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PubMed2003

Mortality of common loons in New England, 1987 to 2000.

Diagnostic findings are presented on 522 common loons (Gavia immer) found dead or moribund in New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont, USA) between 1987 and 2000. Common loon numbers and range in New England have decreased from historic levels over the last century due to a number of proposed factors. Goals of this study were to identify and categorize causes of mortality and quantify natural versus anthropogenic causes. The majority of identifiable mortality in chicks was from intraspecific aggression (25%) and other causes of trauma (32%). Death in immature loons was primarily from fungal respiratory disease (20%) and trauma (18%). Causes of adult loon mortality differed significantly in breeding and wintering habitats. Wintering adults primarily died of trauma (17%) and infection (11%) and had significantly poorer body condition than breeding loons. In breeding adults, confirmed and suspected lead toxicosis from ingested fishing weights accounted for almost half of all mortality. Direct anthropogenic factors accounted for 52% of loon mortality in this study. Because of high carcass recovery rates, we believe these data are a good representation of loon mortality in New England. Results highlight the importance of human influences on conservation and management of the common loon in New England.

Animals↗
PubMedDate not supplied

'The very pests of society': the Irish and 150 years of public health in England.

In the context of efforts to reduce health inequalities, the health status of the Irish in England should be a major subject for concern. As England's longest standing and most numerous ethnic minority, the Irish have at times been regarded as a public health threat and have repeatedly been stereotyped in literature and image. There has also been a failure to recognise and celebrate the contributions to the improvement of public health made by members of the irish community such as Kitty Wilkinson. In recent years alarming evidence has emerged that the mortality of Irish people living in England appears to have worsened in successive generations. Comparison of available data on some of the key determinants of ill health shows that the Irish in England have a worse profile than the Irish living in Ireland. A concerted programme of action is needed to investigate why the Irish should have such poor health status and to develop a programme to address it.

Emigration and Immigration↗
PubMed2001

Rationale for the new GP deprivation payment scheme in England: effects of moving from electoral ward to enumeration district underprivileged area scores.

BACKGROUND: The Department of Health introduced a new deprivation payments system for general practitioners (GPs) on 1 April 1999. Following a three-year phasing-in process, registered patients will attract deprivation payments based on the underprivileged area (UPA) score of their enumeration district (ED) of residence, rather than their electoral ward, changing the pattern and distribution of payments throughout England. AIM: To assess the rationale behind the changed deprivation payments system for GPs in England and to examine its impact on GP and practice payments. DESIGN OF STUDY: A quantitative study modelling practice-based deprivation payments. SETTING: A total of 25,450 unrestricted principal GPs in 8919 practices in England. METHOD: The effect of three new components in the system were examined: changes in the ED score ranges attracting payment, the percentage increase in the size of successive payment bands, and the total budget. The relationship between consultation rates (used as a proxy for workload) and UPA score was examined, together with changes in GP payments calculated nationally and by geographical area. RESULTS: A total of 11.6% of the population of England live in wards with a UPA score of 30 or more, qualifying for deprivation payments, and a similar proportion (11.4%) live in EDs with a UPA score of 20 or more. The larger percentage increases in the size of payments in successive ED UPA bands is supported by the modelled relationship between consultation rate and UPA score. Financially, under the new deprivations payment system, entitlement widens with 88% of practices receiving a payment. Overall, 74% of GPs gain and 13% lose (3% losing more than 1500 Pounds), with 13% receiving no payment. CONCLUSION: The new ED system maps onto the previous system well. Moreover, it more finely discriminates between smaller areas of different relative deprivation and, thereby, targets payments more accurately.

Capitation Fee↗
PubMed2003

The dental caries experience of 5-year-old children in England and Wales. Surveys co-ordinated by the British Association for the Study of Community Dentistry in 2001/2002.

OBJECTIVE: This paper reports the results of standardised clinical caries examinations of 170,731 5-year-old children from across England and Wales. These 2001/2002 co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: The results again demonstrated a wide variation in prevalence across Britain, with mean values for d3mft for the current English Strategic Health Authorities (SHA) (of the National Health Service), Wales and British 'territories' ranging from 0.75 in Jersey and 0.84 in Kent & Medway to 2.73 in Gwent and 2.47 in Greater Manchester. Mean d3mft across England and Wales was 1.52 (d.t = 1.11, mt = 0.20, ft = 0.20). Overall, 40% of children had evidence of caries experience (d3mft > 0); the percentages ranged between 23% (Jersey) or 29% (Essex) and 61% (Gwent) or 54% (Greater Manchester). The distribution of caries was highly skewed. Thus the mean caries experience for those with disease in England and Wales was 3.83, as opposed to the overall mean of 1.52. Trends over time demonstrate slight increase of 3% in overall d3mft for England and Wales since 1999/2000, compared to the 4% improvement seen for the two previous years. Of the three components of dmft, d3t and mt have increased while ft has fallen. The care index has also fallen (13.2% in 2001/2002, compared to 14.3% in 1999/2000); SHA/country percentages for 2001/2002 ranged from 8-29%. This indicator has not, however, regained the levels seen in the past. CONCLUSION: There has been no improvement in the dental health of 5-year-old children. Overall, the provision of operative care for those with dentinal decay has decreased slightly; significant groups remain within the population of 5-year-old children who have dental disease and who are in need of dental care.

Catchment Area, Health↗
PubMed2004

Fatal toxicity of antidepressants in England and Wales, 1993-2002.

This article examines trends in drug poisoning deaths involving antidepressant drugs between 1993 and 2002 in England and Wales as a whole and focuses particularly on the relationship between antidepressant prescribing and deaths in England. Between 1993 and 2002, age-standardised mortality rates in England and Wales decreased from about 9 to 7 per million population for both males and females. However, unlike females, rates in males rose to a peak of 12 per million in 1997 before declining. During the study period, the number of prescription items for antidepressants increased two and a half fold, largely due to increased use of selective serotonin re-uptake inhibitors and other antidepressants. Overall, death rates in England, per million prescription items, declined over the study period, with reductions in the rates for Dothiepin, Amitriptyline and all tricyclic antidepressants. There was no change in the rate for selective serotonin re-uptake inhibitors while rates for other antidepressants increased. Despite these trends, through all the study period rates were highest for tricyclic antidepressants and lowest for selective serotonin re-uptake inhibitors.

Adolescent↗
PubMed2005

The impact of the 2003 heat wave on mortality and hospital admissions in England.

This article quantifies the impact of the heat wave, 4 to 13 August 2003, on mortality and emergency hospital admissions in England by region and age group. The August 2003 heat wave was associated with a large short-term increase in mortality, particularly in London. Overall in England there were 2,091 (17 per cent) excess deaths. Worst affected were those over the age of 75. The greatest increase of any region in England was in London in the over 75 age group with 522 excess deaths (59 per cent). Excess hospital admissions of 16 per cent were recorded in London for the over 75s. Temperatures in England were unusually hot. Ozone and particulate matter concentrations were also elevated during the heat wave. Estimated excess mortality was greater than for other recent heat waves in the UK.

Adolescent↗
PubMedDate not supplied

Barriers to utilization of chronic peritoneal dialysis in network #1, New England.

OBJECTIVE: The percentage of prevalent end-stage renal disease (ESRD) patients maintained on chronic peritoneal dialysis (CPD) therapy in the United States declined from 15% in 1991 to 8.1% in 2002. Previous studies indicate that nephrologists in the United States feel 32.6% of prevalent ESRD patients should be on CPD therapy. The present study was designed to better understand the reasons for the discrepancy in actual versus desired prevalence of CPD utilization. METHODS: The medical directors of all dialysis centers in New England were mailed a questionnaire about the nephrologists' opinions concerning the percentage of patients that should be maintained on CPD therapy, reasons that limited patients' selection of CPD as initial therapy, and concerns about the current status of CPD therapy. The nephrologists were also invited to free text any other comments or concerns. RESULTS: A total of 117 questionnaires were sent; 59 (50.4%) were returned. These medical directors cared for a median of 10 (range 1 - 100) patients on CPD therapy, meaning 15% of dialysis patients in New England are maintained on CPD therapy. The medical directors felt that 29% (range 10% - 50%) of prevalent ESRD patients should be maintained on CPD therapy. The most common reasons cited by the nephrologists as barriers to CPD therapy included patient preference (54%), contraindications to performing CPD therapy (32%), poor social support (31%), significant comorbid disease (20%), late referrals and acute hospital starts (19%), problems with education re chronic kidney disease (12%), and problems with the structure and organization of CPD facilities (12%). These same medical directors stated that concerns about technique failure (25%), long-term viability of CPD therapy (25%), and mortality rates of CPD patients (17%) impacted on their use of CPD therapy as renal replacement therapy for patients with ESRD. CONCLUSION: Nephrologists in New England felt that 29% of prevalent ESRD patients should be maintained on CPD therapy, yet the actual incidence of CPD utilization in New England is 15%. A variety of factors were cited by the nephrologists as important reasons limiting CPD utilization. These nephrologists were also concerned about technique failure and long-term viability of CPD therapy. It is necessary that we look closely at each domain cited by the nephrologists if CPD therapy is to remain a viable option for patients with ESRD in the United States.

Humans↗
PubMed1990

Postsurgical mortality in Manitoba and New England.

Per capita hospital expenditures in the United States exceed those in Canada, but little research has examined differences in outcomes. We used insurance databases to compare postsurgical mortality for 11 specific surgical procedures, both before and after adjustment for case mix, among residents of New England and Manitoba who were over 65 years of age. For low- and moderate-risk procedures, 30-day mortality rates were similar in both regions, but 6-month mortality rates were lower in Manitoba. For the two high-risk procedures, concurrent coronary bypass/valve replacement and hip fracture repair, both 30-day and 6-month mortality rates were lower in New England. Although no consistent pattern favoring New England for cardiovascular surgery was found, the increased mortality following hip fracture in Manitoba was found for all types of repair and all age groups. We conclude that for low- and moderate-risk procedures, the higher hospital expenditures in New England were not associated with lower perioperative mortality rates.

Aged↗
PubMed1980

A comparison of the mortality rates of white South Africans with those of the population of England and Wales.

The health of Whites in South Africa in 1970 was poorer than that of the population of England and Wales, judged by the higher mortality rates (MRs) for all causes of death of White South Africans, for all ages combined and for every age interval from infancy to old age. Two groups of causes of disease were the main reasons for the poorer health of White South Africans: (i) 'diseases of the circulatory system' accounted for 50-60% of the higher MRs for all causes of death; ischaemic heart disease and cerebrovascular disease were the two main causes of circulatory deaths, and MRs for these two diseases were much higher in White South Africans than in England and Wales; (ii) 'accidents, poisonings and violence' accounted for 38% of the higher MRs for all causes of death in males and for 17% of those in females. Motor vehicle accidents and suicide were the main causes of accidental deaths, MRs of White South Africans being much higher than those in England and Wales. These MRs were among the highest in the world. Other diseases which contributed, to a small extent, to the poorer health of White South Africans because of the higher MRs compared with those in England and Wales were cirrhosis of the liver in adults, gastro-enteritis, meningitis and septicaemia in infants and children, and 'other ill-defined and unknown causes of death' in elderly people.

Adolescent↗
PubMed1994

Prevalence of developmental defects of enamel in areas with differing water fluoride levels and socio-economic groups in Sri Lanka and England.

Defects of dental enamel were recorded in 607 12-year-old children in Sri Lanka and north-east England in 1990/91. In each country, children were included from areas which received drinking water containing 0.1, 0.5 or 1.0 ppm F. In some of these areas, children from both low and high socio-economic groups were examined. The index of Developmental Defects of Enamel (DDE) was recorded clinically for the undried buccal surfaces of 10 permanent teeth (maxillary incisors, canines and first premolars, and mandibular first molars). The results revealed a higher prevalence of enamel defects and more teeth affected per person in children in: the high socio-economic group than in the low socio-economic group in the 1.0 ppm F area in England: in the 1.0 ppm F area than in the 0.1 ppm F area in Sri Lanka (in the low socio-economic groups), and in the 1.0 ppm F area than in the 0.1 ppm F area in England (in the high socio-economic groups but not in the low socio-economic groups): in general in Sri Lanka than in England. The occurrence of diffuse opacities increased greatly with increasing water fluoride level. A high prevalence of hypoplastic lesions was recorded in Sri Lanka.

Child↗
PubMed1996

The incidence and prevalence of AIDS and prevalence of other severe HIV disease in England and Wales for 1995 to 1999: projections using data to the end of 1994.

Projections of the future incidence of AIDS cases are needed for planning purposes, to help set research priorities, and to describe the most likely pattern of transmission of HIV infection in the past that underlies the observed and projected incidence of AIDS. Earlier reports of projections for England and Wales were published in 1988, 1990, and 1993. During 1995 a group of experts has worked, using AIDS case reports to the end of December 1994, to make new projections to the end of 1999. The expert group concludes that, after adjustment for underreporting, there will be between 1840 and 2300 new cases of AIDS in England and Wales in 1997, and between 1760 and 2455 new AIDS cases in 1999. For planning purposes, a figure of 2025 new AIDS cases is projected for 1997, and 2010 for 1999. The planning projections for new AIDS cases in 1997 and 1999 among the main exposure categories, after adjustment for underreporting, are as follows: homo/bisexual males 1305 and 1235, people exposed heterosexually 490 and 525, and injecting drug users 140 and 155. Between 1995 and 1999, it is expected that new AIDS cases may fall by 7% in homo/bisexual males, and rise by 25% in the heterosexual exposure category and by 29% in injecting drug users. The incidence of AIDS in the children of mothers infected with HIV is expected to rise steadily from 30 new cases in 1994 to 45 in 1997 and 55 in 1999. New cases in recipients of contaminated blood or blood factors are expected to fall to 35 in 1997 and 30 in 1999, compared with a peak 10 years earlier of over 70 new cases each year. It is projected that 4010 AIDS cases will be alive in England and Wales at the end of 1999, and that the same number of people will be alive with other forms of severe HIV disease. Since 1989 the proportion of reported AIDS cases who live in the NHS Thames regions has remained constant at between 70% and 75%. We expect this concentration of AIDS cases in the south east, particularly within London, to remain unchanged. Compared with the report published in June 1993, the planning projections for 1997 are 37% lower for cases acquired heterosexually, and the upper boundary of the range in this exposure category has fallen from 1140 to 495. The reduction in the planning projection has resulted from a substantial decline in the rate of increase in the number of new AIDS cases arising each year from heterosexual exposure. The range of uncertainty has narrowed largely because more extensive seroprevalence data are now available. For homo/bisexual males, the planning projection for 1997 has fallen by 3%, because the 1993 report presented an over optimistic view of the extent to which patients received treatment and prophylaxis before the onset of AIDS, since such management became available in 1988. Unlike the 1993 working group, the 1995 working group has access to data from several years on the uptake of treatment and prophylaxis given before the diagnosis of AIDS. It is estimated that about 21,900 adults (range 20,400 to 23,400) were infected with HIV in England and Wales at the end of 1993. This total includes 12,350 who had been infected through male homosexual exposure, 2050 men and women infected through injecting drug use, 6800 men and women infected through heterosexual exposure, and about 3000 adults alive with AIDS. Various data indicate that HIV transmission among homo/bisexual men has been substantial since 1989. Use of data from the unlinked anonymous HIV prevalence monitoring programme suggest that between 500 and 1000 HIV infections due to homosexual male exposure occurred each year in 1992 and 1993. Should HIV transmission continue at this level, a high incidence of AIDS within the homo/bisexual male community will be inevitable for many more years. Most HIV infections and AIDS cases due to heterosexual exposure are thought to have been acquired abroad. The future of the epidemic in this exposure category is therefore unclear.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Why did treatment rates for colorectal cancer in south east England fall between 1982 and 1988? The effect of case ascertainment and registration bias.

BACKGROUND: We had two aims in undertaking this study, as follows: (1) to describe regional and district trends in incidence and treatment for colorectal cancer in South East England from 1982 to 1988; (2) to examine the effect of registration practice and case ascertainment on district variations in incidence and treatment using data on death certificate only (DCO) registrations, mortality and stage. METHODS: We included all cases registered by the Thames cancer registry diagnosed with colon or rectal cancer between 1982 and 1988 and resident in 28 districts in the two South Thames regions. Indirect standardized incidence ratios were calculated for the districts and a alpha 2 test for trend was carried out. RESULTS: In the SE England regional analysis, between 1982 and 1988 there was a significant increase in the incidence of cases of colon and rectal cancer in the over-75s, but treatment rates remained unchanged. Treatment rates fell significantly in the under-65s although incidence rates remained unchanged. Age is a strong predictor of nontreatment. Between 1982 and 1988 the relative risk of not receiving treatment increased for all ages over 65 years. DCO registrations accounted for 22 percent and 15 percent of all colon and rectal cancer cases, respectively, between 1982 and 1988. The proportions rose (between 1982 and 1988) from 10 and 8 percent to 25 and 19 percent in colon and rectal cancer, respectively. DCO registration rates increased over time and in all age groups in South East England for both colon and rectal cancer between 1982 and 1988, but the largest increase was in the over-75s. Thirty-two per cent of colon and 25 per cent of rectal cases were unstaged. Although the proportion of unstaged cases remained constant over time, they were increasingly the result of DCO registrations. Errors in the registry staging data rendered those cases which were staged unusable. In the district analysis, there were significant variations in age-standardized incidence, treatment and DCO registration ratios across the 28 districts for men and women with colon and rectal cancer between 1982 and 1988. DCO registrations show a negative correlation with treatment for both colon and rectal cancer (p < 0.05) and with incidence for only rectal cancer. CONCLUSIONS: We report significant differences in age-standardized incidence and treatment ratios across 28 districts in South East England, some of which, can be accounted for by differences in registration practice. There is a complex relationship between DCO registrations and incidence and treatment for both colon and rectal cancer. DCO registrations are a good proxy for under-ascertainment of incidence in rectal cancer but not colon cancer, and are a good proxy for under-ascertainment of treatment in both colon and rectal cancers. Information from the cancer registry can be used to examine registration and treatment rates across districts. However, if variations are to be adequately explained, meticulous data collection on stage and quality control are essential.

Aged↗
PubMed1995

Elevation in anti-Proteus antibodies in patients with rheumatoid arthritis from Bermuda and England.

OBJECTIVE: To determine whether patients with rheumatoid arthritis (RA) from Bermuda and England have an increased anti-Proteus antibody titer when compared to healthy Bermudian and English controls, and to ascertain whether any increase in antibody titer is specific by testing 4 other microbes, Escherichia coli and 3 normal anaerobic bowel bacteria. METHODS: Antibody titers were measured by ELISA and indirect immunofluorescence (IIFA) under coded conditions. RESULTS: Elevated titers of anti-Proteus antibodies were demonstrated in 34 patients with active RA from Bermuda when compared to 33 healthy Bermudian controls by ELISA (p < 0.001) and IIFA (p < 0.001). An elevation of anti-Proteus antibodies was also observed in 34 patients with RA from England when compared to 30 healthy English controls again by ELISA (p < 0.001). A similar antibody elevation in 31 patients with RA from England was observed when compared to 30 healthy controls when measured by IIFA (p < 0.001). However, there was no significant elevation in antibody titers against E. coli or the 3 normal bowel flora isolates in the patients with RA from both countries compared to their respective controls, when measured by ELISA. CONCLUSION: A specific elevation in the immune response to Proteus mirabilis has been demonstrated in patients with RA from both Bermuda and England. However, this study cannot distinguish between antibody association with disease per se and association with disease activity. The role of Proteus in RA and the effect of anti-Proteus therapy in patients with RA merits further study.

Adult↗
PubMed1997

Influenza surveillance in England and Wales: October 1996 to June 1997.

This report summarises information collected for the surveillance of influenza in England and Wales during the winter of 1996/97. Consultations for 'influenza and influenza-like illness' with sentinel general practitioners in England and Wales began to increase towards the end of November and peaked at the start of January. In England, consultations for 'aggregated respiratory disease' (ARD) began to increase a little earlier, perhaps as a result of increased respiratory syncytial virus activity, but also peaked in early January. Influenza A (H3N2) viruses were first detected in early October, but rarely until November, and activity peaked in early January, coinciding with the peak in consultations for flu-like illness. A few influenza B viruses were detected in late November and early December, and substantial activity was recorded in mid-January. Approximately equal numbers of influenza A(H3N2) and B viruses were identified over the winter as a whole, and circulating strains were antigenically similar to those included in the vaccine for 1996/97. Although influenza activity was 'moderate' in terms of consultations and laboratory confirmed infections, a large peak in death registrations occurred at the same time as influenza A(H3N2) virus activity peaked. The number of deaths during the winter was similar to that seen in 1989/90, when the last severe influenza epidemic occurred in England and Wales.

Disease Outbreaks↗
PubMed2003

Screening for hemoglobin disorders in Thai pregnant women by England and Frazer's calculation method.

OBJECTIVE: Our objective was to perform a preliminary study screening for hemoglobin disorders among Thai pregnant women using England and Frazer's calculation method. PATIENTS: One hundred and thirty-five pregnant women who receive antenatal laboratory check-up from the Out-Patient Division, King Chulalongkorn Memorial Hospital. METHODS: Endocrine disruptor testing and assessment (EDTA) blood specimens from each patient were analyzed by two methods in order to screen for inherited hemoglobin disorders. Hemoglobin and genotype analysis was set as the confirmation method. Blood indices investigation performed by automated hematology analyzer was set for England and Frazer's calculation method as the screening method. RESULTS: The sensitivity and specificity of the method using England and Frazer's calculation were 92.3 and 100%. False positive and false negative results were 0% and 7.7%. CONCLUSION: England and Frazer's calculation method can be an alternative method that can help screen for hemoglobin E disorders in pregnant women.

Cost-Benefit Analysis↗
PubMed2002

An outbreak of serious illness and death among injecting drug users in England during 2000.

An outbreak of serious illness and death occurred in injecting drug users during 2000 in Scotland, Ireland and England. National and international collaboration was necessary for the investigation and management of this outbreak. In England and Wales active case-finding was initiated, coupled with standardised data collection and microbiological investigation of cases. Twenty-six definite or probable cases were identified in England between 1 April and 31 Aug. 2000; 17 of these occurred in the North. The overall case fatality was 50% (13/26). The principal apparent risk factor was a history of intramuscular or subcutaneous injection of heroin and the limited duration of the outbreak suggested that the problem might have been related to a particular supply of heroin. Clostridium novyi was isolated from two English cases. Taken in conjunction with contemporaneous microbiological and epidemiological results from Scottish and Irish cases, the probable aetiology for this outbreak was infection with C. novyi associated with both a particular supply of heroin and the method of preparation and injection used. A 'toolkit' was distributed in Sept. 2000 to all Consultants for Communicable Disease Control in England and Wales to assist them with the ongoing surveillance, investigation and management of this condition. Lessons learned have been used to produce guidance for the investigation and management of outbreaks of unexplained serious illness of possible infective aetiology.

Adult↗
PubMed2006

Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival.

BACKGROUND: Time trends in mortality from small intestinal cancer have not been studied for the 1990s. OBJECTIVE: To examine secular trends in incidence of, mortality from, and survival from, small intestinal cancer in England & Wales and Scotland from 1975 to 2002, considering also histological type (incidence), subsite (incidence) and indices of social deprivation (incidence and survival). METHODS: Data were extracted from the Scottish Cancer Registry database and the General Register Office for Scotland, and from the National Cancer Intelligence Centre at the Office for National Statistics for England & Wales. RESULTS: Incidence rates for small intestinal cancer increased for both England & Wales and Scotland over the study period. They were highest among older individuals and generally greater for males than for females. Despite the increase in incidence rates, mortality rates from small intestinal tumours tended to remain stable over the study period, and the general trend was towards increasing survival. Indices of social deprivation were not obviously related to the incidence of small intestinal cancer and did not influence survival. CONCLUSIONS: Incidence rates for small intestinal cancer for both England & Wales and Scotland increased in the last quarter of the 20th century, but survival rates improved and mortality rates declined.

Female↗
PubMed2002

Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63).

OBJECTIVE: To estimate the incremental cost of implementing policies for intensive control of blood glucose concentration and blood pressure for all patients with type 2 diabetes in England. DESIGN: Extrapolation of resource use and cost data derived from a randomised controlled trial. SETTING: General practice, outpatient care, and inpatient care. POPULATION: Trial population with diagnosed type 2 diabetes in England extrapolated to the population of England. MAIN OUTCOME MEASURES: Total costs based on use of healthcare resources including costs of management, treatment, and hospitalisation. RESULTS: The incremental net annual cost of implementing intensive control of blood glucose and blood pressure to all people with diagnosed type 2 diabetes in England is estimated to be pound 100.5m ($156m; euro;159m), which is equivalent to less than 1% of the proposed additional annual expenditure on the NHS in 2001-5. This estimate varied in sensitivity analyses from pound 67m to pound 121m. CONCLUSIONS: Policies to improve control of blood glucose and blood pressure of people with type 2 diabetes are effective in reducing complications associated with the disease and are also cost effective. The total cost represents a small fraction of the NHS's spending plans.

Adult↗