Society for Social Medicine, 61st Annual Scientific Meeting, University of Manchester
September 5-8 2017
Tuesday 5th September 2017- University Place, Oxford Road, University of Manchester10:00 onwards / Early Career Researcher (ECR) Workshop: Room 6.207, University Place
10:00 onwards / Mid Career Researcher (MCR) Workshop: Room 6.205, University Place
10:00 onwards / SSM Mentoring Workshop: Room 6.206, University Place
Wednesday 6th September 2017- University Place, Oxford Road, University of Manchester
10:00-18:00 / Registration
11:00-11:30 / Conference welcome (Lecture Theatre B)
11:30-12:45 / Cochrane Lecture and Discussion (Lecture Theatre B): Professor Jennie Popay “What happened to the ginger bread man: twenty years of qualitative evidence synthesis"
12:45-13:45 / Lunch (ECR/MCR meetings and events)
13:10-13:45 / Early Career Researcher event (1.218)
13:10-13:45 / Mid-Career Researcher event (1.219)
13:45-15:20 / Oral presentation session A and Workshop 1 "Appraisal, revalidation and professional responsibilities as an academic in public health"
15:20-16:20 / Refreshments and poster session A (P1-P48)
16:20-17:55 / Oral presentation session B and Workshop 2 "Context is crucial in interventions, but how do we examine it?"
19:00 / Conference reception: Great Hall, Manchester Town Hall, Albert Square, M2 5DB
Thursday 7th Sept- University Place, Oxford Road, University of Manchester
08:30 onwards / Registration
9:00-10:35 / Oral presentation session C and Workshops 3 "Extending MRC Guidance on Developing and Evaluating Complex Health Interventions" and 4 "Reviewing evidence to support decision-making on changes in service delivery and organisation: practical approaches and challenges"
10:35-11:30 / Refreshments and poster session B (P49-P98)
11:25-13:00 / Oral presentation session D and Workshops 5 "Novel trial designs and analytical methods for evaluating complex public health interventions: a discussion" and 6 "Thinking creatively about communicating your research"
13:00-13:45 / Lunch
13:45-15:00 / "How do we change the social determinants of health and health inequalities?”- A discussion with Professor Michael Marmot and Professor Richard Wilkinson (Lecture Theatre B)
15:15-17:00 / Walking tours
17:00-18:00 / Society for Social Medicine Annual General Meeting (Lecture Theatre B)
18:30 for 19:00 start / Conference dinner: Harvey Nichols Second Floor Bar and Brasserie, 21 New Cathedral Street; Manchester; M1 1AD
Friday 8th Sept- University Place, Oxford Road, University of Manchester
08:30 onwards / Registration
9:00-10:35 / Oral presentation session E and workshop on "Use of Bayesian networks to facilitate evidence synthesis and evaluation of interventions in complex systems"
10:35-11:00 / Refreshments
11:00-12:10 / Plenary session: top ranking abstracts (Lecture Theatre B)
12:15-13:30 / Pemberton Lecture and Discussion: Professor Alastair Leyland "God bless the child: empty pockets and the struggle to reduce inequalities in health" (Lecture Theatre B)
13:30-13:45 / Awards, closing remarks and farewell
12 noon onwards / Lunch (available to take away)
SSM Annual Scientific Meeting 2017 Oral Presentations (OP)
Wednesday 6 September 2017
Children 1
OP01
Changes in the relationship between asthma and associated risk factors in children aged 8-13 over fifty years: ecological study from Aberdeen, North East Scotland
MS Barnish1, N Tagiyeva1, G Devereux1, L Aucott2, S Turner1
1Child Health, University of Aberdeen, Aberdeen, UK
2Medical Statistics, University of Aberdeen, Aberdeen, UK
BackgroundAsthma is the most common chronic childhood medical condition globally. After sharp rises in prevalence over the second half of the twentieth century, falling prevalence has been found in some countries including the United Kingdom during the first decade of the twenty-first century. In order to gain insight into the hitherto unconfirmed factors underlying changing susceptibility to asthma, we used data from one of the longest-running paediatric asthma epidemiology studies in the world: the Aberdeen Schools Asthma Survey (ASAS). We hypothesised that the relationship between asthma and associated risk factors had changed between 1964 and 2014.
MethodsAn ecological study design was used. Parents of children aged 8-13 in state schools in the City of Aberdeen, North East Scotland, were invited to participate in a questionnaire survey in May 1964, May 1989 and then at five-year intervals to 2014. Child history of asthma and eczema, parental smoking, parental asthma, sex and socioeconomic status (SES) were determined. 2 knot structural change models, with knots after 1964 and 1999, were constructed to assess changes in the relationship between child history of asthma and these risk factors over time.
ResultsData for analysis were available for 15,108 children aged 8-13 (75% response rate). Asthma prevalence rose from 4% in 1964 to 28% in 2004 before falling to 22% in 2009 and 19% in 2014. Parental smoking prevalence fell in a near-linear fashion from 58% in 1989 to 28% in 2014. The odds ratio (OR) for a child with asthma to have eczema increased between 1989 and 1999 by 1.031 (95 confidence interval 1.028, 1.035) and by 1.042 (1.038, 1.047) between 2004 and 2014. The OR for a child with asthma to have a parent who smoked rose by 1.032 (1.028, 1.036) between 1989 and 1999 and by 1.043 (1.038, 1.047) between 2004 and 2014. The OR for a child with asthma to have a parent with asthma, to be male and to be from the most deprived communities also rose over the study period.
ConclusionAs hypothesized, we found that the relationship between asthma and associated risk factors such as child eczema, sex, parental smoking, parental asthma and deprivation changed over the period 1964 to 2014. Limitations in our study include regulatory changes and falling response rates over time. The changing nature of relationships with asthma suggests that modification of environmental exposures, e.g. to second-hand smoke, can reduce population asthma susceptibility.
Keywords: epidemiology, paediatrics, asthma
OP02
Trends in cure and relapse by clinical characteristics for children diagnosed with leukaemia aged 0-17 years in Yorkshire 1990-2009: a population-based study
L Smith1, AW Glaser2, 3, SE Kinsey2, 3, DC Greenwood1, RG Feltbower1
1Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
2Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
3Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
BackgroundThe 10-year survival estimates for children aged 0-14 years diagnosed with leukaemia have increased from 23% during the early 1970s to 81% for 2001-2005. Statistical cure models offer an alternative approach to examining survival by simultaneously estimating the proportion of patients cured and the survival of those ‘uncured’. The proportion cured is defined as the proportion of patients as a group for whom there is no excess mortality compared to the general population. The aims of this study were to estimate the cure proportion for childhood leukaemia and examine trends by clinical prognostic risk factors. Trends in relapse free survival were also examined.
MethodsChildren aged 0-17 diagnosed with leukaemia between 1990 and 2009 were extracted from the Yorkshire Specialist Register of Cancer in Children and Young People (n=583). Flexible parametric cure models were used to estimate cure proportions and median survival times (MSTs) of those ‘uncured’ by age at diagnosis, sex, diagnostic subtype, white cell count (WCC), and period of diagnosis. A further cure model based on relapse free survival and a competing risk model for relapse with death as a competing risk were also fitted to examine patterns of relapse.
ResultsThe standardised (adjusting for age, sex, subtype and WCC) cure proportion increased from 0.63 (95%CI: 0.55-0.70) for those diagnosed between 1990 and 94 to 0.83 (95%CI: 0.75-0.88) for those diagnosed 2005-2009. Over this same time period the MST of the uncured remained around 2 years. There were significant differences in cure proportions by age, subtype and WCC, and differences in MST by age and subtype. Models based on relapse free survival found that the proportion cured increased from 0.45 (95%CI: 0.38-0.53) to 0.78 (95%CI: 0.71-0.84) and the MST to relapse or death remained between 1.5-1.7 years. The risk of relapse decreased over time (Hazard ratio 0.18 (95%CI: 0.10-0.31) for 2005-09 compared to 1990-94).
ConclusionThese results demonstrate that the proportion of patients cured, defined either by overall survival or relapse free survival, has increased substantially. There was no change in the median survival time of the uncured group during this time period, however, the risk of relapse has decreased. Cure models provide an alternative and clinically informative method to assess trends in survival for cancer patients.
Keywords: cancer, survival methods, children
OP03
Is in-utero exposure to maternal H1N1 influenza infection and vaccination associated with an increased risk of childhood seizures? A Norwegian registry-based study
L Oakley1, IJ Bakken2, SE Håberg2
1Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
2Department of Children’s Health, Norwegian Institute of Public Health, Oslo, Norway
Background Previous studies have suggested that in-utero exposure to infection is associated with an increased risk of childhood seizures, but there is a lack of evidence regarding in-utero exposure to influenza. The objective of this study was toinvestigate whether in-utero exposure to the H1N1 pandemic, influenza infection, or vaccination is associated with a higher risk of childhood seizures.
MethodsRegistry-based study including all children born in Norway between 01/10/2009 and 31/12/2015 (n=254,347). Data were linked from sources including the Medical Birth Registry, the Norwegian Immunization Register, the primary care reimbursement system, and the Norwegian Patient Registry. We investigated three exposures: 1) in-utero exposure to the H1N1 pandemic (≥1 pregnancy day during the main H1N1 pandemic wave), 2) in-utero exposure to maternal influenza infection (diagnosis of influenza-like illness in primary care, and/or laboratory confirmed H1N1 infection), and 3) in-utero exposure to H1N1 vaccination. We used Cox Proportional Hazards modelling to compare the incidence of seizures (any seizure, febrile seizure, epilepsy) according to exposure status from birth until 31/12/2015. Hazard ratios were adjusted for parity, maternal age, multiplicity, sex and maternal smoking.
Results24.4% (62,032) children were exposed in-utero to the H1N1 pandemic, of whom 3.7% (2,299) were exposed in-utero to maternal influenza. Among 77,671 children with ≥1 in-utero day during the vaccination period, 34.9% (n=27,138) were exposed to vaccination. The risk of febrile seizures was slightly increased after in-utero exposure to the pandemic (aHR 1.06, 95%CI 1.00-1.12), but there was no evidence of an increased risk of epilepsy (aHR 1.08, 95%CI 0.93-1.26). There was no evidence of an overall association between in-utero exposure to maternal H1N1 infection and childhood seizures (febrile seizures aHR 1.17, 95%CI 0.92-1.49; epilepsy aHR 0.93, 95%CI 0.50-1.75). However, when stratified by trimester of exposure we observed a 40% increased risk of febrile seizures after infection during the second trimester (aHR 1.42, 95%CI 1.02-1.99). In-utero exposure to vaccination was not associated with an increased risk of childhood seizures.
DiscussionThis large study benefits from virtually no loss to follow-up and mandatory vaccination reporting. The limitations includes our inability to validate outcome data, and the under-reporting of influenza infection.Our finding of no increased risk subsequent to in-utero exposure to H1N1 vaccination supports the safety of vaccination in pregnancy. Although we found no overall evidence that in-utero exposure to maternal H1N1 infection was associated with febrile seizures, a small increased risk of febrile seizures after second trimester exposure warrants further investigation.
Keywords: pregnancy, influenza, febrile seizures
OP04
The association between the childcare energy-balance environment and UK 3-4-year-olds’ anthropometric indices
KR Hesketh1,2, SE Benjamin Neelon1,2, EM van Sluijs1
1CEDAR and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
2Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
BackgroundAlthough parents provide the majority of childcare before they enter formal schooling, preschool-aged children now spend increasing amounts of time in out-of-home care. Childcare centres, in addition to parents, therefore have a significant responsibility for shaping children’s energy-balance behaviours. However, little is known about how the UK childcare environment influences children’s anthropometric indices. We assessed how the amount of time spent in childcare, and how the nutrition, physical activity and overall childcare environment were associated with children’s anthropometric indicators (z-BMI score; waist-to-height ratio (WHR); sum of skinfold thickness (SST)).
MethodsWe recruited 3-4-year-old children across socio-economic strata from 30 childcare centres in Cambridgeshire, UK. Trained personnel measured children’s height, weight, waist circumference, and subscapular and tricep skinfolds. Parents reported weekly childcare attendance patterns; we assessed the childcare environment relating to obesity (e.g. nutrition and physical activity) using the Environment and Policy Assessment and Observation system. We explored associations between childcare attendance and environment and anthropometric outcomes using two-level hierarchical regression (level 1: child; level 2: childcare centre). All models were adjusted for child ethnicity; maternal educational attainment; maternal BMI; and maternal employment. WHR and SST models were additionally adjusted for child sex and age in months (which are both taken into account when calculating z-BMI scores).
Results196 children (49% female) from 30 childcare centres provided valid data. Neither time spent in care, nor the nutrition, physical activity, or overall childcare environment were associated with children’s z-BMI score, WHR and SST. These findings remained after adjusting for child and maternal variables; several of the latter were independently associated with the outcomes of interest.
DiscussionIn constrast to previous international evidence, neither time spent in childcare nor the environment itself were associated with UK preschool-aged children’s adiposity-related outcomes. The childcare environment remains important to the Government’s obesity strategy, and has been central to intervention efforts to prevent or reduce early childhood obesity to date. However, family-level factors also warrant substantial attention when considering obesity prevention strategies for young children.
Keywords: Childcare Family Anthropometry
Health Inequalities 1
OP05
Which ages and causes of death explain the widening lifespan variation gap in Scotland? A population based study using routine data
R Seaman1,2, A.H. Leyland2, F Popham2
1Max Planck Institute for Demographic Research , The Max Planck Society , Rostock , Germany
2MRC/CSO Social and Public Health Sciences Unit, University of Glasgow , Glasgow , UK
BackgroundScotland’s relative lifespan variation ranking within Western Europe deteriorated after 1980. It is not clear how Scotland’s national lifespan variation trend is associated with socioeconomic inequalities in age and cause of death. We calculate lifespan variation for deprivation quintiles over a thirty year period. We apply stepwise decomposition by age and cause of death to better understand the changing nature of mortality inequalities.
MethodsCensus population estimates and mortality records from 1981-2011, were matched with the Carstairs score, an area level measure of relative deprivation. Life tables by year, sex and deprivation quintile were constructed. Lifespan variation was calculated using e†. The magnitude of inequalities were estimated using the slope and relative indices of inequality. 95% confidence intervals were produced using Monte-Carlo simulation. The lifespan variation gap between the most and least deprived at (1) the same time point and (2) a comparable level of life expectancy was decomposed. The sensitivity of the results to starting at age 0 were tested by repeating the analysis starting at age 35.
ResultsLifespan variation for males from the most deprived quintile was 12.2 years (12.1 years-12.3 years) in 1981 and increased to 12.3 years (12.1 years-12.4 years) in 2011. For the least deprived lifespan variation decreased from 11.2 years (11.0 years-11.3 years) to 10.4 years (10.3 years-10.6 years). This caused the socioeconomic gap to widen over time in absolute and relative terms. In 2011 there was a 2.1 year (1.9 year-2.4 year) difference or a 19%(17%-21%) difference. The gap widened because of increasing differences in mortality rates across working ages from external causes. In 1981 external causes explained 55.1% of the gap and by 2011 they explained 69.5% of the gap. Deaths from circulatory disease explain less of the lifespan variation gap over time. At a shared level of life expectancy the most deprived quintile experience higher mortality rates from external causes of death despite arriving at this life expectancy thirty years later in time. Substantive conclusions were unchanged during sensitivity analysis.
ConclusionThe lifespan variation gap widened because of deaths across working ages from external causes. Scotland must reduce deaths across working adult ages from external causes if it is to reduce the gap and improve its ranking within Western Europe. Routinely monitoring lifespan variation inequalities is valuable for extending our understanding of the changing nature of mortality inequalities and is relevant for countries considering which public health strategies will reduce mortality inequalities.
Keywords: Lifespan variation, mortality inequalities, age and cause of death
OP06
Socio-demographic inequalities in cardiovascular risk management and early detection of vascular conditions by the NHS Health Check: a difference-in-differences matching analysis
K Chang1, JT Lee2, E Vamos1, R Palladino1, M Soljak1, A Majeed1, C Millett1
1Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, United Kingdom
2Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
BackgroundEngland’s National Health Service (NHS) Health Check is a nationwide cardiovascular risk assessment and management programme implemented with aims to prevent cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM) and chronic kidney disease, as well as to reduce inequalities in health.Weaimed to compare the impact of the NHS Health Check on: i) Early detection of vascular conditions among population subgroups of age, sex, ethnicity and deprivation; and ii) The management of cardiovascular risk among high-risk population subgroups of age, sex, and deprivation.
MethodsWe obtained retrospective electronic medical records from the Clinical Practice Research Datalink for a randomly selected sample of 138,788 patients aged 40–74 years, without known CVD or diabetes, and were registered with 462 English general practices between 2009 and 2013. We estimated programme impact for each subgroup using a difference-in-differences matching analysis that compared changes in outcome over time and between Health Check attendees and non-attendees.
Results21.4% (29,672/138,788) of the study population attended a Health Check. The programme was associated with increased detection of hypertension and T2DM among Health Check attendees. A significantly greater number of hypertension and T2DM incident cases were detected in male than female attendees (e.g. an additional 4.02%, 95% CI: 3.65% to 4.39%, and 2.08%, 1.81% to 2.35% male and female attendees were detected with hypertension respectively). A significantly greater number of T2DM incident cases were detected among attendees living in the most deprived area (1.60%, 1.23% to 1.97%) compared with those living in the least deprived area (0.79%, 0.52% to 1.06%).
The programme was associated with significant reductions in 10-year CVD risk scores, total cholesterol and systolic blood pressure while statin prescribing increased among high-risk attendees. However, no major differences in programme impact on cardiovascular risk management were observed between subgroups (e.g. programme impact on 10-year CVD risk score was -1.13%, -1.48% to -0.78% in male and -1.53%, -2.36% to -0.71% in female attendees).