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PubMed1992

A comparison of perinatal outcome, antenatal and intrapartum care between England and Wales, and France.

OBJECTIVE: To compare the national statistics of England and Wales with the national statistics of France, and see if there are significant differences in obstetric care resulting in a significantly different perinatal outcome. DESIGN: Retrospective analysis of national statistics 1970-1989 (latest available figures) relating to perinatal outcome, antenatal and intrapartum care. SETTING: HIPE and DoH statistics (England and Wales); INSERM statistics (France). SUBJECTS: Pregnant women residents of England and Wales, and of France. INTERVENTIONS: Different aspects of obstetric care for which comparable data were available from national statistics. MAIN OUTCOME MEASURES: Perinatal mortality rate, incidence of low birth weight and preterm delivery; type of antenatal care, number of antenatal visits and in-patient admission rate; induction of labour rate, incidence of acceleration of labour with oxytocin, incidence of spontaneous and operative deliveries and person undertaking delivery; episiotomy rate and postnatal in-patient stay. RESULTS: More antenatal intervention and marginally less intrapartum intervention in England and Wales as compared with France. No significant difference in the perinatal mortality rate, in the incidence of low birth weight or preterm delivery, with similar trends being observed over the two decades. CONCLUSION: Significant differences in obstetric practices between the two countries without a major difference in perinatal outcome.

England↗
PubMed1996

Maternal mortality in England and Wales 1970-1985: an analysis by country of birth.

OBJECTIVE: To determine the risk of maternal mortality in immigrants to England and Wales. DESIGN: Analysis of death registrations, 1970-1985, by country of birth. SETTING: England and Wales. POPULATION: Women dying in England and Wales during pregnancy, childbirth or the puerperium, or dying from malignant tumour of the placenta. MAIN OUTCOME MEASURES: The risk of dying in pregnancy, childbirth or the puerperium, adjusted for age and year of death, and the risk of cause-specific death, adjusted for age, in immigrants compared with women born in England and Wales. RESULTS: Women born in West Africa (relative risk 10.3; 95% CI 8.0-13.2) and the Caribbean (4.6; 3.8-5.7) were at very elevated risk of maternal death and of the main causes of death. Women from Southern Asia (1.6; 1.3-2.0) and "Europe and the USSR' (1.7; 1.2-2.3) were at moderate risk. Adjustment for year of death increased the estimates of risk and women born in the "Rest of the World' and Scotland were at significantly elevated risk. CONCLUSIONS: An increased incidence of obstetric conditions in immigrant groups may account for the elevated risk but it is also possible that differences in care may account for some of the additional risk. The pattern of increased risk does not appear to be explicable by the parity or social class distribution of immigrants as far as data are available on these. Research is required into the aetiology of the differential incidence of obstetric disease. The collection of routine mortality data which include maternal reproductive and social factors would elucidate the significance of such factors to maternal health. Further investigation into possible differences in the process of antenatal care between immigrants and non-immigrants is required, and into whether this affects the risk of maternal mortality.

Adult↗
PubMed2001

Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales.

OBJECTIVE: To present recent trends in cervical and uterine cancer adjusted for true population at risk, using accurate estimates of the prevalence of hysterectomy where the cervix has been removed or not. To describe trends and projections of hysterectomy incidence and prevalence with and without cervix removal. DESIGN: Collation of available NHS and private sector information. SETTING: England and Wales. SAMPLE: NHS operations from Hospital Inpatient Enquiry, Hospital Episode Statistics and Hospital Activity Analysis for England and Wales. Private sector data from surveys with up to 97% coverage. METHODS AND MAIN OUTCOME: Measures NHS data by 5-year age group, year and operation type were collated for 1961-1995. non-NHS operations for 1981, 1986, and 1992/3 were back-projected. Hysterectomy incidence rates, 1961-95, were back-projected to estimate prevalence rates by accumulation. True populations at risk of disease and hysterectomy were calculated by applying one minus the relevant hysterectomy prevalence rates to the population by age group and year. RESULTS: When based on the true population at risk, the age standardised cervical cancer incidence rate in 1992 was 14.4 per 100,000, compared with 12.6 when based on the all women population estimate. Incidence rates for earlier years were also affected, but there was no important effect on the rate of change over time. Absolute changes for uterine cancer are greater because the true population at risk is proportionally smaller particularly at the older ages, but there are again no major effects on the rate of change. By 1995 2.3 million women in England and Wales were without a uterus, with a peak prevalence of 21.3% in the age group 55-59. Projections based on 1995 incidence rates show hysterectomy prevalence for the screened age groups, 25-64, will now fall. Subtotal hysterectomy is 3.5% of operations and increasing. CONCLUSIONS: True populations at risk must be used to assess the impact of screening if further reductions in cervix cancer incidence rates are not to be masked. It is essential to monitor hysterectomy by type, as subtotal hysterectomy is becoming more common. Hysterectomy incidence may have peaked. Hysterectomy prevalence in England and Wales may not be as high as would be estimated from some regional studies.

Adolescent↗
PubMed1990

Pap smear usage in New South Wales--impact of active promotion.

Less than 25 per cent of eligible Australian women have cervical ('Pap') smear tests in any year. Rates are particularly low (less than 8%) for women over 55 years, the group at highest risk of cervical cancer. A regional program, actively promoting Pap smears by widespread direct community intervention and attention to service needs, targeting women over 55 years and under 25 years, was conducted on the North Coast (population 132,000 women) immediately after a New South Wales State-wide media campaign in February 1988. The number of Pap smears done in the region increased 119 per cent for women over 55 years and 44 per cent for 15-24 year-olds during the promotion (63% overall) compared to New South Wales increases of 58 per cent for women over 55 years and 23 per cent for 15-24 year-olds (31% overall). Differences between the North Coast and New South Wales were statistically significant for all age groups in March and in April for women over 55 years. Differences between New South Wales and Australia (no active promotion) were significant for women over 55 years in March and April. Records from a sample of 152 women attending clinics during the campaign showed 63 per cent had not had a smear test for three or more years, 10 per cent never.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Teenage pregnancy and fertility in New South Wales: an examination of fertility trends, abortion and birth outcomes.

This paper reviews the data available in New South Wales on teenage fertility rates and pregnancy outcomes. Teenage births comprise six per cent of all births in New South Wales, but they constitute a significant public health problem because they are associated with elevated rates of adverse pregnancy outcomes, which include low birthweight, perinatal death and pre-eclampsia. Risk is concentrated in females under 18 years of age. Pregnancy outcomes for females aged 18 to 19 years are similar to those of women aged 20 to 24 years. Teenage fertility rates have remained stable since the mid-1980s, following a decline which began in the early 1970s. There are large geographic variations in teenage fertility within the state, with the highest rates in the far west of New South Wales and in western Sydney. Teenage pregnancy in New South Wales (as distinct from fertility which reflects births) cannot be assessed accurately because of the lack of information on terminations of pregnancy. However, available data suggest that teenage pregnancy rates have not increased during the 1980s.

Abortion, Induced↗
PubMed1981

Survey of sickle-cell disease in England and Wales.

The incidence and the clinical course of patients suffering from sickle-cell syndrome (Hb SS; Hb SC; Hb S thal) in England and Wales are not known. In 1979 an ad hoc committee was formed to investigate these problems. Initially, a questionnaire was sent to 227 haematologists in England and Wales to determine the number of cases in these countries. The replies have indicated that 1367 cases were seen in 1978 and 1979. Probably this may represent only half the total number of cases. From this survey it has been possible to draw up a composite map showing the location of patients, which has provided a basis to determine the clinical course of the disease, and for further studies into the complications and management of sickle-cell disease in England and Wales. From a second questionnaire preliminary data about the general management and mortality in England and Wales have been recorded.

Adolescent↗
PubMed1992

Potential for cadaveric organ retrieval in New South Wales.

OBJECTIVES: To measure the potential for cadaver organ retrieval in New South Wales and to determine the reasons for potential donors failing to become actual donors. DESIGN: Prospective audit of all patients dying in five hospitals in New South Wales between 1 December 1989 and 30 November 1990; quality assurance of the data by independent medical specialist and if disagreement by study committee. PATIENTS: 2879 patients (100% of all deaths) yielding 364 patients with coma and 181 potential donors. OUTCOME MEASURES: Realistic medically suitable potential donor rate, missed potential donor rate, rate of potential donors with permission refused, donor rate, reasons for realistic medically suitable potential donors failing to become actual donors. RESULTS: 2879 deaths yielded 73 medically suitable potential donors, resulting in 19 actual donors, 30 missed potential donors, 19 potential donors with permission refused, and five in whom adequate resuscitation failed. The most common reason for a potential donor failing to become an actual donor was a decision by the senior medical practitioner to withdraw or not to institute ventilatory or haemodynamic support (26/73). The second major obstacle was refusal of permission by the next of kin (17/73). Assuming that the potential donor rate was that implied by the observed donor rate (13/million population/year) the projected missed potential donor rate was 9/million population/year (95% confidence interval 4 to 15) and the projected rate of potential donors with permission refused was 13/million population/year (95% confidence interval 5 to 22). Assuming that the rate of potential donors in the study hospitals was the same as in the other New South Wales hospitals, the projected donor rate for New South Wales was 18/million population/year (10 to 26); the projected missed potential donor rate was 15/million population/year (7 to 23); and the projected rate of potential donors with permission refused was 18/million population/year (10 to 27). CONCLUSIONS: The donor rate could be increased 70%-80% by overcoming the reluctance of medical practitioners to resuscitate missed potential donors and increased further by gaining permission for organ retrieval from the next of kin.

Cadaver↗
PubMed1995

Increasing incidence of tuberculosis in England and Wales: a study of the likely causes.

OBJECTIVE: To examine factors responsible for the recent increase in tuberculosis in England and Wales. DESIGN: Study of the incidence of tuberculosis (a) in the 403 local authority districts in England and Wales, ranked according to Jarman score, and (b) in one deprived inner city district, according to ethnic origin and other factors. SETTING: (a) England and Wales 1980-92, and (b) the London borough of Hackney 1986-93. MAIN OUTCOME MEASURE: Age and sex adjusted rate of tuberculosis. RESULTS: In England and Wales notifications of tuberculosis increased by 12% between 1988 and 1992. The increase was 35% in the poorest 10th of the population and 13% in the next two; and in the remaining 70% there was no increase. In Hackney the increase affected traditionally high risk and low risk ethnic groups to a similar extent. In the "low risk" white and West Indian communities the incidence increased by 58% from 1986-8 (78 cases) to 1991-3 (123), whereas in residents of Indian subcontinent origin the increase was 41% (from 51 cases to 72). Tuberculosis in recently arrived immigrants--refugees (11% of the Hackney population) and Africans (6%)--accounted for less than half of the overall increase, and the proportion of such residents was much higher than in most socioeconomically deprived districts. The local increase was not due to an increase in the proportion of cases notified, to HIV infection, nor to an increase in homeless people. CONCLUSIONS: The national rise in tuberculosis affects only the poorest areas. Within one such area all residents (white and established ethnic minorities) were affected to a similar extent. The evidence indicates a major role for socioeconomic factors in the increase in tuberculosis and only a minor role for recent immigration from endemic areas.

Asia↗
PubMed1996

Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995.

OBJECTIVE: To assess the prevalence of antibiotic resistance and serotype distribution among pneumococci in England and Wales in 1990 and 1995. DESIGN: Observational surveys in March 1990 and March 1995. During two weeks in each survey period all pneumococci isolated in public health laboratories in England and Wales were collected and assessed for sensitivity to antibiotics and the distribution of serogroups or serotypes. SETTING: The network of public health laboratories throughout England and Wales. SUBJECTS: 1127 individual patient isolates of Streptococcus pneumoniae obtained during the two surveys. MAIN OUTCOME MEASURES: Sensitivity or resistance to a range of antibiotics; serogroup or serotype. RESULTS: The prevalence of intermediate or full resistance to penicillin increased from 1.5% in 1990 to 3.9% in 1995 and resistance to erythromycin increased from 2.8% to 8.6%. About 92% of isolates belonged to serogroups or serotypes included in the currently available pneumococcal vaccine. CONCLUSION: Resistance to penicillin and erythromycin has increased among pneumococci in England and Wales. Continued surveillance to assess further increases in the prevalence of pneumococcal resistance to antibiotics is essential.

Anti-Bacterial Agents↗
PubMed2005

Childhood cancer in relation to distance from high voltage power lines in England and Wales: a case-control study.

OBJECTIVE: To determine whether there is an association between distance of home address at birth from high voltage power lines and the incidence of leukaemia and other cancers in children in England and Wales. DESIGN: Case-control study. SETTING: Cancer registry and National Grid records. SUBJECTS: Records of 29 081 children with cancer, including 9700 with leukaemia. Children were aged 0-14 years and born in England and Wales, 1962-95. Controls were individually matched for sex, approximate date of birth, and birth registration district. No active participation was required. MAIN OUTCOME MEASURES: Distance from home address at birth to the nearest high voltage overhead power line in existence at the time. RESULTS: Compared with those who lived > 600 m from a line at birth, children who lived within 200 m had a relative risk of leukaemia of 1.69 (95% confidence interval 1.13 to 2.53); those born between 200 and 600 m had a relative risk of 1.23 (1.02 to 1.49). There was a significant (P < 0.01) trend in risk in relation to the reciprocal of distance from the line. No excess risk in relation to proximity to lines was found for other childhood cancers. CONCLUSIONS: There is an association between childhood leukaemia and proximity of home address at birth to high voltage power lines, and the apparent risk extends to a greater distance than would have been expected from previous studies. About 4% of children in England and Wales live within 600 m of high voltage lines at birth. If the association is causal, about 1% of childhood leukaemia in England and Wales would be attributable to these lines, though this estimate has considerable statistical uncertainty. There is no accepted biological mechanism to explain the epidemiological results; indeed, the relation may be due to chance or confounding.

Adolescent↗
PubMed2005

Geographical variation in life expectancy at birth in England and Wales is largely explained by deprivation.

STUDY OBJECTIVE: To describe the population mortality profile of England and Wales by deprivation and in each government office region (GOR) during 1998, and to quantify the influence of geography and deprivation in determining life expectancy. DESIGN: Construction of life tables describing age specific mortality rates and life expectancy at birth from death registrations and estimated population counts. Life tables were created for (a) quintiles of income deprivation based on the income domain score of the index of multiple deprivation 2000, (b) each GOR and Wales, and (c) every combination of deprivation and geography. SETTING: England and Wales.PATIENTS/ PARTICIPANTS: Residents of England and Wales, 1998. MAIN RESULTS: Life expectancy at birth varies with deprivation quintile and is highest in the most affluent groups. The differences are mainly attributable to differences in mortality rates under 75 years of age. Regional life expectancies display a clear north-south gradient. Linear regression analysis shows that deprivation explains most of the geographical variation in life expectancy. CONCLUSIONS: Geographical patterns of life expectancy identified within these data for England and Wales in 1998 are mainly attributable to variations in deprivation status as defined by the IMD 2000 income domain score.

Adolescent↗
PubMed2005

Breast cancer survival in South Asian women in England and Wales.

STUDY OBJECTIVES: To estimate ethnic and socioeconomic differences in breast cancer incidence and survival between South Asians and non-South Asians in England and Wales, and to provide a baseline for surveillance of cancer survival in South Asians, the largest ethnic minority. SETTING: 115 712 women diagnosed with first primary invasive breast cancer in England and Wales during 1986-90 and followed up to 1995. METHODS/DESIGN: Ethnic group was ascribed by a computer algorithm on the basis of the name. Incidence rates were derived from 1991 census population denominators for each ethnic group. One and five year relative survival rates were estimated by age, quintile of material deprivation, and ethnic group, using national mortality rates to estimate expected survival. MAIN RESULTS: Age standardised incidence was 29% lower among South Asian women (40.5 per 100 000 per year) than among all other women (57.4 per 100 000). Five year age standardised relative survival was 70.3% (95%CI 65.2 to 75.4) for South Asian women and 66.7% (66.4 to 67.0) for other women. For both ethnic groups, survival was 8%-9% higher for women in the most affluent group than those in the most deprived group. In each deprivation category, however, survival was 3%-8% higher for South Asian women than other women. CONCLUSIONS: This national study confirms that breast cancer incidence is substantially lower in South Asians than other women in England and Wales. It also provides some evidence that South Asian women diagnosed up to 1990 had higher breast cancer survival than other women in England and Wales, both overall and in each category of deprivation.

Age Distribution↗
PubMed1977

The hazard of old lead mines in Wales.

Two population surveys were conducted near old lead workings in Wales. The first, at Y Fan in the middle of Wales, gave evidence suggestive of a gradient in blood lead level, highest in subjects resident close to the contaminated spoil heaps, and lowest in those who lived in farms some distance away. However, the gradient was significant (P less than 0.05) only in males, and all but one of the blood lead levels were below 2.0 mumol/l. In the second survey, at Halkyn in North Wales, levels in subjects living in the area contaminated by spoil were compared with those in subjects living in a nearby industrial area, and with subjects in a market town some distance away. Mean blood lead in people living in the three areas were homogeneous. These studies give no evidence that old lead workings in Wales are a serious hazard to health.

Adult↗
PubMed1980

Cervical cancer in Finland and South Wales: implications of end results data on the natural history.

The population-based cancer registry data on patients with cervical cancer in Finland and South Wales in 1960--69 were analysed for survival. Patients with carcinoma-in-situ experienced essentially the normal life expectancy. Those with invasive carcinoma experienced 75% of normal post-registration life expectancy in Finland but only 45% in South Wales. The difference was due to higher frequency and to better survival of patients with localised carcinoma in Finland, which was attributed to the fact that in Wales the mean age of the population is higher than that in Finland, and also to the longer delya in Wales from first symptoms to diagnosis among women with localised cancer. The differences in mean age by clinical stage and in survival combined with the duration of symptoms support the hypothesis that speed of tumour growth is a major determinant of clinical stage at diagnosis.

Adult↗
PubMed1985

Comparison of birthweight and infant mortality between Singapore and England and Wales, 1980.

For 1980 Singapore was found to have overall a more favourable birthweight distribution than England and Wales. The proportion of very low birthweight babies (less than 1500 g) and heavy babies (3500 g and over) was 0.4% and 18.5% in Singapore and 0.7% and 34.9% in England and Wales for live births, and 0.6% and 18.5% against 0.9% and 34.7% for total births. However, for low birthweight (less than 2500 g) Singapore with 7.5% in live births and 7.9% in total births had higher rates than England and Wales (6.7% and 7.2%). While infant mortality rates were very similar, Singapore had a somewhat higher neonatal mortality rate but a considerably lower postneonatal mortality rate than England and Wales. The effects on mortality of standardising for birthweight are examined. The problems of interpretation and the implications of the findings are discussed.

Birth Weight↗
PubMed1993

Economics of a reduction in smoking: case study from Heartbeat Wales.

STUDY OBJECTIVE: This study aims to apply economic principles and techniques in evaluating a health promotion programme. DESIGN: This study is an economic appraisal of the Heartbeat Wales no smoking intervention programme. The costs incurred over the four year period 1985-89 have been identified and estimates have been made of the likely future impact of the reduced smoking prevalence within Wales in terms of reduced morbidity and displaced mortality in three disease groups--coronary heart disease, lung cancer, and chronic bronchitis. SETTING: Wales, UK. RESULTS: The net present value of benefits is considerably greater than costs in terms of both the NHS and the economy as a whole in Wales. In addition, the net costs per life year saved shows that the programme generates additional working life years at relatively low cost. Because not all the benefits can be fully attributed to the programme 'impact rates' ranging from 100 to 10% have been applied to the level of benefits. The evidence suggests that even if only 10% of the benefits could be attributed to the programme there is still a positive net present value of benefits. The relative efficiency of this programme has not been considered here. CONCLUSION: Large scale benefits to the NHS and the economy as a whole can be derived from reductions in smoking.

Adolescent↗
PubMed1996

Deprivation and mortality in non-metropolitan areas of England and Wales.

OBJECTIVE: To test the hypothesis that the relationship between deprivation and mortality is weaker among residents of non-metropolitan areas of England and Wales than among residents of metropolitan areas. DESIGN: This study compared mortality, expressed as standardised mortality ratios (SMRs), in residents of metropolitan and non-metropolitan districts at three levels of deprivation classified by an electoral ward deprivation score and by home and car ownership. SMRs were computed for all causes of death, for bronchitis and asthma (ICD9 codes 490-493), and for accident, violence, and poisoning (ICD9 codes 800-999). SETTING: England and Wales. PARTICIPANTS: Members of the longitudinal study of the Office of Population Censuses and Surveys, a quasi-random 1% sample of the population of England and Wales. MAIN RESULTS: There was an association between deprivation and mortality which was clear for all cause mortality, more noticeable for respiratory disease, and less clear for deaths from accident, violence, and poison. In general, the results showed a remarkable similarity between metropolitan and non-metropolitan areas. CONCLUSIONS: This study does not support the hypothesis that the relationship between mortality and deprivation differs between residents of metropolitan and non-metropolitan areas of England and Wales.

Accidents↗
PubMed2002

Interval breast cancers in New South Wales, Australia, and comparisons with trials and other mammographic screening programmes.

OBJECTIVE: To present information on 1st year interval breast cancer from the New South Wales mammographic screening programme and to compare with published results from trials and services. SETTING: New South Wales data were derived from a population based biennial mammographic screening programme, which achieved statewide coverage in 1995. Women aged 50-69 years screened during 1995-7 were included. METHODS: Bilateral two view mammography with reading by two radiologists is used for biennial screening examinations. Interval cancers were detected by the screening programme and by linkage with the statewide cancer registry. In situ carcinoma was excluded. Incidence of interval cancer was estimated as a proportion of the expected underlying incidence of breast cancer. Comparative data were derived from the published literature and meta-analyses were performed. RESULTS: Although randomised trials of screening have a proportional incidence by meta-analysis of 19% (95% confidence interval (95% CI) 12% to 25%), service studies yield a proportional incidence by meta-analysis of 27% (95% CI 25% to 30%), and more than half report proportional incidences greater than 25%. In the New South Wales mammographic screening programme the proportional incidence of interval breast cancer was 33% (95% CI 29% to 38%) for ages 50-59 years, 28% (95% CI 24% to 32%) for ages 60-69 years, and 31% (95% CI 28% to 34%) for ages 50-69 years combined. Proportional incidence in the New South Wales programme for ages 50-69 years was not significantly different from the rate for service studies by meta-analysis. CONCLUSIONS: Effectiveness of mammographic screening for reducing mortality from breast cancer needs to be examined relative to rates of interval cancer from actual service situations as trials may concentrate resources and expertise in ways which may be less replicable in routine delivery of the service.

Aged↗