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Fischbacher C.M.,NHS National Services Scotland | Fischbacher C.M.,University of Edinburgh | Cezard G.,University of Edinburgh | Bhopal R.S.,University of Edinburgh | And 2 more authors.
International Journal of Epidemiology

Background: Ethnic health inequalities are substantial. One explanation relates to socioeconomic differences between groups. However, socioeconomic variables need to be comparable across ethnic groups as measures of socioeconomic position (SEP) and indicators of health outcomes. Methods: We linked self-reported SEP and ethnicity data on 4.65 million individuals from the 2001 Scottish Census to hospital admission and mortality data for cardiovascular disease (CVD). We examined the direction, strength and linearity of association between eight individual, household and area socioeconomic measures and CVD in 10 ethnic groups and the impact of SEP adjustment. Results: There was wide socioeconomic variation between groups. All eight measures showed consistent, positive associations with CVD in White populations, as did educational qualification in non-White ethnic groups. For other SEP measures, associations tended to be consistent with those of White groups though there were one or two exceptions in each non-White group. Multiple SEP adjustment had little effect on relative risk of CVD for most groups. Where it did, the effect varied in direction and magnitude (for example increasing adjusted risk by 23% in Indian men but attenuating it by 11% among Pakistani women). Conclusions: Across groups, SEP measures were inconsistently associated with CVD hospitalization or death, with effect size and direction of effect after adjustment varying across ethnic groups. We recommend that researchers systematically explore the effect of their choice of SEP indicators, using standard multivariate methods where appropriate, to demonstrate their cross-ethnic group validity Published by Oxford University Press on behalf of the Intas potential confounding variables for the specific groups and outcomes of interest. © The Author 2013; all rights reserved. Source

Libby G.,University of Dundee | Brewster D.H.,NHS National Services Scotland | Steele R.J.C.,University of Dundee
British Journal of Surgery

Background: Small studies have examined the effect of faecal occult blood test (FOBT) screening on the proportion of hospital admissions for colorectal cancer (CRC) classed as an emergency. This study aimed to examine this and short-term outcomes in persons invited for screening compared with a control group not invited.Methods: The invited group comprised all individuals invited between 1 April 2000 and 31 July 2007 in the Scottish arm of the UK demonstration pilot of FOBT, and subsequently diagnosed with CRC aged 50-72 years between 1 May 2000 and 31 July 2009. The controls comprised all remaining individuals in Scotland not invited for FOBT but diagnosed with CRC aged 50-72 years in the same period.Results: There were 2981 people diagnosed with CRC in the group invited for screening (58·3 per cent participated) and 9842 in the control group. Multivariable regression adjusted for sex, age, deprivation, co-morbidities, tumour site and Dukes' stage showed no difference between the groups for emergency admissions (odds ratio (OR) 0·89, 95 per cent confidence interval (c.i.) 0·77 to 1·02; P =0·084) or length of hospital stay (LOS) (ß coefficient -1·02 (95 per cent c.i. -1·05 to 1·01) days; P =0·226). Comparing participants with controls, there were fewer emergency admissions (OR 0·59, 0·49 to 0·71; P <0·001) and shorter LOS (ß coefficient -1·06 (-1·10 to -1·02) days; P =0·001). Short-term mortality was lower in the screened than the non-screened population (1·1 versus 2·8 per cent; P =0·001).Conclusion: People who participated in FOBT screening had fewer emergency admissions and a shorter LOS. Deprivation was associated negatively with participation, but the impact of FOBT participation on emergency admissions was independent of deprivation level. The reduction in LOS has potential to reduce financial costs. © 2014 Crown copyright. Source

Bhopal R.S.,University of Edinburgh | Humphry R.W.,University of Edinburgh | Fischbacher C.M.,NHS National Services Scotland
BMJ Open

Objectives: Reducing disease inequalities requires risk factors to decline quickest in the most disadvantaged populations. Our objective was to assess whether this happened across the UK's ethnic groups. Design: Secondary analysis of repeated but independent cross-sectional studies focusing on Health Surveys for England 1999 and 2004. Setting: Community-based population level surveys in England. Participants: Seven populations from the major ethnic groups in England (2004 sample sizes): predominantly White general (6704), Irish (1153), Chinese (723), Indian (1184), Pakistani (941), Bangladeshi (899) and Black Caribbean (1067) populations. The numbers were smaller for specific variables, especially blood tests. Outcome measures: Data on 10 established cardiovascular risk factors were extracted from published reports. Differences between 1999 and 2004 were defined a priori as occurring when the 95% CI excluded 0 (for prevalence differences), or 1 (for risk ratios) or when there was a 5% or more change (independent of CIs). Results: Generally, there were reductions in smoking and blood pressure and increases in the waist-hip ratio, body mass index and diabetes. Changes between 1999 and 2004 indicated inconsistent progress and increasing inequalities. For example, total cholesterol increased in Pakistani (0.3 mmol/L) and Bangladeshi men (0.3 mmol/L), and in Pakistani (0.3 mmol/L), Bangladeshi (0.4 mmol/L) and Black Caribbean women (0.3 mmol/L). Increases in absolute risk factor levels were common, for example, in Pakistani (five risk factors), Bangladeshi (four factors) and general population women (four factors). For men, Black Caribbeans had the most (five factor) increases. The changes relative to the general population were also adverse for three risk factors in Pakistani and Black Caribbean men, four in Bangladeshi women and three in Pakistani women. Conclusions: Changes in populations with the most cardiovascular disease and diabetes did not decline the quickest. Cardiovascular screening programmes need more targeting. Source

Jenkins P.J.,Queen Margaret Hospital | Watts A.C.,Queen Margaret Hospital | Norwood T.,NHS National Services Scotland | Duckworth A.D.,Queen Margaret Hospital | And 2 more authors.
Acta Orthopaedica

Background and purpose Total elbow replacement (TER) is used in the treatment of inflammatory arthropathy, osteoarthritis, and posttraumatic arthrosis, or as the primary management for distal humeral fractures. We determined the annual incidence of TER over an 18-year period. We also examined the effect of surgeon volume on implant survivorship and the rate of systemic and joint-specific complications. Methodology We examined a national arthroplasty register and used linkage with national hospital episode statistics, and population and mortality data to determine the incidence of complications and implant survivorship. Results There were 1,146 primary TER procedures (incidence: 1.4 per 105 population per year). The peak incidence was seen in the eighth decade and TER was most often performed in females (F:M ratio = 2.9:1). The primary indications for surgery were inflammatory arthropathy (79%), osteoarthritis (9%), and trauma (12%). The incidence of TER fell over the period (r = -0.49; p = 0.037). This may be due to a fall in the number of procedures performed for inflammatory arthropathy (p < 0.001). The overall 10-year survivorship was 90%. Implant survival was better if the surgeon performed more than 10 cases per year. Interpretation The prevalence of TER has fallen over 18 years, and implant survival rates are better in surgeons who perform more than 10 cases per year. A strong argument can be made for a managed clinic network for total elbow arthroplasty. Source

Agency: GTR | Branch: ESRC | Program: | Phase: Research Grant | Award Amount: 623.09K | Year: 2016

This proposal is motivated by the need to reduce the public deficit. One way to do this is by achieving efficiency savings in procurement for large public institutions such as the National Health Service, city councils, or the Ministry of Defence. We propose to contribute towards this goal by attempting to better align the stylised theoretical analysis of tendering - a form of trading mechanism - with the facts on the ground. The focus of our study is the provision and use of information in the tendering process, building on two recent methodological developments: Information Design and Simple Auctions. Trading mechanisms have been the subject of a great deal of study, especially in the last half a century. More recently, the enormously successful sale of the 3G mobile phone licences by simultaneous auctions - £22.5 billion was raised for the public purse and the band of radio frequency was efficiently assigned - in 2000, provided vivid evidence of how useful this theory can be. The literature on auctions is focussed on finding the optimal trading mechanism, which maximizes expected benefits. However, on the one hand, this optimization assumes that the information available to the bidders is predetermined. This is often too strong an assumption as the bid taker may have significant leeway in choosing what information to gather and disclose. On the other hand, the optimization traditionally leaves both the complexity of the mechanism and its use of the information revealed by the bidders unconstrained. This often results in very complicated optimal mechanisms, which are hard to implement in practice. We propose to push out the research frontier by analysing what information, and in which form, is presented to the potential traders and how information revealed by them is used by the designer to determine prices and trades. The first of these novel ideas is information design: the optimal provision of information to a group of interacting agents by a desiner with a certain objective. By strategically choosing its method for scoring the bids and by seeking out and revealing additional facts that might affect the cost of suppliers, the designer can create interdependence between the agents information; this can then be exploited through the competitive bidding process, ultimately benefiting the designers objective. The second idea is based on the observation that due to the complex objective of the buyer (quality, timing, transparency, sustainability etc. in addition to price) most actual tenders are multi-dimensional: the bids submitted include several different factors besides price. While a pre-announced scoring rule can transform these bids into readily comparable one-dimensional scores, it does not eliminate the complexity of bids and of the bidders beliefs about the bids of others. For practical reasons, the designer needs to compensate for this innate complication by simplifying the mechanism, resulting in additional restrictions on the set of mechanisms she can choose from. These restrictions imply that families of mechanisms previously discarded as sub-optimal, now become relevant. To capture this scenario, we analyse decentralised mechanisms, where conditional on trading, prices are independent of the bids of competitors. In the context of scoring auctions, this would correspond to a discriminatory first-score auction. According to the existing theoretical literature, when the quantity traded is not set beforehand, these auctions are not optimal. Together, these two approaches make it possible to advance our understanding of issues like simultaneous bidding and realistic mechanisms that deal with interdependent valuations. While doing that we will also pay particular attention not to be hemmed in by the artificial boundary between micro- and macro-economic analyses, so that our insights can be exported to system-wide markets, such as the labour and credit markets.

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