Objectives To determine the extent to which type of hospital admission (emergency compared with elective) and surgical procedure varied by socioeconomic circumstances, age, sex, and year of admission for colorectal, breast, and lung cancer.Design Repeated cross sectional study with data from individual patients, 1 April 1999 to 31 March 2006.Setting Hospital episode statistics (HES) dataset.Participants 564 821 patients aged 50 and over admitted with a diagnosis of colorectal, breast, or lung cancer.Main outcome measures Proportion of patients admitted as emergencies, and the proportion receiving the recommended surgical treatment.Results Patients from deprived areas, older people, and women were more likely to be admitted as emergencies. For example, the adjusted odds ratio for patients with breast cancer in the least compared with most deprived fifth of deprivation was 0.63 (95% confidence interval 0.60 to 0.66) and the adjusted odds ratio for patients with lung cancer aged 80-89 compared with those aged 50-59 was 3.13 (2.93 to 3.34). There were some improvements in disparities between age groups but not for patients living in deprived areas over time. Patients from deprived areas were less likely to receive preferred procedures for rectal, breast, and lung cancer. These findings did not improve with time. For example, 67.4% (3529/5237) of patients in the most deprived fifth of deprivation had anterior resection for rectal cancer compared with 75.5% (4497/5959) of patients in the least deprived fifth (1.34, 1.22 to 1.47). Over half (54.0%, 11 256/20 849) of patients in the most deprived fifth of deprivation had breast conserving surgery compared with 63.7% (18 445/28 960) of patients in the least deprived fifth (1.21, 1.16 to 1.26). Men were less likely than women to undergo anterior resection and lung cancer resection and older people were less likely to receive breast conserving surgery and lung cancer resection. For example, the adjusted odds ratio for lung cancer patients aged 80-89 compared with those aged 50-59 was 0.52 (0.46 to 0.59).Conclusions Despite the implementation of the NHS Cancer Plan, social factors still strongly influence access to and the provision of care.
Objectives To determine the extent to which secondary drug prevention for patients with stroke in routine primary care varies by sex, age, and socioeconomic circumstances, and to quantify the effect of secondary drug prevention on one year mortality by sociodemographic group. Design Cohort study using individual patient data from the health improvement network primary care database. Setting England. Participants 12 830 patients aged 50 or more years from 113 general practices who had a stroke between 1995 and 2005 and who survived the first 30 days after the stroke. Main outcome measures Multivariable associations between odds of receiving secondary prevention after a stroke, and sex, age group, and socioeconomic circumstances; hazard ratios for all cause mortality from 31 days after the stroke and within the first year among patients receiving treatment and by social group; and probabilities of one year mortality for social factors of interest and treatment. Results Only 25.6% of men and 20.8% of women received secondary prevention. Receipt of secondary prevention did not vary by socioeconomic circumstances or by sex. Older patients were, however, substantially less likely to receive treatment. The adjusted odds ratio for 80-89 year olds compared with 50-59 year olds was 0.53 (95% confidence interval 0.41 to 0.69). This was because older people were less likely to receive lipid lowering drugs-for example, the adjusted odds ratio for 80-89 year olds compared with 50-59 year olds was 0.44 (95% confidence interval 0.33 to 0.59). Secondary prevention was associated with a 50% reduction in mortality risk (adjusted hazard ratio 0.50, 95% confidence interval 0.42 to 59). On average, mortality within the first year was 5.7% for patients receiving treatment compared with 11.1% for patients not receiving treatment. There was little evidence that the effect of treatment differed between the social groups examined. Conclusion Under-treatment among older people with stroke in routine primary care cannot be justified given the lack of evidence on variations in effectiveness of treatment by age. INTRODUCTIONThe contribution of medical care to population health has been a topic of scientific debate for years. McKeown's work sparked controversy, but there is agreement with his claim that clinical interventions played little part in the decline in mortality before the mid-20th century.1 Major advances in medical technology during the 20th century stimulated a re-examination of the role of health care in population health. International studies have focused on coronary heart disease. These suggest that 50-75% of the reductions in deaths from cardiac causes can be attributed to improvements in the major risk factors at population level, particularly smoking but also cholesterol levels and blood pressure, 2-5 whereas the remaining 25-50% can be attributed to medical intervention. Among patients with established coronary heart disease, nearly 78% of prevented or postponed deaths are attributable to medical or surgical interv...
Assessing longevity risk is crucial to the financial management of annuities and longevity-related financial instruments. Actuaries have been using socio-economic circumstances (SEC) of individuals estimated through postcodes, pension size and occupation to price annuities for prospective customers. Differences in mortality rates of people in different SEC have been discussed extensively but less is known about how their mortality rates have changed over time. A lack of regular, consistent and credible mortality data for people in different SEC has hampered the study of historical mortality trends. This in turn has made forecasting a greater challenge. To address some of these data issues, we have obtained mortality and population data between 1981 and 2007 for England, divided into SEC quintiles (measured by the relative deprivation of the area of residence according to the Index of Multiple Deprivation (IMD) 2007). Using the data, we have analysed the mortality trends by SEC. These findings can provide insight into mortality improvement for people in different SEC. This can contribute to commercial decisions for annuity businesses, reinsurance and longevity swaps. KeywordsSocio-Economic Circumstance; Mortality Improvement Rates; Longevity Risk; Basis Risk 2.3.1. A spreadsheet based tool (CMI Mortality Projection Spreadsheet v3.0) supplied by the Continuous Mortality Investigation Board (CMIB) of the Institute and Faculty of Actuaries (http:// www.actuaries.org.uk/) was used to smooth the mortality data by 5-year age bands and calendar year, divided by gender and IMD quintile.2.3.2. We employed the P-Spline (Age-Period) method supplied by the tool. The P-Spline regression method is a localised 2 dimensional (age and period) smoothing mechanism (Eilers et al., 1996; CMI, 2007). Default parameters for age and period were selected including the following: i) Order of penalty: second order (linear projection); ii) Distance between knots (B-Spline basis): 5 knots. Other parameters include the degree of the B-Spline used as the basis for the fit (comparable to the order of the function within a polynomial regression the default value is 3).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.