Harm ◽  
The Uk

BackgroundThe Health of the Nation includes a target for reducing population suicide rates. We have examined and quantified various high-risk and population-based strategies for prevention based upon a number of stated assumptions and hypothetical interventions.MethodThe published literature was used to estimate the population attributable fractions for both high-risk and population-based strategies. The number needed to treat for the high-risk strategies was calculated, assuming an intervention that reduced suicide rates by 25%ResultsInterventions that would reduce rates of suicide by 25% would reduce population rates by about 2.6% for those recently discharged from hospital and by up to 5.8% for those presenting to general hospital with deliberate self-harm. The population attributable fraction for unemployment was 10.9%ConclusionsHigh-risk strategies will have only a modest effect on population suicide rates, even if effective interventions are developed. Evaluating interventions for deliberate self-harm patients seems worthwhile. The UK Government's target for suicide reduction is more likely to be achieved using population-based strategies. Reducing the availability of methods commonly used for committing suicide is the most practicable current policy, although more radical approaches, for example reducing unemployment, may also substantially reduce suicide rates.

scholarly journals Comparison in intersectional discrimination

Legal Studies ◽  
2018 ◽  
Vol 38 (3) ◽  
pp. 379-395 ◽  
Author(s):  
Shreya Atrey
Keyword(s):  
Black Women ◽  
South African ◽  
White Women ◽  
Personal Characteristics ◽  
White Men ◽  
Test Cases ◽  
Flexible Approach ◽  
The Us ◽  
Strict Requirement ◽  
The Uk

AbstractThis article considers the use of comparison in establishing multi-ground claims of intersectional discrimination. Leading examples of test cases from the US and the UK exemplify the challenges in using comparison to establish discrimination against Black women, based on the grounds of both race and sex. These challenges include: the insistence on using a single mirror comparator (viz white men) or the difficulties in choosing multiple comparators from a range of options (viz white women, Asian women, Black men, white men etc); the missing rationale for the selection; and the unwieldiness in actually appreciating the nature of intersectional discrimination based on this exercise. To overcome these, Canadian courts have relaxed the strict requirement of necessarily resorting to comparison for proving discrimination and switched to the flexible approach. However, in practice, flexible approach appears as fastidious as strict comparison in its selection and use of comparators. Thus, neither of the two approaches has been too helpful in supporting intersectional claims. The article argues that instead, a useful way of proving intersectional discrimination is to follow the South African approach of making comparisons contextually: (i) between all relevant comparators, identified in reference to one, some, and all of the grounds or personal characteristics; and (ii) sifting through comparative evidence with the purpose of establishing similar and different patterns of group disadvantage which characterise the nature of intersectional discrimination. This approach brings both principle and purpose to employing comparison and can be especially useful in appreciating intersectional discrimination as based on multiple grounds.

scholarly journals Interleukin-6 and heart rate in a population-based sample:

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1348-1348
Author(s):  
Russell P Tracy ◽  
Anne B Newman ◽  
Jeff D Williamson ◽  
Tamara B Harris ◽  
Steve R Cummings
Keyword(s):  
Cardiovascular Disease ◽  
Heart Rate ◽  
Black Women ◽  
Interleukin 6 ◽  
White Women ◽  
Population Based ◽  
Smoking History ◽  
High Heart Rate ◽  
Resting Heart Rate ◽  
History Of

0022 Inflammatory cytokines enhance the spontaneous beating rate of cardiac myocytes. We hypothesize that higher levels of interleukin-6 (IL-6) may be associated with a higher resting heart rate in a population-based sample. IL-6 (mean±SEM 2.39±0.5 ng/ml, range 0.21-15.96 ng/ml, n=2824) was measured in Health ABC, a cohort study of 3075 well functioning older adults living in Memphis, TN, and Pittsburgh, PA (age 73.6±0.3 years, 51.5% women, 41.7% African American). Heart rate was calculated from electrocardiogram strips recorded at the baseline clinic visit after 15 min resting in supine position. Participants with arrhythmias or conduction anomalies were excluded. After adjustment for demographics, body-mass index, smoking, history of cardiovascular disease, and use of digoxin, beta-blockers, calcium antagonists, anti-inflammatory drugs and antiarrhythmic drugs, higher log (IL-6) was significantly correlated with a higher heart rate (β=.17, p<0.001, n=2377). Such an association was significant in all race and gender strata (white men β=0.17, p<0.001; white women β=0.13, p=0.001; black men β=0.18, p<0.001; black women β=0.18, p<0.001). The overall il-6/heart rate association was even more evident when the analyses were restricted to the participants who had no history of cardiovascular disease and were not using any these cardiovascular drugs (β=0.21, p<0.001, n=1196). The table shows heart rate according to IL-6 quintiles. Circulating IL-6 was strongly and independently correlated with resting heart rate. Circulating IL-6 is a possible biological mediator that may contribute to explain the increased mortality associated with high heart rate. Table 1.

scholarly journals Race disparities in mortality by breast cancer from 2000 to 2017 in São Paulo, Brazil: a population-based retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ana Cláudia Marcelino ◽  
Bruno Gozzi ◽  
Cássio Cardoso-Filho ◽  
Helymar Machado ◽  
Luiz Carlos Zeferino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Black Women ◽  
Causes Of Death ◽  
White Women ◽  
Mortality Rates ◽  
Population Based ◽  
Sao Paulo ◽  
São Paulo ◽  
Race Disparities

Abstract Background In Brazil, inequalities in access may interfere with cancer care. This study aimed to evaluate the influence of race on breast cancer mortality in the state of São Paulo, from 2000 to 2017, contextualizing with other causes of death. Methods A population-based retrospective study using mortality rates, age and race as variables. Information on deaths was collected from the Ministry of Health Information System. Only white and black categories were used. Mortality rates were age-adjusted by the standard method. For statistical analysis, linear regression was carried out. Results There were 60,940 deaths registered as breast cancer deaths, 46,365 in white and 10,588 in black women. The mortality rates for 100,000 women in 2017 were 16.46 in white and 9.57 in black women, a trend to reduction in white (p = 0.002), and to increase in black women (p = 0.010). This effect was more significant for white women (p < 0.001). The trend to reduction was consistent in all age groups in white women, and the trend to increase was observed only in the 40–49 years group in black women. For ‘all-cancer causes’, the trend was to a reduction in white (p = 0.031) and to increase in black women (p < 0.001). For ‘ill-defined causes’ and ‘external causes’, the trend was to reduce both races (p < 0.001). Conclusion The declared race influenced mortality rates due to breast cancer in São Paulo. The divergences observed between white and black women also were evident in all cancer causes of death, which may indicate inequities in access to highly complex health care in our setting.

Population-based end-of-life care

2019 ◽  
pp. 739-762
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Population Based ◽  
Ageing Population ◽  
Life Care ◽  
Care Services ◽  
The Face ◽  
The Uk ◽  
Developed Nations

This chapter describes the changing face of end-of-life care in the face of demographic changes and the need for a population-based approach in providing end-of-life care in a meaningful manner. Building on the major advances in palliative or end of life care across the world over recent decades, there now seems to be radical groundswell of change in this area, as we face the major challenge of meeting the needs the ageing population. This challenge, most noted in the developed nations, now places specific and seemingly overwhelming unprecedented demands on all our health and social care services. Some would argue that a new approach is needed, building on lessons learnt, to care for the rising numbers of people nearing the last stage of life within our population—in other words, a population approach to end-of-life care. Using examples from the Gold Standards Framework in the UK, the chapter explores the importance of enabling generalists to deliver high quality care across a population, citing a variety of examples and programmes promoting person-centred care at the end of life.

scholarly journals Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study

2019 ◽  
Vol 3 (2) ◽  
pp. 91-98 ◽  
Author(s):  
Madeleine Irish ◽  
Francesca Solmi ◽  
Becky Mars ◽  
Michael King ◽  
Glyn Lewis ◽  
...  
Keyword(s):  
Cohort Study ◽  
Young Adulthood ◽  
Sexual Minorities ◽  
Population Based ◽  
Self Harm ◽  
The Uk

scholarly journals Racial inequalities in access to women's health care in southern Brazil

2011 ◽  
Vol 27 (12) ◽  
pp. 2364-2372 ◽  
Author(s):  
Fernanda Souza de Bairros ◽  
Stela Nazareth Meneghel ◽  
Juvenal Soares Dias-da-Costa ◽  
Diego Garcia Bassani ◽  
Ana Maria Baptista Menezes ◽  
...  
Keyword(s):  
Health Care ◽  
Black Women ◽  
Early Detection ◽  
Health Care Services ◽  
White Women ◽  
Pap Smear ◽  
Population Based ◽  
Southern Brazil ◽  
Cross Sectional ◽  
Racial Inequalities

The aim of this population-based cross-sectional study was to investigate access by 20 to 60 year-old women - both black and white - to early detection (pap-smear) exams for breast and cervical cancer in two towns - São Leopoldo and Pelotas - in Rio Grande do Sul State, southern Brazil. Estimates of the association between race/color and access to pap-smear and breast exams were adjusted for income, education, economic class and age. Of the 2,030 women interviewed, 16.1% were black and 83.9%, white. Black women were significantly less likely to have had a pap-smear and/or breast exam than white women. Racial inequalities in access to cancer early detection exams persisted after controlling for age and other socioeconomic factors. Racial differentials in access to early detection (pap-smear) exams for breast and cervical cancers might result from racial and socioeconomic inequalities experienced by black women in access to reproductive health care services and programs.

scholarly journals Changes in the Prevalence of Chronic Hypertension in Pregnancy, United States, 1970 to 2010

Hypertension ◽  
2019 ◽  
Vol 74 (5) ◽  
pp. 1089-1095 ◽  
Author(s):  
Cande V. Ananth ◽  
Christina M. Duzyj ◽  
Stacy Yadava ◽  
Marlene Schwebel ◽  
Alan T.N. Tita ◽  
...  
Keyword(s):  
United States ◽  
Black Women ◽  
Birth Cohort ◽  
Rate Ratio ◽  
White Women ◽  
Cohort Analysis ◽  
The United States ◽  
Population Based ◽  
Chronic Hypertension ◽  
Cross Sectional

We estimated changes in the prevalence of chronic hypertension among pregnant women and evaluated the extent to which changes in obesity and smoking were associated with these trends. We designed a population-based cross-sectional analysis of over 151 million women with delivery-related hospitalizations in the United States, 1970 to 2010. Maternal age, year of delivery (period), and maternal year of birth (birth cohort), as well as race, were examined as risk factors for chronic hypertension. Prevalence rates and rate ratios with 95% CIs of chronic hypertension in relation to age, period, and birth cohort were derived through age-period-cohort models. We also examined how changes in obesity and smoking rates influenced age-period-cohort effects. The overall prevalence of chronic hypertension was 0.63%, with black women (1.24%) having more than a 2-fold higher rate than white women (0.53%; rate ratio, 2.31; 95% CI, 2.30–2.32). In the age-period-cohort analysis, the rate of chronic hypertension increased sharply with advancing age and period from 0.11% in 1970 to 1.52% in 2010 (rate ratio, 13.41; 95% CI, 13.22–13.61). The rate of hypertension increased, on average, by 6% (95% CI, 5–6) per year, with the increase being slightly higher among white (7%; 95% CI, 6%–7%) than black (4%; 95% CI, 3%–4%) women. Adjustments for changes in rates of obesity and smoking were not associated with age and period effects. We observed a substantial increase in chronic hypertension rates by age and period and an over 2-fold race disparity in chronic hypertension rates.

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