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PubMed2005

Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'.

OBJECTIVES: To determine the degree to which changing patterns of deprivation in Scotland and the rest of Great Britain between 1981 and 2001 explain Scotland's higher mortality rates over that period. DESIGN: Cross-sectional analyses using population and mortality data from around the 1981, 1991 and 2001 censuses. SETTING: Great Britain (GB). PARTICIPANTS: Populations of Great Britain enumerated in the 1981, 1991 and 2001 censuses. MAIN OUTCOME MEASURES: Carstairs deprivation scores derived for wards (England and Wales) and postcode sectors (Scotland). Mortality rates adjusted for age, sex and deprivation decile. RESULTS: Between 1981 and 2001 Scotland became less deprived relative to the rest of Great Britain. Age and sex standardized all-cause mortality rates decreased by approximately 25% across Great Britain, including Scotland but mortality rates were on average 12% higher in Scotland in 1981 rising to 15% higher in 2001. While over 60% of the excess mortality in 1981 could be explained by differences in deprivation profile, less than half the excess could be explained in 1991 and 2001. After adjusting for age, sex and deprivation, excess mortality in Scotland rose from 4.7% (95% CI: 3.9% to 5.4%) in 1981 to 7.9% (95% CI: 7.2% to 8.7%) in 1991 and 8.2% (95% CI: 7.4% to 9.0%) in 2001. All deprivation deciles showed excess indicating that populations in Scotland living in areas of comparable deprivation to populations in the rest of Great Britain always had higher mortality rates. By 2001 the largest excesses were found in the most deprived areas in Scotland with a 17% higher mortality rate in the most deprived decile compared to similarly deprived areas in England and Wales. Excess mortality in Scotland has increased most among males aged <65 years. CONCLUSIONS: Scotland's relative mortality disadvantage compared to the rest of Great Britain, after allowing for deprivation, is worsening. By 1991 measures of deprivation no longer explained most of the excess mortality in Scotland and the unexplained excess has persisted during the 1990s. More research is required to understand what is causing this 'Scottish effect'.

Adolescent↗
PubMed2006

Estimating diabetes prevalence by small area in England.

BACKGROUND: Diabetes risk is linked to both deprivation and ethnicity, and so prevalence will vary considerably between areas. Prevalence differences may partly account for geographic variation in health performance indicators for diabetes, which are based on age standardized hospitalization or operation rates. A positive correlation between prevalence and health outcomes indicates that the latter are not measuring only performance. METHODS: A regression analysis of prevalence rates according to age, sex and ethnicity from the Health Survey for England (HSE) is undertaken and used (together with census data) to estimate diabetes prevalence for 354 English local authorities and 8000 smaller areas (electoral wards). An adjustment for social factors is based on a prevalence gradient over area-deprivation quintiles. A Bayesian estimation approach is used allowing simple inclusion of evidence on prevalence from other or historical sources. RESULTS: The estimated prevalent population in England is 1.5 million (188 000 type 1 and 1.341 million type 2). At strategic health authority (StHA) level, prevalence varies from 2.4 (Thames Valley) to 4 per cent (North East London). The prevalence estimates are used to assess variations between local authorities in adverse hospitalization indicators for diabetics and to assess the relationship between diabetes-related mortality and prevalence. In particular, rates of diabetic ketoacidosis (DKA) and coma are positively correlated with prevalence, while diabetic amputation rates are not. CONCLUSIONS: The methodology developed is applicable to developing small-area-prevalence estimates for a range of chronic diseases, when health surveys assess prevalence by demographic categories. In the application to diabetes prevalence, there is evidence that performance indicators as currently calculated are not corrected for prevalence.

Age Factors↗
PubMed2006

Emergency call work-load, deprivation and population density: an investigation into ambulance services across England.

Demand for emergency ambulance services has risen steeply over the recent years. This study examined differences in work-load of ambulance services across England and investigated factors linked to high demand. The number of emergency calls received by each ambulance service in 1997 and 2002 and population and area data were used to calculate call rates and population density for each of 27 service areas. Deprivation score and proportion of the population under age 15 and over age 65 were calculated for each service area. There was wide variation in emergency call rates across England, with London having the highest rate both in 1997 (125.6 calls per 1000 persons) and in 2002 (140.1 per 1000). Statistically significant positive associations were observed between call rates and deprivation (1997, r = 0.49; 2002, r = 0.53) and between call rates and population density (1997, r = 0.70; 2002, r = 0.68). Following multivariable regression, the effect of deprivation score was consistently weaker, but the effect of population density was virtually unchanged. We conclude that areas with higher population density have higher call rates, which is not explained by deprivation. Deprivation is associated with higher usage, but its effect is partly due to population density. There is no evidence that these relationships are confounded by age.

Adolescent↗
PubMed2006

The effects of surgical volumes and training centre status on outcomes following total joint replacement: analysis of the Hospital Episode Statistics for England.

OBJECTIVE: Previous work from other countries has shown a significant inverse relationship between the number of some surgical procedures undertaken in a hospital and in an adverse outcomes. In the light of the changing nature of the provision of joint replacements in the United Kingdom, we have examined the effects of surgical volumes and the presence/absence of training centre status, on outcomes following total joint replacement (TJR) in England. METHODS: Analysis of the Hospital Episode Statistics (HES) on all hip/knee joint replacements in English National Health Service (NHS) trusts between financial years 1997 and 2002. Exposures explored were the volume of hip/knee replacements per annum in an NHS trust, training centre status and whether the admission was routine or emergency. Four surrogate measures of adverse outcome were assessed: 30-day in-hospital mortality, length of stay in hospital, readmission within a year and surgical revision within 5 years. Age and sex were controlled for as potential confounders. RESULTS: Data from a total of 281 360 hip replacements and 211 099 knee replacements were examined. HES data show that the numbers of TJRs performed in low volume trusts are small and decreasing. Adverse outcomes were also uncommon. Nevertheless, significant associations between adverse outcomes and low volume units, and better outcomes in training centres, were detected. For example, the odds ratio (OR) for in-hospital death within 30 days of hip replacement in trusts doing <50 hip/replacements per annum is 1.98 [95% confidence interval (95% CI) = 1.13-3.47] compared with trusts doing 251-500 operations/annum. Similarly, surgery in non-training centres is more likely to result in mortality than that in training centres (OR = 1.25, 95% CI = 1.05-1.48). The examination of surgical revision indicated adverse outcomes in higher volume units; this may be due to case-mix. CONCLUSION: In England, there are fewer adverse events following TJR in high volume centres and in orthopaedic training centres. Standardization of procedures may account for this finding. The data have implications for private practice in the United Kingdom and for the current move to undertake TJRs in Independent Sector Treatment Centres.

Arthroplasty, Replacement, Hip↗
PubMed2006

Trends in the treatment of breast cancer in Southeast England following the introduction of national guidelines.

There is little published evidence on trends in the treatment of breast cancer in England following the publication of the Calman-Hine report in 1995. Reliable national data are available for women with screen-detected breast cancer, but data on women presenting symptomatically have been difficult to collect. Using data from both a clinical audit database and a population-based cancer register, we show that between 1996 and 2003 the rates of mastectomy and chemotherapy treatment for women with breast cancer in Southeast England have increased marginally, whereas there has been a steady decline in the use of hormone therapy and radiotherapy recorded within 6 months of diagnosis.

Antineoplastic Agents↗
PubMed2006

Trends in the prescription and cost of diabetic medications and monitoring equipment in England 1991-2004.

BACKGROUND: To report the trend in prescriptions and cost of antidiabetic drugs and glucose monitoring equipment in England from 1991 to 2004. METHODS: We analysed data on all community antidiabetic drug prescriptions in England collated from the Prescription Cost Analysis system. RESULTS: The total number of diabetes prescriptions (medicines and monitoring) rose from 7,613,000 (1991) to 24,325,640 (2004) (>300% increase). Meanwhile, total costs increased by 650%. Insulins are the biggest contributor to cost followed by monitoring equipment and then oral medications. Three times as many items of oral tablets are prescribed than insulins. Metformin accounts for 40% of all diabetic drug dispensations but only 7% of the costs. More is spent on glitazones now than on either metformin or sulphonylureas. CONCLUSIONS: There has been a substantial increase in the cost of managing diabetes in the community. Costs are likely to continue to rise in the future, as the prevalence of diabetes increases and through more aggressive identification and management of patients with diabetes in the hope of reducing the even more costly complications. The cost implications of glucose monitoring merits further study.

Administration, Oral↗
PubMed1997

Mortality from aortic aneurysm in migrants between counties of England and Wales: evidence for causes acting early in life.

We assessed whether the causes of aortic aneurysm underlying its distinctive geographical distribution in England and Wales act early or later in life from the OPCS data on deaths in England and Wales during April 1969-December 1972. From these data, we calculated proportional mortality ratios (PMRs) for aortic aneurysm by county of birth and county of death, for men and women aged 45-74. Among people resident in the county of their birth, PMRs for aortic aneurysm by county ranged from 31 in Pembrokeshire to 194 in Surrey. Among 'migrants', who died in a different county from that in which they were born, PMRs by place of death varied from 85 in the group of counties which had the lowest mortality in non-migrants to 111 in those with the highest mortality in non-migrants, and PMRs by place of birth varied from 74 in counties with lowest mortality in non-migrants to 113 in those with highest mortality in non-migrants. After adjustment for place of residence at death, the relation of mortality to place of birth was highly significant statistically (P < < 0.001). These findings indicate important causes of aortic aneurysm acting early in life, perhaps related to the formation of elastin in the arterial wall.

Aged↗
PubMed2003

Sudden, unexpected cardiac or unexplained death in England: a national survey.

BACKGROUND: Post-mortem examinations of adults who were apparently healthy but died suddenly and unexpectedly sometimes reveal no morphological abnormalities to explain their deaths. The frequency of such unexplained deaths in relation to other causes of sudden cardiac death is not known. AIM: To estimate the frequency of sudden unexpected cardiac or unexplained death in England. DESIGN: Prospective survey using a stratified random sample of 83 of the 132 H.M. Coroner's jurisdictions in England. METHODS: Consecutive White Caucasians, aged 16-64 years, with no medical history of cardiac disease, seen alive within 12 h of death, on whom autopsy found either a cardiac or no identifiable cause of death, were included. The coroner's officer sent a copy of the post-mortem report and a completed case registration form to the investigators, with tissue samples. RESULTS: Sixty-seven (81%) coroners participated, each maintaining prospective surveillance for 4 months. Of 692 ascertained cases, case registration forms were received for 650 (94%), post-mortem reports for 682 (99%), blood samples for 569 (82%), myocardial slices for 517 (75%) and whole hearts for 47 (7%). In cases with myocardial tissue, death was ascribed to ischaemic heart disease in 465 (82.4%). In 43.1% the ischaemia was acute, in 19.1% there was myocardial scarring but no acute ischaemia, and 20.2% had coronary atheroma only. Death was due to left ventricular hypertrophy in 32 (5.7%), to other cardiac causes in 30 (5.3%) and in 23 (4.1%) there was no clear cause. Those with cardiac causes were 81% male, median ages 55.9 (male) and 56.6 (female) years. The 23 unexplained deaths were 57% female, median ages 40.5 (male) and 54.9 (female) years. The estimated annual frequency of sudden unexpected death due to cardiac or unidentified causes, in English adults of employment age, was 11/100,000 (3481 annual deaths). DISCUSSION: In 4.1% of sudden unexpected deaths under 65 years, no cause was found. Until it becomes accepted practice to identify these cases by a name, such as Sudden Adult Death Syndrome (SADS), it will not be possible to study their aetiology systematically.

Adolescent↗
PubMed2005

Self-poisoning suicides in England: a multicentre study.

BACKGROUND: Suicide by self-poisoning is an important cause of death worldwide. A substantial proportion of those with a fatal outcome may come into contact with medical services before they die. AIM: To estimate the proportion of self-poisoning suicides who reached hospital alive; to compare those who reached hospital alive with those who did not; to describe in detail the clinical characteristics and medical management of those dying in hospital. DESIGN: Retrospective audit. METHODS: We studied 24 coroners' jurisdictions across England, reviewing coroners' files and identifying all suicides by self-poisoning (drugs and other ingestible poisons) from 1 January 2001 to 31 December 2001. RESULTS: Of the 214 individuals who completed suicide by self-poisoning during the study period, 49 (23%) reached hospital alive. Those reaching hospital were more likely to be female, more likely to have ingested paracetamol and less likely to have ingested co-proxamol. In the hospital sample, the commonest causes of death were respiratory (n = 10), hepatic or hepatorenal (n = 8), cardiac (n = 5), or a result of hypoxic brain injury (n = 5). Only 18% of in-hospital deaths occurred within 24 h of the overdose. DISCUSSION: Extrapolating to England as a whole, we might expect 300 self-poisoning suicides per year to reach hospital alive (6% of all suicides). Improved medical management might produce a small but significant reduction in the rate of suicide. Such interventions should not be restricted to the emergency care domain. Further research will help to clarify the likely contribution of improved medical management to suicide prevention.

Adult↗
PubMed1987

Mortality from systemic lupus erythematosus in England and Wales, 1974-1983.

Mortality rates from systemic lupus erythematosus (SLE) in England and Wales were estimated from Office of Population Censuses and Surveys data from 1974 to 1983, by age and sex. Age-specific average annual mortality rates showed unimodal distributions for both sexes with maximal death rates in the 65-74-year age groups. The overall age-adjusted mortality rate for females was about four times that in males, 3.94 versus 1.02 per million person-years, respectively. Examination of individual age-specific rates showed an early sharp rise in females producing female-to-male ratios which exceeded 10 in the 25-34-year age group. Age-adjusted annual mortality rates in females significantly declined during the 10-year interval studied from 4.47 to 2.99 per million person-years (p = 0.0083). These patterns of mortality from SLE observed in England and Wales are comparable to those reported among Caucasians in the United States during a similar time period.

Adolescent↗
PubMed1997

Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period.

Data from 1158 cases of septic arthritis reported to the Public Health Laboratory Service (PHLS) Communicable Disease Control Centre (CDSC) from England and Wales over a 4 yr period (January 1990 December 1993) are presented. Reports where a bacterial organism was isolated from synovial fluid, or where an organism was isolated from blood cultures where a diagnosis of septic arthritis was reported, were examined. Reports of infection were more common in children (12.7% of infections were in the under 10 age group) and the elderly (54.7% aged 60 or over), and were higher in males in all age groups except in the elderly. The most common causative organisms remain staphylococcal and streptococcal species, comprising 40.6% (470) and 28% (324) of cases, respectively. The most common streptococci seen were Streptococcus pneumoniae and Lancefield group A beta-haemolytic Streptococcus organisms, 60.8% (197/324), although group B, C and G organisms accounted for 33.6% of streptococcal isolates (109/324). Haemophilus influenzae septic arthritis is not exclusive to children as 23.2% (16-69) of cases occurred over the age of 15. A total of 48% (635) of isolates were identified from both synovial fluid and blood cultures, 32.6% (378) from joint fluid alone and 12.5% (146) from blood cultures. Although this study excludes cases of septic arthritis where no organism was isolated, it presents important bacteriological information from a large number of isolates from England and Wales over a 4 yr period. Risk factors identified include a joint prosthesis, joint disease/connective tissue disorder. immunosuppression and diabetes.

Adolescent↗
PubMed2004

A study of the prevalence of systemic sclerosis in northeast England.

OBJECTIVES: We aimed to obtain an estimate of the prevalence and demographics of systemic sclerosis (SSc) and its subtypes at the turn of the millennium. METHODS: Case finding from multiple sources from a defined geographical area. Diagnosis confirmed by clinical examination. RESULTS: The crude prevalence of SSc in northeast England was 8.8 (95% CI: 6.8-10.8) per 100,000. The prevalence when adjusted for the entire UK is 8.2 (95% CI: 6.2-9.8) per 100,000. The ratio of women to men was 5.2:1. The median age of patients was 57.1 yr. The ratio of limited cutaneous SSc to diffuse cutaneous SSc was 4.7:1. Limited cutaneous SSc is associated with the presence of anticentromere antibodies; diffuse cutaneous SSc is associated with anti-Scl 70 antibodies, but either antibody was found in either form of SSc. CONCLUSIONS: SSc appears to be more common in northeast England than was found in the West Midlands in 1986. This may reflect changes in the diagnostic definition of SSc.

Adolescent↗
PubMed2000

Patients' rights and the law of contract in eighteenth-century England.

The study of 34 lawsuits between practitioners and patients shows how the law relating to contracts was brought to bear on convicts over medical practice in eighteenth-century England. It shows that patients in this period had rights, and explores them though the practice of the courts. The article illuminates two substantial changes: the decline of the contract of cure, and the creation of the patient's right to disregard bills for fees from physicians and apothecaries. It argues that the common law created a medical market-place that was differentiated by the legal status of the patient, and that this affected the character of many healing relationships, even though the legal scrutiny of a patient-practitioner encounter was a relatively infrequent occurrence. The inability of married women and minors to make contracts, along with the legal and customary responsibility of employers for the health of servants and apprentices, meant that many patients in eighteenth-century England were not the autonomous consumers of medical care that existing histories of the patient in this period suggest. The essay thus investigates the impact of the law on the culture of medicine, whilst using legal sources to address questions about power in healing relationships.

Contracts↗
PubMed1992

Two methods for assessing the risk-factor composition of the HIV-1 epidemic in heterosexual women: southeast England, 1988-1991.

OBJECTIVE: The prevalence of HIV-1 in the heterosexual population in southeast England between 1988 and 1991 was examined using two methods. DESIGN AND METHODS: First, district neonatal seroprevalence was compared on a geographical basis to social and demographic variables reflecting risk-factor prevalence. Second, over the same period eight children who developed AIDS within the first 12 months of life were born. RESULTS: The differences in seroprevalence between districts could be explained by the proportion of livebirths to women born in parts of Africa. An estimated 92% of neonatal seropositives could be associated with this demographic variable. The proportions of livebirths to women born in other countries, the prevalence of notified injecting drug use, and area measures of social deprivation, were only poorly related to HIV seroprevalence, and had no additional explanatory value. Seven of the eight (87.5%) children who developed AIDS in the first year were born to black women from Africa. CONCLUSIONS: Both methods suggest that a high proportion of heterosexually transmitted HIV in southeast England has been imported.

Adult↗
PubMed1993

Risk behaviour, anti-HIV and anti-hepatitis B core prevalence in clinic and non-clinic samples of gay men in England, 1991-1992.

OBJECTIVE: To describe the sexual risk behaviour of and HIV and hepatitis B antibody prevalence in gay men in England. DESIGN: Cross-sectional. RESPONDENTS: Gay men recruited from community settings (bars, clubs, gay organizations) and genito-urinary clinics in London, Manchester, the Midlands and Bristol; men who participated in an earlier study. METHODS: Interview including demographic information, sexual behaviour, partner type and health service use. Subjects donated saliva, which was screened for antibodies to HIV-1 by immunoglobulin G (IgG) antibody capture enzyme-linked immunosorbent assay (GACELISA) and to hepatitis B core (HBc) antigen by IgG antibody capture radioimmunoassay (GACRIA). RESULTS: Ninety-four out of 580 (16.2%) men were HIV-antibody-positive; 6.2% of men aged < or = 25 years were positive versus 19.5% of men aged > or = 26 years. HIV-antibody prevalence was highest in London (21.1%), and twice that previously reported outside London (10.5%). Ninety-four out of 568 (16.5%) men were HBc-antibody-positive; 6.9% of men aged < or = 25 years were positive versus 19.7% of men aged > or = 26 years. Anti-HBc prevalence was highest in London (19.8 versus 12.7% outside London). Manual workers were more likely to be anti-HBc-positive, as were men who reported recent high-risk intercourse. Sexually transmitted diseases associated with frequent partner change (gonorrhoea, non-specific urethritis) were reported. CONCLUSION: The HIV epidemic in gay men in England continues, particularly outside London, where prevalence was double that of previous studies. We found relatively high rates of infection in young men whose main sexual experience has been in a time of unprecedented awareness of AIDS. Our data on hepatitis B suggests that further pro-active immunization programmes are urgently required. These findings add to concerns about provision of interventions targeting gay men.

Adult↗
PubMed1993

HIV infection in injecting drug users attending centres in England and Wales, 1990-1991.

OBJECTIVE: To monitor trends in HIV infection and associated risk behaviours in injecting drug users (IDU) in England and Wales. DESIGN: Ongoing voluntary unlinked anonymous cross-sectional survey. METHOD: IDU attending centres in 1990 and 1991 were invited to complete a brief questionnaire requesting demographic and behavioural information, and to provide a saliva sample to be tested for antibodies to HIV and to the core antigen of hepatitis B virus (HBV). RESULTS: In 1990, 1.2% (19 out of 1543) of samples from 33 centres, and in 1991 1.8% (25 out of 1417) of samples from 37 centres contained antibody to HIV. Antibody t9 HBV core-antigen was found in 33 and 31% of IDU in 1990 and 1991, respectively. The prevalence of HIV infection in IDU attending centres in London (4.2%) was higher than in those attending centres elsewhere (0.8%). The prevalence of HIV infection in 1991 varied between individual centres from 0 to 10.6%, and at many centres outside London no IDU were infected with HIV. In the same year the prevalence of past infection with HBV varied from 14 to 54%, and IDU who had evidence of HBV infection were found among attenders in nearly all centres. The prevalences of sharing injecting equipment and risky sexual behaviour were high at many centres. The prevalence of HIV infection was higher in IDU who had started to inject in 1985 or earlier, than in those who started injecting later. In each year, approximately half the IDU surveyed reported having had a voluntary confidential HIV-antibody test, and the prevalence of HIV infection was five times higher in those tested than in those who had not been tested. CONCLUSIONS: HIV prevalence in IDU attending centres in England and Wales was low in 1990-1991. There is some indication that IDU have modified their injecting or sexual behaviour, but even at existing reduced levels of risk behaviour, transmission can occur in HIV is introduced into previously unexposed groups.

Adolescent↗
PubMed1998

An evaluation of partner notification for HIV infection in genitourinary medicine clinics in England.

OBJECTIVE: To evaluate the feasibility and effectiveness of a standardized HIV partner notification programme within genitourinary medicine clinics in England. DESIGN: A prospective survey of HIV partner notification activity over a 12-month period. SETTING: Nineteen genitourinary medicine clinics in England. PATIENTS AND PARTICIPANTS: A total of 501 eligible HIV-positive patients (either newly diagnosed or with whom partner notification had not been undertaken previously) seen during the study period. MAIN OUTCOME MEASURES: The numbers of partners named by patients, and the number of contacts notified, counselled and HIV-tested. RESULTS: Information on overall partner notification activity was obtained by reviewing available medical records of 471 patients; 353 (75%) had discussed partner notification with a health-care worker during the study period and 197 (42%) had undertaken partner notification. Detailed information on outcomes was obtained for only 70 patients who named 158 contacts as being at risk of acquiring HIV. Although 71 (45%) contacts were eventually notified, only 28 were subsequently seen in participating clinics. Almost all contacts (n = 27) requested HIV counselling and testing, and five were diagnosed HIV-positive. Patient referral was the most popular notification method chosen. CONCLUSIONS: This study illustrates some of the practical difficulties that limit HIV partner notification within genitourinary medicine clinics. These include health-care workers' misgivings about undertaking partner notification, insufficient locating information to identify contacts, and migration of newly diagnosed patients, which prevents continuity and completion of notification. Nevertheless, HIV partner notification uncovered previously undiagnosed HIV infections. Further work needs to be undertaken in staff training and policy implementation if higher rates of partner notification and outcome measurements are to be achieved.

Adolescent↗
PubMed1997

Blood pressure in women using oral contraceptives: results from the Health Survey for England 1994.

OBJECTIVE: To assess whether the blood pressure is higher among women who take oral contraceptives than it is among those who do not. DESIGN: A cross-sectional survey of a stratified random sample of English adults (aged > or = 16 years). SETTING: Non-institutionalized households in England during 1994. PARTICIPANTS: From this sociodemographically representative sample of English adults, 3545 premenopausal women, of whom 892 were current users of oral contraceptives, were evaluated. INTERVENTIONS: An interviewer-administered questionnaire determined details of menopausal status, use of oral contraceptives and antihypertensive agents and other sociodemographic variables. Measurements of the weight, height and blood pressure (the mean of the last two of three readings taken with a Dinamap 8100 device) were recorded. MAIN OUTCOME MEASURES: Systolic and diastolic blood pressures adjusted for potential confounders by oral-contraceptive-user status. RESULTS: Mean blood pressures adjusted for age were significantly higher among oral contraceptive users (125/70 mmHg) than they were among non-users (123/68 mmHg, P < 0.001 both for systolic and for diastolic blood pressures). These results remained unchanged after further adjustment for the body mass index, alcohol intake, physical activity and hypertension treatment. Blood pressure differences tended to be larger among older oral contraceptive users. Oral contraceptives containing progestogen only were not associated with higher blood pressures. CONCLUSIONS: Despite the fact that most combined oral contraceptives in current use in England contain low doses of oestrogen, slightly but significantly higher blood pressures were observed among oral contraceptive users. Blood pressures should be screened before oral contraceptives are supplied and should be monitored regularly during oral contraceptive use.

Adolescent↗