Objectives Infection exerts a major burden in ANCA-associated vasculitis (AAV), however, its precise extent and nature remains unclear. In this national study we aimed to longitudinally quantify, characterize and contextualize infection risk in AAV. Methods We conducted a multicentre matched cohort study of AAV. Complementary data on infections were retrieved via data linkage with the population-based Scottish microbiological laboratory, hospitalization and primary care prescribing registries. Results A total of 379 AAV patients and 1859 controls were followed up for a median of 3.5 years (interquartile range 1.9–5.7). During follow-up, the proportions of AAV patients with at least one laboratory-confirmed infection, severe infection and primary care antibiotic prescription were 55.4%, 35.6% and 74.6%, respectively. The risk of infection was higher in AAV than in matched controls {laboratory-confirmed infections: incidence rate ratio [IRR] 7.3 [95% confidence interval (CI) 5.6, 9.6]; severe infections: IRR 4.4 [95% CI 3.3, 5.7]; antibiotic prescriptions: IRR 2.2 [95% CI 1.9, 2.6]}. Temporal trend analysis showed that AAV patients remained at a higher risk of infections throughout the follow-up period, especially year 1. Although the Escherichia genus was the most commonly identified pathogen (16.6% of AAV, 5.5% of controls; P < 0.0001), AAV patients had the highest risk for Herpes [IRR 12.5 (95% CI 3.7, 42.6)] and Candida [IRR 11.4 (95% CI 2.4, 55.4)]. Conclusion AAV patients have up to seven times higher risk of infection than the general population and the overall risk remains significant after 8 years of follow-up. The testing of enhanced short- to medium-term prophylactic antibiotic regimes should be considered.

ObjectiveInequality is deeply embedded in our economic structures—it is necessary to address these economic inequalities if we are to reduce health inequalities. An inclusive economic approach was conceptualised as a way to reduce these economic inequalities, although the attributes of this approach are unclear. Public health practitioners are increasingly asked to provide a health perspective on the economic recovery plans in the light of the COVID-19 pandemic. This paper aims to identify the attributes of an inclusive economy to enable the public health profession to influence an inclusive economic recovery.ApproachWe conducted a rapid review of grey and peer-reviewed literature to identify the attributes of an inclusive economy as currently defined in the literature.Attributes of an inclusive economyTwenty-two concepts were identified from 56 reports and articles. These were collapsed into four distinct attributes of an inclusive economy: (1) an economy that is designed to deliver inclusion and equity, (2) equitable distribution of the benefits from the economy (eg, assets, power, value), (3) equitable access to the resources needed to participate in the economy (eg, health, education), and (4) the economy operates within planetary boundaries.ConclusionAs economies are (re)built following the COVID-19 pandemic, these attributes of an inclusive economy—based on the current literature—can be used to develop, and then monitor progress of, economic policy that will reduce health inequalities, improve health and mitigate against climate change.

Background The world is facing an unprecedented systemic shock to population health, the economy and society due to the devastating impact of the COVID-19 pandemic. As with most economic shocks, this is expected to disproportionately impact vulnerable groups in society such as those in poverty and those in precarious employment as well as marginalised groups such as women, the elderly, Black, Asian and Minority Ethnic (BAME) groups and those with health conditions. The current literature is rich in normative recommendations on plural ownership as a key building block of an inclusive economy rooted in communities and their needs. There is, however, a need for a rigorous synthesis of the available evidence on what impact (if any) plural ownership may potentially have on the inclusivity of the economy. This review seeks to synthesise and compare the available evidence across the three economic sectors (private, public and third). Methods We will search eight bibliographic databases (Sociological abstracts, EBSCO Econlit, OVID Embase, OVID Medline, Applied Social Sciences Index and Abstracts (ASSIA), ProQuest Public Health, Web of Science, Research Papers in Economics (Repec) – EconPapers) from the earliest data available in each database until January 2021. Grey literature will be identified from Google (advanced), Google Scholar and 37 organisational websites identified as relevant to the research question. We will include comparative studies of plural ownership from high-income countries that report outcomes on access to opportunities, distribution of benefits, poverty, and discrimination. A bespoke search strategy will be used for each website to account for the heterogeneity in content and search capabilities and will be fully documented. A standardised data extraction template based on the Population-Intervention-Context-Outcome (PICO) template will be developed. We will assess the strength of evidence for different forms of economic ownership identified in relation to the impact of each on the four economic outcomes of interest, paying particular attention to the role of wider contextual factors as they emerge through the evidence. Discussion The findings of this review are intended to inform policymaking at local, national and international level that prioritises and supports the development of different economic and business models. Systematic review registration Open Science Framework registration DOI: 10.17605/OSF.IO/BYH5A

Objective. Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is considered a chronic, relapsing condition. To date, no studies have investigated multimorbidity in AAV nationally. This study was undertaken to characterize temporal trends in multimorbidity and report excess health care expenditures associated with multimorbidities in a national AAV cohort from Scotland. Methods. Eligible patients with AAV were diagnosed between 1997 and 2017. Each patient was matched with up to 5 general population controls. Linked morbidity and health care expenditure data were retrieved from a Scottish national hospitalization repository and from published national cost data. Multimorbidity was defined as the development of ≥2 disorders. Prespecified morbidities, individually and together, were analyzed for risks and associations over time using modified Poisson regression, discrete interval analysis, and chi-square test for trend. The relationship between multimorbidities and health care expenditure was investigated using multivariate linear regression. Results. In total, 543 patients with AAV (median age 58.7 years [range 48.9-68.0 years]; 53.6% male) and 2,672 general population controls (median age 58.7 years [range 48.9-68.0 years]; 53.7% male) were matched and followed up for a median of 5.1 years. AAV patients were more likely to develop individual morbidities at all time points, but especially <2 years after diagnosis. The highest proportional risk observed was for osteoporosis (adjusted incidence rate ratio 8.0, 95% confidence interval [95% CI] 4.5-14.2). After 1 year, 23.0% of AAV patients and 9.3% of controls had developed multimorbidity (P < 0.0001). After 10 years, 37.0% of AAV patients and 17.3% of controls were reported to have multimorbidity (P < 0.0001). Multimorbidity was associated with disproportionate increases in health care expenditures in AAV patients. Health care expenditure was highest for AAV patients with ≥3 morbidities (3.89-fold increase in costs, 95% CI 2.83-5.31; P < 0.001 versus no morbidities). Conclusion. These findings emphasize the importance of holistic care in patients with AAV, and may identify a potentially critical opportunity to consider early screening.

Background. An inclusive economy is increasingly recognised as an effective way to tackle widening inequalities within populations and ensure nations can “build back better” after the COVID-19 pandemic. However, the different mechanisms that can be used to deliver an inclusive economy are not well established, and the strength and quality of evidence supporting such mechanisms are yet to be synthesised. Aim. To systematically review the literature to identify the political, economic and social mechanisms that can be used to deliver an inclusive economy. Search methods. We will search eight peer-reviewed databases including EconLit, Web of Science, Sociological Abstracts, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Proquest Public Health Database, Embase and Medline. Grey literature will be searched using Google Scholar and websites for various governmental and non-governmental organisations. Selection criteria. We will include literature reviews assessing the impact of social, political and/or economic mechanisms that can deliver an inclusive economy. Relevant exposures include any population-level social, political or economic mechanisms and relevant outcomes include increased equity in any of the following: (i) opportunities, e.g. access to education, training, employment, owning and running businesses, owning and managing community assets, finance; (ii) the experiences of people in different social classes, and (iii) the distribution of the economy’s outcomes, e.g. resources, good quality jobs and living standards, and power, income and wealth. Data collection and analysis. A modified version of the AMSTAR-2 criteria will be used for critical appraisal. Data will then be synthesised qualitatively (or quantitatively, where applicable) giving greater weight to higher quality reviews. Discussion: Our review will synthesise the available reviewed evidence on mechanisms that have been evaluated in relation to inclusive economy outcomes. This will help policymakers and practitioners identify potential interventions and levers that can be used to deliver an inclusive economy. We will also assess the depth as well as the strengths and weaknesses in existing reviewed evidence base and identify areas that require further reviews of primary research and evaluation.

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