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PubMed1990

Risk of death from cardiovascular disease and chronic bronchitis determined by place of birth in England and Wales.

STUDY OBJECTIVE: The aim of the study was to examine the relation between place of birth within England and Wales and cause of death. DESIGN: The study was a population survey using data provided by the Office of Population Censuses and Surveys which, for a trial period between 1969 and 1972, coded place of birth on death certificates. SETTING: The survey involved almost 2 million people who died in England and Wales between April 1969 and December 1972. MAIN RESULTS: Persons born in northern counties and industrial towns, and in Wales, had increased risk of ischaemic heart disease and stroke, which persisted whether or not they had moved to other parts of the country. A low risk of cardiovascular disease among people born in and around London went with them when they moved. People born in cities and large towns had an increased and persisting risk of chronic bronchitis. CONCLUSIONS: These findings are evidence that past geographical differences in fetal and infant growth, and in exposure to respiratory infection in early childhood, partly determine today's differences in adult death rates.

Bronchitis↗
PubMed1991

Ischaemic heart disease in England and Wales around the year 2000.

STUDY OBJECTIVE: The aim was to predict death rates from ischaemic heart disease in England and Wales during the next 20 years. STUDY DESIGN: Age and sex specific death rates for 1968-1987 were used to predict national and regional trends until 2007. SETTING: The nine standard regions of England and Wales. RESULTS: There will be a large fall in deaths from ischaemic heart disease. The fall will be greater in men and women below 65 years of age. There will, however, be a sharp worsening of the north/south divide. The largest fall in any region will be in Wales. CONCLUSION: The campaign to change the national diet should give highest priority to the norther regions. Because infant growth is inversely related to adult risk of ischaemic heart disease, the poor growth of young children in some northern areas is a cause for concern.

Adult↗
PubMed1993

Maintaining evaluation designs in long term community based health promotion programmes: Heartbeat Wales case study.

STUDY OBJECTIVE: To examine the difficulties of developing and maintaining outcome evaluation designs in long term, community based health promotion programmes. DESIGN: Semistructured interviews of health promotion managers. SETTING: Wales and two reference health regions in England. PARTICIPANTS: Nine health promotion managers in Wales and 18 in England. MEASUREMENTS AND MAIN RESULTS: Information on selected heart health promotion activity undertaken or coordinated by health authorities from 1985-90 was collected. The Heartbeat Wales coronary heart disease prevention programme was set up in 1985, and a research and evaluation strategy was established to complement the intervention. A substantial increase in the budget occurred over the period. In the reference health regions in England this initiative was noted and rapidly taken up, thus compromising their use as control areas. CONCLUSION: Information on large scale, community based health promotion programmes can disseminate quickly and interfere with classic intervention/evaluation control designs through contamination. Alternative experimental designs for assessing the effectiveness of long term intervention programmes need to be considered. These should not rely solely on the use of reference populations, but should balance the measurement of outcome with an assessment of the process of change in communities. The development and use of intervention exposure measures together with well structured and comprehensive process evaluation in both the intervention and reference areas is recommended.

Cardiovascular Diseases↗
PubMed1997

Fatal methadone and heroin overdoses: time trends in England and Wales.

STUDY OBJECTIVE: Although the total number of self poisonings in England and Wales has dropped by 32%, the number involving methadone and/or heroin rose by 900% in 1974-92. Because of concern about the role of methadone in this increase, the part played by methadone and heroin in poisoning deaths in England and Wales in 1974-92 was investigated. DESIGN: A proportional mortality design was used to study whether the ratio between deaths involving methadone or heroin and other substances had increased. The time trend was examined with logistic regression. SETTING: England and Wales, 1974-92. SUBJECTS: Accidental, undetermined, and suicidal poisoning deaths (n = 43,231). MAIN RESULTS: The proportions of poisoning deaths involving methadone (alone or in combination with heroin) rose by 80% (95% CI 69%, 92%) per 3 year period. The proportion of poisoning deaths involving heroin without methadone rose by 76% (95% CI 60%, 93%) per 3 year period. Similar results were obtained when poisoning deaths were examined in relation to gender and legal category (suicide and undetermined versus accidental deaths). CONCLUSIONS: The impact of opiate addiction on rates of death by poisoning is rising quickly. This may reflect the growth of the addict population and is an important public health problem. There is no evidence that methadone's involvement in these deaths has risen disproportionately in relation to that of heroin up to 1992.

Accidents↗
PubMed2003

Social inequalities in low birth weight in England and Wales: trends and implications for future population health.

STUDY OBJECTIVE: To examine social inequalities and trends in low birth weight in England and Wales. DESIGN: Analysis of routine birth data, comparing (a) couple and sole registered births, and (b) manual and non-manual occupational groups. SETTING: England and Wales, 1993-2000. MAIN RESULTS: Social inequalities in low birth weight were evident throughout 1993-2000: relative to the non-manual group, there is an increased risk for the manual group (range in RR 1.22-1.35) and sole registrations (RR 1.51-1.67). An estimated 6.5% (2979 births) of low birth weight in 2000 could have been avoided if risks associated with the manual group were absent, and 2.8% (1290 births) avoided if risks associated with sole registration were absent. Between 1993 and 2000, the low birthweight rate increased significantly with an estimated overall increase of 11%. Increases were evident in all social groups (15% in manual, 11% in sole registrations and 9% in non-manual); however relative to non-manual the increase in RRs were not statistically significant for manual or sole registrations. When multiple births are excluded, the rate of low birth weight is reduced but there is still a significant increase over time and social differentials are undiminished. CONCLUSIONS: There are social inequalities in low birth weight in England and Wales that have not narrowed over an eight year period, 1993-2000. These inequalities are likely to affect childhood and adult health inequalities in the future, hence strategies will need to address differences in low birth weight and further monitoring of trends is therefore desirable.

Birth Weight↗
PubMed1993

Motor neuron disease and multiple sclerosis mortality in Australia, New Zealand and South Africa compared with England and Wales.

There has been a marked increase in the reported mortality from motor neuron disease (MND) but not multiple sclerosis (MS) in England and Wales and in a number of other countries. A comparison has been made of the mortality from MND and from MS for two time periods in Australia, New Zealand and South Africa. An increase in MND mortality occurred in Australia and New Zealand between 1968-77 and 1978-87, greater than that which occurred in England and Wales, but there was no increase in MS mortality. Among the white population of South Africa, the MND mortality was half of that in England and Wales, Australia and New Zealand in both time periods. Both MND and MS mortality is higher in the English-speaking than in the Afrikaans-speaking white South African-born. The marked increase in MND mortality which has now been reported from many countries, is good evidence that an environmental factor is important in causing this disease. The large differences in MND mortality in different populations may be important clues to the environment factors causing the disease.

Adult↗
PubMed1981

Nasal cancer in England and Wales: an occupational survey.

A national survey of the incidence of nasal cancer in England and Wales during the period 1963-7 with special reference to occupation confirmed the well-known increases in incidence of nasal cancer in cabinet makers and wood machinists, together with the absence of any significant increase in carpenters and joiners, and the increases in boot and shoe operatives and repairers, and in nickel smelters in South Wales. The significant excesses of cases found among coalminers, furnacemen in the gas, coke, and chemical industry, and furnacemen and labourers in foundries may be associated with exposure to coal and coke dust or may be spurious. No excess of nasal cancer was found among male textile workers. Excesses of uncertain significance were found among tailors and dressmakers, bakers and pastry cooks, and printers. Apart from the well-known relationships between adenocarcinoma and work in the furniture and footwear industries there is no definite indication in this survey of any association between a particular histological type of nasal tumour and occupation in England and Wales.

Adolescent↗
PubMed1990

Occupation and malignant melanoma: a study based on cancer registration data in England and Wales and in Sweden.

An analysis of the incidence of malignant melanoma according to occupation is presented using data from two national cancer registries. The data relate to 3991 cases of cutaneous malignant melanoma, 662 cases of ocular melanoma, and 179 cases of noncutaneous, non-ocular melanoma in subjects aged 15-64 in England and Wales diagnosed from 1971 to 1978 and to 5003 cases of cutaneous malignant melanoma diagnosed from 1961 to 1979 in Sweden in subjects born between 1896 and 1940. Professional workers of both sexes in both countries experienced an excess incidence of cutaneous malignant melanoma. An excess of ocular melanoma and of non-cutaneous, non-ocular melanoma also existed for this group in England and Wales. Pharmacists, medical doctors, and dentists had a high incidence of cutaneous melanoma in both countries and were represented three times when listing the top 20 occupations in both countries and both genders. Combining the data from cutaneous malignant melanoma over both sexes and both registries the occupations with the highest incidence ratios (expressed as a percentage) were: airline pilots, incidence ratio (IR) = 273, (95% confidence limits 118-538); finance and insurance brokers IR = 245 (140-398); professional accountants IR = 208 (134-307); dentists IR = 207 (133-309); inspectors and supervisors in transport IR = 206 (133-304); pharmacists IR = 198 (115-318); professionals not elsewhere classified IR = 196 (155-243); judges IR = 196 (126-289); doctors IR = 188 (140-248); university teachers IR = 188 (110-302); and chemists IR = 188 (111-296). No particular exposure in the workplace seemed to link these groups and only a few worked in high technology environments. Many of the highest risk groups have in common a high level of education. In England and Wales and in Sweden this might correlate particularly with foreign travel abroad was more unusual than it is now, but evidence on present and past exposure to sun by occupation is needed to clarify the reasons for the association.

England↗
PubMed2000

The burden of infection with HSV-1 and HSV-2 in England and Wales: implications for the changing epidemiology of genital herpes.

OBJECTIVE: To measure the burden of infection with herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2) in the general population of England and Wales and to assess temporal changes in the incidence of HSV-1 infection in childhood. METHODS: 4930 residual blood samples taken from people aged 0-69 years and submitted to 15 public health laboratories in England and Wales between January 1994 and June 1995, and 500 samples taken from people aged 10-14 years between November 1986 and December 1987, were screened for IgG antibody to HSV-1 and HSV-2 using type specific ELISA assays. RESULTS: The prevalence of antibody to HSV-1 in 10-14 year olds declined from 34% in samples collected in 1986-7 to 24% in samples collected in 1994-5 (p < 0.001). HSV-1 antibody prevalence in adults increased with age and was higher in females than males, reaching 54% in females aged 25-30 years in 1994-5. In samples collected in 1994-5 from people aged 16-69 years HSV-2 antibody was detected in sera from 3.3% of men and 5.1% of women. CONCLUSIONS: The incidence of HSV-1 infection in childhood is falling in England and Wales. The prevalence of HSV-2 infection in the general population is low, with the rate of infection significantly lower than that described for the general population in the United States and developing countries. The falling rate of HSV-1 infection in childhood may be one factor contributing to the increasing incidence of genital HSV-1 infection.

Adolescent↗
PubMed2002

An estimate of the contribution of HIV infection to the recent rise in tuberculosis in England and Wales.

BACKGROUND: The number of patients with tuberculosis has been increasing slowly in England and Wales since the late 1980s. HIV infection has been a contributory factor to increases in tuberculosis in a number of comparable industrialised countries. This study investigated the extent of tuberculosis and HIV co-infection in England and Wales in 1993 and 1998, and estimated its contribution to the increase in tuberculosis observed during this period. METHODS: Patients aged 16-54 years old at diagnosis on the 1993 and 1998 National Tuberculosis Survey databases were matched with those on the HIV/AIDS patient database. A coded process maintained patient confidentiality. Primary outcome measures were the increase between 1993 and 1998 in the numbers with both infections reported and an estimate of the proportion of the increase in tuberculosis during this period attributable to HIV co-infection. RESULTS: In 1993 61 (2.2%) tuberculosis patients aged 16-54 years matched with patients reported to the HIV database, increasing to 112 (3.3%) in 1998 (p=0.08; OR 1.35; 95% CI 0.97 to 1.87). Patients co-infected with HIV contributed an estimated 8.5% of the increase in number of tuberculosis patients between 1993 and 1998 nationwide (11% in London). In both years prevalence of co-infection was greatest in London and in patients of white and black African ethnic groups. CONCLUSIONS: In 1998 the number of tuberculosis patients co-infected with HIV in England and Wales, though still small, had nearly doubled since 1993, with most of the increase occurring in London. As HIV infection may be undiagnosed in patients with tuberculosis, and tuberculosis may be unreported in patients with diagnosed HIV infection, the true extent of co-infection will have been underestimated by this study. In addition, constraints in coded matching make it inevitable that some reported co-infections are missed. Routine HIV testing of all patients with tuberculosis should now be considered, particularly in patients of white or black African ethnic origin under 55 years of age.

AIDS-Related Opportunistic Infections↗
PubMed2005

Trends in deaths from respiratory illness in children in England and Wales from 1968 to 2000.

BACKGROUND: Childhood mortality has decreased markedly over the last three decades. A study was undertaken to determine trends in deaths from respiratory illness in children in England and Wales. METHODS: Mortality data collected by the Office for National Statistics were analysed. The data included all deaths registered from all causes in children aged between 28 days and 16 years in England and Wales from 1 January 1968 to 31 December 2000. The main outcome measures were overall and age-specific mortality rates due to all respiratory disorders and specific rates for pneumonia, asthma, cystic fibrosis (CF), and bronchiolitis. RESULTS: In children aged 1-16 years the overall mortality rate (per 100,000 children) declined from 49.9 in 1968 to 16.3 in 2000, and rates due to respiratory illness fell from 8.6 to 1.3. The proportion of all deaths caused by respiratory illness in children aged 28 days to 16 years fell from 30.8% in 1968 to 9.9% in 2000. In post-neonatal infants (aged 28-364 days), the "all cause" mortality rate fell from 592.8 in 1968 to 176 in 2000 and the rates due to respiratory illness fell from 280 to 22.8. In 2000, pneumonia, asthma and CF together accounted for 73% of all respiratory deaths in 1-16 year olds. In this age group, mortality rates per 100,000 for pneumonia fell from 4.22 to 0.57, for asthma from 0.83 to 0.25, and for CF from 0.66 to 0.12 between 1968 and 2000. Over the same period mortality rates for pneumonia in post-neonatal infants fell from 165 to 6.78 per 100,000 and for CF from 4.88 to 0.33. Bronchiolitis mortality rates per 100,000 in post-neonatal infants fell from 21.47 in 1979 to 1.82 in 2000. CONCLUSIONS: Mortality rates due to all respiratory illnesses in children have fallen markedly in the last three decades. This decline has been more rapid than the overall decline in childhood mortality and respiratory diseases are now responsible for a smaller proportion of deaths in children. These data could provide a foundation for assessing the impact on mortality of future health initiatives such as the introduction of a universal pneumococcal vaccination programme in England and Wales.

Adolescent↗
PubMed1992

National survey of notifications of tuberculosis in England and Wales in 1988. Medical Research Council Cardiothoracic Epidemiology Group.

BACKGROUND: A survey was undertaken to determine the distribution of tuberculosis in England and Wales and, by comparison with the findings of similar surveys in 1978-9 and 1983, to study trends in the incidence of the disease by ethnic group over the decade. METHODS: The survey included all cases of tuberculosis in England and Wales newly notified to the medical officers for environmental health during the six months from 2 January to 1 July 1988. Notification rates were calculated from population estimates from the 1988 Labour Force Survey. RESULTS: Clinical details were obtained from the clinician for 2149 (99.4%) of the 2163 newly notified and previously untreated patients. Over 90% were either white (53%) or of Indian, Pakistani, or Bangladeshi ethnic origin (39%). The notification rate in the white population was 4.7/100,000/year, a decline of 7.2% per year since 1978. The rate was 134.6/100,000/year in the population of Indian ethnic origin, and 100.5/100,000/year in that of Pakistani or Bangladeshi ethnic origin, a decline of 6% a year since 1978 for the two groups combined (standardised for age, country of birth, and length of time in the UK). In all ethnic groups rates of disease were much higher in the elderly than in the young. Bacteriological results were available in 1161 (80%) of the 1443 pulmonary cases. In 939 (81%) Mycobacterium tuberculosis was cultured; 614 cases (53%) also had positive smears, of which 424 (69%) were from white patients. CONCLUSIONS: Notification rates for tuberculosis in England and Wales declined over the decade, but major differences remained between ethnic groups.

Adolescent↗
PubMed1993

Tuberculosis and HIV: estimates of the overlap in England and Wales.

BACKGROUND: A study was designed to determine the extent of the interaction between tuberculosis and human immunodeficiency virus infection in England and Wales. METHODS: Data were obtained from the United Kingdom national AIDS surveillance and the Medical Research Council tuberculosis notification surveys in England and Wales (1983 and 1988). The proportion of patients reported with AIDS known to have had tuberculosis and the proportion of patients notified with tuberculosis known to have HIV infection were estimated. RESULTS: Of the 4360 patients with AIDS reported by 30 June 1991, 200 (4.6%) were in patients reported to have had tuberculosis. Only one of the 3002 patients (0.03%) reported in the 1983 survey of tuberculosis notifications in England and Wales was known to be infected with HIV compared with nine of 2163 patients (0.42%) in the 1988 survey. CONCLUSION: Although the reported number of cases of HIV infection with tuberculosis in this country is increasing it remains small. Complete reporting of cases of AIDS and notification of cases of tuberculosis are essential to enable the two infections to be monitored as the HIV epidemic develops. Special studies, such as those reported here, will need to be undertaken regularly to assess the future extent of the interaction.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Tuberculosis in England and Wales in 1993: results of a national survey. Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group.

BACKGROUND: A national survey of tuberculosis notifications in England and Wales was carried out in 1993 to determine the notification rate of tuberculosis and the trends in the occurrence of disease by ethnic group in comparison with the findings of similar surveys in 1978/79, 1983, and 1988. The prevalence of HIV infection in adults notified with tuberculosis in the survey period was also estimated. METHODS: Clinical, bacteriological, and sociodemographic information was obtained on all newly notified cases of tuberculosis in England and Wales during the six months from 2 January to 2 July 1993. The prevalence of HIV infection in 16-54 year old patients with tuberculosis notified throughout 1993 was assessed using "unlinked anonymous" testing supplemented by matching of the register of patients with tuberculosis with that of patients with AIDS reported to the PHLS AIDS centre. Annual notification rates were calculated using population estimates from the 1993 Labour Force Survey. RESULTS: A total of 2706 newly notified patients was eligible for inclusion in the survey of whom 2458 were previously untreated the comparable figures for 1988 were 2408 and 2163. The number of patients of white ethnic origin decreased from 1142 (53%) in 1988 to 1088 (44%) in 1993 whereas those of patients of Indian, Pakistani, or Bangladeshi (Indian subcontinent (ISC)) ethnic origin increased from 843 (39%) in 1988 to 1014 (41%) and those of "other" (non-white, non-ISC) ethnic origins increased from 178 (8%) to 356 (14%). The largest increase was seen in the black African ethnic group from 37 in 1988 to 171 in 1993. Forty nine per cent of patients had been born abroad and the highest rates were seen in those who had recently arrived in this country. The overall annual notification rate for previously untreated tuberculosis in England and Wales increased between 1988 and 1993 from 8.4 to 9.2 per 100,000 population. The rate declined in the white, Indian, and black Caribbean ethnic groups and increased in all other groups. In the white group the rate of decline has slowed since the last survey: in several age groups the rates were higher in 1993 than 1988 but the numbers in these groups were small. Thirty six (4.1%) of the 882 previously untreated respiratory cases were resistant to isoniazid and three (0.3%) to isoniazid and rifampicin. Sixty two (2.3%) adults aged 16-54 years were estimated to be HIV-infected. Evidence of under-reporting of HIV positive tuberculosis patients was found. CONCLUSIONS: The number of cases and annual notification rate for previously untreated tuberculosis increased between 1988 and 1993. Although the decline in rates in the white population has continued, the rate of decline has slowed. The high rates in the ISC ethnic group population have continued to decline since 1988 whereas rates in the black African group have increased. An increased proportion of cases were found among people born abroad, particularly those recently arrived in this country. In previously untreated cases the level of drug resistance remains low and multi-drug resistance is rare. A small proportion of adults with tuberculosis were infected with HIV but there may be selective undernotification of tuberculosis in these patients.

Adolescent↗
PubMed1978

Hydatid disease in Wales: 2. Eradication.

The importance of hydatid disease in man and domesticated animals in Britain, and particularly in Wales, is reviewed. While the disease occurs throughout Wales the rural population in Powys shows the highest rate as estimated by hospital records and serological findings. The losses due to offal condemnation in sheep and cattle are estimated as at least 250,000. It is suggested that the feasibility of an area eradication scheme for Wales should be investigated; the form which this scheme might take is outlined.

Animals↗
PubMed1997

Antibodies to Brucella in marine mammals around the coast of England and Wales.

Following the isolation of previously unrecognised species of Brucella from stranded seals and cetaceans in Scotland and northern England, a serological survey was carried out to investigate the range of marine mammal species which may have been exposed to Brucella species around the coasts of England and Wales, the prevalence of infection and the temporal and geographical distribution of seropositive animals. Serum collected from 153 stranded marine mammals from the coasts of England and Wales between 1989 and 1995 were tested by competitive and indirect ELISA. Positive titres were recorded for six of 62 (10 per cent) grey seals (Halichoerus grypus), one of 12 (8 per cent) common seals (Phoca vitulina), 11 of 35 (31 per cent) harbour porpoises (Phocoena phocoena) and nine of 29 (31 per cent) common dolphins (Delphinus delphis) tested. Positive titres were also found in a striped dolphin (Stenella coeruleoalba), a bottlenose dolphin (Tursiops truncatus), a killer whale (Orcinus orca) and a pilot whale (Globicephala melas). The seropositive animals were from all around the coasts of England and Wales and the first seropositive sample was from a common dolphin in 1990.

Animals↗
PubMed1998

Prevalence of antibodies to bovine virus diarrhoea virus and other viruses in bulk tank milk in England and Wales.

Bulk tank milk samples from 1070 dairy herds in England and Wales were tested by ELISA for antibodies to bovine virus diarrhoea virus (BVDV). A subset of 341 herds was tested by ELISA for antibodies to bovine herpesvirus 1 (BHV-1), bovine respiratory syncytial virus (BRSV) and bovine coronavirus (BCV). None of the herds had less than 40 dairy cows and none had been vaccinated against BVDV. The prevalence of BVDV antibody-positive herds in the national population was estimated at 95 per cent and approximately 65 per cent of the herds had a high level of bulk tank antibody suggestive of recent infection with BVDV. Dairy herds in East Anglia and the south-east of England had a significantly lower risk of being BVDV antibody-positive than herds in the rest of England and Wales. However, these regional differences tended to diminish with increasing herd size. Around 69 per cent of the herds were BHV-1 antibody-positive and all the herds were antibody positive to BRSV and BCV. Comparison with earlier serological surveys revealed that there had been little change in the prevalence and distribution of BVDV antibody-positive herds in England and Wales over the last 20 years, but that there had been an increase in the prevalence of BHV-1 antibody-positive herds.

Animals↗
PubMed2005

Quality of life assessment of growth hormone deficiency in adults (QoL-AGHDA): comparison of normative reference data for the general population of England and Wales with results for adult hypopituitary patients with growth hormone deficiency.

BACKGROUND/AIM: Age- and gender-specific reference values for the quality of life (QoL) measures used in assessing the impact of growth hormone deficiency (GHD) are important. The objective of this study was to develop such data for the QoL-AGHDA instrument for the population of England and Wales and to demonstrate the QoL deficit in patients with GHD. METHODS: For the purpose of this study, a questionnaire was developed that contained the EurQoL EQ-5D, QoL-AGHDA, questions recording an individual's general situation and social functioning, and a self-reported five-point rating scale of general health. The questionnaire was mailed out to a sample of 1,190 individuals drawn from the general population of England and Wales. Corresponding data for 836 patients were retrieved from KIMS (Pfizer International Metabolic Database). The postal survey data were weighted to ensure that they were representative of the general population. RESULTS: The mean weighted QoL-AGHDA scores for the general population were 6.2 and 7.1 for men and women, respectively, compared with 13.6 and 15.7 for patients. For both males and females the differences in mean QoL-AGHDA scores between the general population and patients were statistically significant for all age categories (p < 0.01). In the general population the mean QoL-AGHDA score for each category of self-assessed health status increased progressively, indicating a poorer QoL as health status declined. CONCLUSIONS: This study reports QoL-AGHDA normative values for the population of England and Wales and confirms the extent of QoL impairment in patients with GHD in comparison with the general population.

Adult↗