Social deprivation and patterns of consultation for respiratory symptoms: a population-based cohort study

Objective: To investigate the relationship between social deprivation and incident diabetes-related foot disease (DFD), in newly-diagnosed patients with type 2 diabetes. Research design and methods: A population-based, open retrospective cohort study, using The Health Improvement Network (01/01/2005-31/12/2019). Patients with type 2 diabetes, free of DFD at baseline, were stratified by Townsend deprivation index and the risk of developing DFD was calculated. DFD was defined as a composite of foot ulcer (FU), Charcot arthropathy, lower limb amputation (LLA), peripheral neuropathy (PN), peripheral vascular disease (PVD) and gangrene. Results: 176,359 patients were eligible (56% men; aged 62.9±13.1years). After excluding 26,094 patients with DFD before/within 15 months of type 2 diabetes diagnosis, DFD was incidentally developed in 12.1% of study population during 3.27years (IQR:1.41-5.96). Patients in the most deprived Townsend quintile had increased risk of DFD compared to those in the least deprived (aHR:1.22, 95%CI:1.16-1.29) after adjusting for sex, age at type 2 diabetes diagnosis, ethnicity, smoking, BMI, HbA1c, cardiovascular disease, hypertension, retinopathy, eGFR, insulin, glucose/lipid-lowering medications and baseline foot risk. Patients in the most deprived Townsend quintile had higher risk of PN (aHR:1.18, 95%CI:1.11-1.25), FU (aHR:1.44, 95%CI:1.17-1.77), PVD (aHR:1.40, 95%CI:1.28-1.53) LLA (aHR:1.75, 95%CI:1.08-2.83) and gangrene (aHR:8.49, 95% CI:1.01-71.58) compared to those in the least. Conclusion: Social deprivation is an independent risk factor for the development of DFD, PN, FU, PVD, LLA and gangrene in newly-diagnosed patients with type 2 diabetes. Considering the high individual and economic burden of DFD, strategies targeting patients in socially deprived areas are needed to reduce health inequalities.

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Acute respiratory symptoms and general illness during the first year of life: A population-based birth cohort study

Pediatric Pulmonology ◽

10.1002/ppul.20828 ◽

2008 ◽

Vol 43 (6) ◽

pp. 584-593 ◽

Cited By ~ 41

Author(s):

Marie-Louise von Linstow ◽

Klaus Kähler Holst ◽

Karina Larsen ◽

Anders Koch ◽

Per Kragh Andersen ◽

...

Keyword(s):

Cohort Study ◽

Birth Cohort ◽

Respiratory Symptoms ◽

Population Based ◽

Birth Cohort Study ◽

First Year ◽

First Year Of Life

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Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study

10.2337/figshare.13476807 ◽

2021 ◽

Author(s):

Jenny Riley ◽

Christina Antza ◽

Punith Kempegowda ◽

Anuradhaa Subramanian ◽

Joht Singh Chandan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Social Deprivation ◽

Population Based ◽

Incident Diabetes ◽

Lipid Lowering ◽

Diabetes Diagnosis ◽

Newly Diagnosed ◽

Foot Disease

Objective: To investigate the relationship between social deprivation and incident diabetes-related foot disease (DFD), in newly-diagnosed patients with type 2 diabetes. Research design and methods: A population-based, open retrospective cohort study, using The Health Improvement Network (01/01/2005-31/12/2019). Patients with type 2 diabetes, free of DFD at baseline, were stratified by Townsend deprivation index and the risk of developing DFD was calculated. DFD was defined as a composite of foot ulcer (FU), Charcot arthropathy, lower limb amputation (LLA), peripheral neuropathy (PN), peripheral vascular disease (PVD) and gangrene. Results: 176,359 patients were eligible (56% men; aged 62.9±13.1years). After excluding 26,094 patients with DFD before/within 15 months of type 2 diabetes diagnosis, DFD was incidentally developed in 12.1% of study population during 3.27years (IQR:1.41-5.96). Patients in the most deprived Townsend quintile had increased risk of DFD compared to those in the least deprived (aHR:1.22, 95%CI:1.16-1.29) after adjusting for sex, age at type 2 diabetes diagnosis, ethnicity, smoking, BMI, HbA1c, cardiovascular disease, hypertension, retinopathy, eGFR, insulin, glucose/lipid-lowering medications and baseline foot risk. Patients in the most deprived Townsend quintile had higher risk of PN (aHR:1.18, 95%CI:1.11-1.25), FU (aHR:1.44, 95%CI:1.17-1.77), PVD (aHR:1.40, 95%CI:1.28-1.53) LLA (aHR:1.75, 95%CI:1.08-2.83) and gangrene (aHR:8.49, 95% CI:1.01-71.58) compared to those in the least. Conclusion: Social deprivation is an independent risk factor for the development of DFD, PN, FU, PVD, LLA and gangrene in newly-diagnosed patients with type 2 diabetes. Considering the high individual and economic burden of DFD, strategies targeting patients in socially deprived areas are needed to reduce health inequalities.

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Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study

Diabetes Care ◽

10.2337/dc20-1027 ◽

2021 ◽

Vol 44 (3) ◽

pp. 731-739

Author(s):

Jenny Riley ◽

Christina Antza ◽

Punith Kempegowda ◽

Anuradhaa Subramanian ◽

Joht Singh Chandan ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cohort Study ◽

Social Deprivation ◽

Population Based ◽

Incident Diabetes ◽

Foot Disease

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Gout and the risk of Alzheimer's disease: a population-based, BMI-matched cohort study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-206917 ◽

2015 ◽

Vol 75 (3) ◽

pp. 547-551 ◽

Cited By ~ 56

Author(s):

Na Lu ◽

Maureen Dubreuil ◽

Yuqing Zhang ◽

Tuhina Neogi ◽

Sharan K Rai ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Uric Acid ◽

Cohort Study ◽

General Population ◽

Social Deprivation ◽

Population Based ◽

Deprivation Index ◽

Matched Cohort ◽

Matched Cohort Study ◽

Entry Time

ObjectiveWhile gout is associated with cardiovascular (CV)-metabolic comorbidities and their sequelae, the antioxidant effects of uric acid may have neuroprotective benefits. We evaluated the potential impact of incident gout on the risk of developing Alzheimer's disease (AD) in a general population context.MethodsWe conducted an age-matched, sex-matched, entry-time-matched and body mass index (BMI)-matched cohort study using data from The Health Improvement Network, an electronic medical record database representative of the UK general population, from 1 January 1995 to 31 December 2013. Up to five non-gout individuals were matched to each case of incident gout by age, sex, year of enrolment and BMI. We compared incidence rates of AD between the gout and comparison cohorts, excluding individuals with prevalent gout or dementia at baseline. Multivariate hazard ratios (HRs) were calculated, while adjusting for smoking, alcohol use, physician visits, social deprivation index, comorbidities and medication use. We repeated the same analysis among patients with incident osteoarthritis (OA) as a negative control exposure.ResultsWe identified 309 new cases of AD among 59 224 patients with gout (29% female, mean age 65 years) and 1942 cases among 238 805 in the comparison cohort over a 5-year median follow up (1.0 vs 1.5 per 1000 person-years, respectively). Univariate (age-matched, sex-matched, entry-time-matched and BMI-matched) and multivariate HRs for AD among patients with gout were 0.71 (95% CI 0.62 to 0.80) and 0.76 (95% CI 0.66 to 0.87), respectively. The inverse association persisted among subgroups stratified by sex, age group (<75 and ≥75 years), social deprivation index and history of CV disease. The association between incident OA and the risk of incident AD was null.ConclusionsThese findings provide the first general population-based evidence that gout is inversely associated with the risk of developing AD, supporting the purported potential neuroprotective role of uric acid.

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Mesenteric vascular disease: A population-based cohort study

Vascular ◽

10.1177/1708538120937954 ◽

2020 ◽

pp. 170853812093795

Author(s):

Marta J Madurska ◽

Robert G Anderson ◽

David J Anderson ◽

Caitlin J McNeill ◽

Jan O Jansen ◽

...

Keyword(s):

Cohort Study ◽

Vascular Disease ◽

Social Deprivation ◽

Population Based ◽

International Classification ◽

Healthcare Provision ◽

Multiple Deprivation ◽

International Classification Of Disease ◽

Index Of Multiple Deprivation

Objectives Mesenteric vascular disease carries a high risk of mortality and morbidity; however, due to obscure clinical presentation, it can be under-recognized. Currently, epidemiology of mesenteric vascular disease remains poorly defined. The aim of this study is to analyze changes in Scottish mortality rates from mesenteric vascular disease overtime. Methods This is a retrospective, longitudinal population-based cohort study using data extracted from death certificates and Scottish Index of Multiple Deprivation. All deaths related to a vascular disorder of the intestines recorded as an underlying cause of death between 1979 and 2014 were identified using International Classification of Disease-9 or International Classification of Disease-10 code groups. Data included demographics and location of death. The residence postcodes were used to classify socio-economic status using the Scottish Index of Multiple Deprivation. Results From 2,142,921 deaths over 36 years, 14,530 (0.7%) were due to mesenteric vascular disease with a median (interquartile range) age of 77 and a 2:1 female to male gender ratio. The mean ± standard deviation age significantly increased from 72.6 ± 12.1 in 1979 to 76.8 ± 11.1 in 2014 ( p < 0.001, R2 = 0.772). Males were consistently younger than females at the time of death. The two lowest Scottish Index of Multiple Deprivation categories accounted for half of the cohort, throughout the study period ( p = 0.068). The adjusted death rate per 100,000 population increased from 7.6 in 1979 to 12.1 in 2014. Conclusions The reported death rates of mesenteric vascular disease in Scotland between 1979 and 2014 have nearly doubled. Mesenteric vascular disease affects twice as many women as men and is associated with social deprivation. The increased reporting of mesenteric vascular disease is likely due to increased recognition and incidence. These implications should be considered when planning healthcare provision in Scotland.

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