Trends in live births by mother's country of birth and other factors affecting low birthweight in England and Wales, 1983-2001

This article investigates trends in low birthweight singleton live births by mother's country of birth. 11.4 million birth records from registration data in England and Wales from 1983 to 2001 were used. The analysis focuses on births to mothers born in the UK and countries that contribute to the main ethnic minority groups in England and Wales. The results show that the prevalence of low birthweight babies varies by mother's country of birth. Important differentials also exist by mother's age at birth, multiplicity and registration status.     

Inequalities in infant mortality: trends by social class, registration status, mother's age and birthweight, England and Wales, 1976-2000

This article examines trends in inequalities in infant mortality in England and Wales between 1976 and 2000. It describes variations in neonatal, postneonatal and infant mortality by mother's age, registration status, father's social class, multiplicity and birthweight. Throughout the period, social class differences in mortality were wider in the postneonatal period than the neonatal period and there was considerable variation in infant mortality by age of mother, birthweight and multiplicity within both manual and non-manual groups.     

Salmonella bacteraemia in England and Wales, 1981-1990.

AIMS: To report the incidence of nontyphoidal salmonellas in England and Wales and identified in the Division of Enteric Pathogens, London between 1981 and 1990. METHODS: Strains were serotyped and phage typed for Salmonella typhimurium, S enteritidis, and S virchow, using established methods. RESULTS: Overall, less than 2% of nontyphoidal salmonellas isolated from humans were from blood culture. The highest numbers of bloodstream isolates were from infections caused by S enteritidis and S typhimurium, but the highest incidence of septicaemias was attributable to infections with S cholerae-suis, S dublin, and S virchow. 2.2% of S typhimurium isolates phage type 204C were from blood culture; likewise, 5.5% of S virchow phage type 19. This could be a cause for concern as most isolates of both these phage types are multiresistant to antimicrobial drugs. CONCLUSIONS: Salmonella septicaemia is rare in England and Wales in other than a few serotypes of limited epidemiological importance.     

Geographical variations in premature mortality in England and Wales, 1981-2006

Levels of premature mortality in England and Wales have declined markedly over time, with the probability of survival to age 75 increasing from 38 to 66 per cent for males, and from 54 to 77 per cent for females, between 1950 and 2004. To assess the application of this measure to monitor premature mortality in sub-national geographical areas, this article presents an analysis of the probability of survival at local authority level. Results for 1981-83 and 2004-06 are presented for Government Office Regions in England, Wales and local authorities in England and Wales. Significant differences in premature mortality are described within, and between, regions. Patterns of probability of survival to age 75 for local authorities are compared with other measures of mortality.     

Fusobacterium necrophorum infections in England and Wales 1990-2000

In response to a marked increase in both the number of Fusobacterium necrophorum bacteraemia reports to the PHLS Communicable Disease Surveillance Centre and the number of F. necrophorum isolates referred to the PHLS Anaerobe Reference Unit in 1999, the data from both sources on F. necrophorum infections were reviewed for the decade 1990-2000. There were 208 reports of F. necrophorum bacteraemia (average 19/year; range 14-34/year) with a peak in incidence in the late winter months; 68% were from male patients and the peak age range was 16-23 years. Of 205 referred isolates of F. necrophorum, 122 (59%) were from blood cultures and these represented 58% of the bacteraemia reports; the others were from brain and soft tissue abscesses, pleural and joint fluids, eyes, ears and lymphatic tissue. The average number of referrals was 19/year (range 9-37/year). The peak year for bacteraemia reports (34) and isolate referrals (37) was 1999; this increase was not sustained in 2000. All isolates were susceptible to metronidazole, but 2% were resistant to penicillin and 15% to erythromycin. F. necrophorum continues to be a regular but uncommon cause of bacteraemia and metastatic abscesses following an acute sore throat, especially in young, otherwise healthy adults.     

Surveillance of HIV-1 subtypes among heterosexuals in England and Wales, 1997-2000

The molecular diversity and demographic characteristics among 976 anti-HIV-1-positive heterosexuals attending 15 sexually transmitted infection (STI) clinics participating in an unlinked anonymous HIV prevalence serosurvey in England and Wales during 1997-2000 were investigated. Subtypes were assigned by heteroduplex mobility assay or sequencing of the p17/p24 region of gag and the V3/V4 region of env and by sequencing of the protease gene. Overall, there was no significant change in the subtype distribution, with subtype C accounting for the majority (32%) of subtyped infections. Subtypes B (29%), A (12%), circulating recombinant forms (CRFs, 9%), unique recombinant forms (URFs, 8%), and subtypes D-H (8%) were also detected. Thirty-nine percent of infections in men were with subtype B, whereas subtype C was most common (38%) in women. Logistic regression analyses showed the relative risk (RR) of infection with a non-B subtype, compared with subtype B, to be greater in African-born individuals (RR = 28.9, P < 0.01), among newly diagnosed infections (RR = 3.4, P < 0.01), and in women (RR = 2.4, P < 0.01). These findings indicate a high level of genetic diversity among HIV-infected heterosexual STI clinic attendees in England and Wales. Recently, subtype C has become most prevalent, particularly in younger age groups, suggesting recent acquisition of this viral strain. The high proportion of non-B, CRF, and URF infections among UK-born individuals is consistent with mixing between migrants and UK-born individuals in England and Wales. As migration patterns change, continued monitoring of HIV genetic diversity will aid understanding of transmission patterns.     

Down syndrome birth weight in England and Wales: Implications for clinical practice

The aim of this study was to determine if syndrome‐specific birth weight charts were beneficial for babies with Down syndrome in England and Wales. Birth weights of 8,825 babies with Down syndrome born in England and Wales in 1989–2010 were obtained from the National Down Syndrome Cytogenetic Register. Birth weight centiles for 30–42 weeks gestation by sex were fitted using the LMS method and were compared to those for unaffected babies from the UK‐WHO growth charts. For babies born with Down syndrome the median birth weight from 37 to 42 weeks was 2,970 g (10th–90th centile: 2,115–3,680) for boys and 2930 g (2,100–3,629) for girls, and the modal age of gestation was 38 weeks, 2 weeks earlier than for unaffected babies. At 38 weeks gestation they were only slightly lighter than unaffected babies (159 g for boys and 86 g for girls). However at 40 weeks gestation the shortfall was much greater (304 g and 239 g, respectively). In neonates with Down syndrome there is little evidence of growth restriction before 38 weeks gestation, so up to this age it is appropriate to use the UK‐WHO birth weight charts. Thereafter birth weight is below that of unaffected babies and it should be plotted on the UK Down syndrome growth charts. © 2015 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.     

Age-period-cohort effects on inequalities in psychological distress, 1981-2000

BACKGROUND: In the closing decades of the twentieth century, changes in population sociodemographics took place that might be thought to have an adverse influence on the nation's psychological distress. Here, we examine the stability of social and gender inequalities in psychological distress throughout the 1980s and 1990s. METHODS: The study uses data from the 1958 National Child Development Study and the 1970 British Cohort Study collected when the cohort members were aged between 23 and 42. Multilevel logistic regression models were used to examine the effects of social class, gender, age, period and cohort on psychological distress as measured by the Malaise Inventory. RESULTS: We identify clear social inequalities in psychological distress during 1981-2000 that reduced in magnitude over this period. Non-linear age effects were observed: psychological distress improves in early adulthood but declines again on approaching mid-life. The 1970 cohort had poorer psychological distress than the 1958 cohort. Although women had higher rates of psychological distress than men, gender differences reduced in magnitude. Declining rates of women's psychological distress over time have not been matched in men. A reduction in social inequalities over time was also observed. Improvements in the psychological health of those in manual occupations were not equalled among those in non-manual occupations. CONCLUSIONS: Both social and gender inequalities have narrowed in the last two decades of the twentieth century.     

Alcohol-related deaths by occupation, England and Wales, 2001-05

This article continues a long tradition of examining alcohol-related deaths by occupation in England and Wales. Results are presented for men and women which show those occupations with the highest and lowest indicators of alcohol-related mortality in 2001-05. For both sexes, many of the occupations with the highest alcohol-related mortality were found among those working in the drinks industry, including publicans and bar staff. Low indicators of alcohol-related deaths were found for men who worked as farmers and drivers, and women who worked with children.     

Incidence and routes of transmission of hepatitis B virus in England and Wales, 1995-2000: implications for immunisation policy.

BACKGROUND: The incidence of hepatitis B virus (HBV) infection in the UK is low. Since the infection can have serious sequelae, there is a continuing need to examine its epidemiology so as to inform control measures. OBJECTIVES: We aimed to describe the current HBV incidence and patterns of transmission in the UK, to estimate the rate of new carrier infections, and to discuss implications for the control of HBV through immunisation. STUDY DESIGN: We analysed routine England and Wales laboratory surveillance data of acute HBV infection (1995-2000) and data on migration and global HBsAg prevalence. RESULTS: The estimated annual incidence of HBV infection in England and Wales was 7.4 per 100,000. Injecting drug use was the most frequently reported route of transmission. The number of cases attributed to heterosexual contact was fairly stable, whereas the number of cases in men having sex with men decreased. These observations continue trends reported for the early 1990s. Transmission during childhood was rarely reported, but was more frequent among South Asians. The incidence in South Asians is relatively high, and their main risk factors are medical treatment overseas and heterosexual contact. For about a third of cases of acute HBV infection no route of transmission is reported, but analysis of secular trends and age distribution suggest that many of these may be related to injecting drug use. Endemic transmission gives rise to only a small proportion of all new chronic infections, with the vast majority arising from immigration of established HBV carriers. CONCLUSIONS: The incidence of acute HBV infection in England and Wales has remained low, with a similar pattern of reported routes of transmission compared to the early 1990s. The UK prevalence of HBV infection is dependant on global rather than national immunisation policy. Endemic transmission may be reduced by improving immunisation coverage among injecting drug users, which is expected to also reduce the number of cases without a risk factor reported. In addition, immunisation options that better suit the needs of ethnic minorities need to be explored.     

Biologic risk factors for low birthweight in Al Ain,United Arab Emirates

A prospective study of biological factors for low birthweight (LBW) among UAE nationals in the Al Ain Medical District was undertaken from 15 January 1992 to 14 January 1993, using a case control method. All 293 mothers of LBW infants and an equal number of mothers of the next normal weight infants born after the LBW infant were studied. Of the 3,485 live births, 293 (8.4%) were LBW (less than 2,500 g). Maternal age less than 25 years, lighter weight at booking, nulliparity, first cousin marriage and short interpregnancy interval (IPI) of 3 months or less significantly increased the risk of LBW in this population. After adjusting for other biologic confounders, only low maternal weight and short IPI significantly increased the risk of LBW. Modification of these biologic risk factors would help to reduce the incidence of LBW among the UAE population. © 1996 Wiley-Liss, Inc.     

Trends in premature mortality in England and Wales, 1950-2004

Premature mortality is a major public health concern but there has been little consensus among researchers on how it should be defined and reported. In this article four means of measuring early deaths are considered using four different age thresholds to define prematurity. Using these four indicators, trends in premature mortality are reported for England and Wales from 1950 to 2004. All measures show that, however 'premature' is defined, levels of premature mortality have decreased markedly over time. This article discusses which mortality indicator and age threshold would be most appropriate for a measure of premature mortality for use in national mortality statistics for England and Wales.