Exploring socioeconomic differences in receipt of resection for the primary lesion and time to resection for colon cancer in England: population-based study

Background A persistent socioeconomic gap in colon cancer survival is observed in England. Provision of cancer care may also vary by socioeconomic status (SES). We investigated population-based data to explore differential care by SES. Methods We analysed a retrospective cohort of patients diagnosed with colon cancer in England (2010–2013) using the national cancer registry data. We examined potential factors associated with receipt of or time to resection and whether socioeconomic differences exist in these two outcomes using logistic and linear regressions. Multiple imputation was used for missing stage, tumour grade and emergency presentation (EP). Results A total of 68169 colon cancer patients were analysed. In the most affluent group, 21.0% (3138/14917) had EP whereas 27.9% (2901/10386) in the most deprived. Patients with higher age at diagnosis (80<) and higher number of comorbidities had more than twice the odds of not receiving resection compared with the reference group (age <65, having no comorbidities). Contrary, patients with EP had approximately 40% reduced odds (adjusted odds ratio 0.61, 95% confidence interval CI 0.58–0.64) of not receiving resection compared with those without EP. We observed no socioeconomic variation in the receipt of resection in all stages. However, among a total of 45332 patients undergoing resection, the proportion of patients receiving urgent surgery (surgery before or within seven days of diagnosis) was higher in the most deprived group (39.9%, 2685/6733) than the most affluent (35.4%, 3595/10146, p <0.001). Days from diagnosis to resection ranged from 33.9 (95% CI 33.1–34.8) in stage II to 38.2 (95% CI 36.8–39.7) in stage I, but no socioeconomic differences in time were seen in all stages when patients were confined to those undergoing elective surgery (surgery more than seven days after diagnosis). Conclusions Deprived groups tended to have higher proportions in EP and urgent surgery, which in part contributed to the apparent no socioeconomic variation in receipt of resection for all patients, nor time to treatment for patients undergoing elective surgery shown in this study. Other steps in care to reduce EP and urgent surgery should be considered to improve socioeconomic inequalities in colon cancer survival.

Nature–Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes

Engagement with nature is an important part of many people’s lives, and the health and wellbeing benefits of nature–based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature–based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature–based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

Ethnic and socioeconomic variation in cause-specific preterm infant mortality by gestational age at birth: national cohort study

ObjectiveTo describe ethnic and socioeconomic variation in cause-specific infant mortality of preterm babies by gestational age at birth.DesignNational birth cohort study.SettingEngland and Wales 2006–2012.SubjectsSingleton live births at 24–36 completed weeks’ gestation (n=256 142).Outcome measuresAdjusted rate ratios for death in infancy by cause (three groups), within categories of gestational age at birth (24–27, 28–31, 32–36 weeks), by baby’s ethnicity (nine groups) or area deprivation score (Index of Multiple Deprivation quintiles).ResultsAmong 24–27 week births (5% of subjects; 47% of those who died in infancy), all minority ethnic groups had lower risk of immaturity-related death than White British, the lowest rate ratios being 0.63 (95% CI 0.49 to 0.80) for Black Caribbean, 0.74 (0.64 to 0.85) for Black African and 0.75 (0.60 to 0.94) for Indian. Among 32–36 week births, all minority groups had higher risk of death from congenital anomalies than White British, the highest rate ratios being 4.50 (3.78 to 5.37) for Pakistani, 2.89 (2.10 to 3.97) for Bangladeshi and 2.06 (1.59 to 2.68) for Black African; risks of death from congenital anomalies and combined rarer causes (infection, intrapartum conditions, SIDS and unclassified) increased with deprivation, the rate ratios comparing the most with the least deprived quintile being, respectively, 1.54 (1.22 to 1.93) and 2.05 (1.55 to 2.72). There was no evidence of socioeconomic variation in deaths from immaturity-related conditions.ConclusionsGestation-specific preterm infant mortality shows contrasting ethnic patterns of death from immaturity-related conditions in extremely-preterm babies, and congenital anomalies in moderate/late-preterm babies. Socioeconomic variation derives from congenital anomalies and rarer causes in moderate/late-preterm babies. Future research should examine biological origins of extremely preterm birth.