The pain of low status: the relationship between subjective socio-economic status and analgesic prescriptions in a Scottish community sample.

There is a strong positive relationship between objective measures of socio-economic status (OSS) and general health. However, there is an increasing interest in the relationship between health and subjective socio-economic status (SSS), which describes one's perceived rank in relation to the rest of the society, based on factors such as income, occupation and education. While the relationship between SSS and general health is well established, the relationship between SSS and pain has received little attention. Gathering both self-report questionnaire data and General Practitioner medical data from a large representative community sample in Scotland between 2012 and 2013 (N = 1824), we investigated the relationship between SSS and prescriptions for analgesic drugs. We found that higher levels of SSS significantly predicted lower odds of participants having been prescribed at least one analgesic drug in the previous six months. We obtained this result even after controlling for OSS-related variables (education, occupational status and geographical location) and demographic variables (age and gender). This suggests that, just like the relationship between SSS and general health, SSS has important effects on pain that go beyond the influence of OSS.

Greater number of group identifications is associated with lower odds of being depressed: evidence from a Scottish community sample.

PURPOSE: Group identification has been shown to be associated with reduced risk of depression, but this research has important limitations. Our aim was to establish a robust link between group identification and depression whilst overcoming previous studies' shortcomings. METHODS: 1824 participants, recruited from General Practice throughout Scotland, completed a questionnaire measuring their identification with three groups (family, community, and a group of their choice), as well as their intensity of contact with each group. They also completed a self-rated depression measure and provided demographic information. Their medical records were also accessed to determine if they had been prescribed antidepressants in the previous 6 months. RESULTS: The number of group identifications was associated with both lower self-rated depression and lower odds of having received a prescription for antidepressants, even after controlling for the number of contact-intensive groups, level of education, gender, age, and relationship status. CONCLUSIONS: Identifying with multiple groups may help to protect individuals against depression. This highlights the potential importance of social prescriptions, where health professionals encourage a depressed patient to become a member of one or more groups with which the patient believes he/she would be likely to identify.

Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

BACKGROUND: Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. METHODS: In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. FINDINGS: 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). INTERPRETATION: Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. FUNDING: Scottish Government Chief Scientist Office.

Recovery of renal function after 90 d on dialysis: implications for transplantation in patients with potentially reversible causes of renal failure.

BACKGROUND: Late recovery of renal function in patients requiring dialysis is a well recognized but uncommon phenomenon. Moves to increase the number of live donor transplants and the recognition that early transplantation is associated with better graft survival means it is possible that patients who are going to recover renal function may be transplanted unnecessarily. DESIGN: Prospective survey of patients receiving dialysis for more than 90 d in south west Scotland from 1 January 1994 to 31 December 2005. METHODS: Routine measurement of residual renal function by combined urea and creatinine clearance allowed us to detect late recovery whenever this occurred. RESULTS: Eight of 202 (4%) patients recovered sufficient renal function to stop dialysing after 90-d treatment. The likely cause of the renal failure in five of these patients was atheroembolism. One with atherosclerotic renovascular disease had been stented and would have received a live related renal transplant had his sister not had second thoughts about the procedure. CONCLUSION: It may be sensible to postpone transplantation in patients with certain types of renal failure, perhaps particularly patients with renovascular disease who have recently undergone a failed revascularization procedure.

Greater number of group identifications is associated with healthier behaviour: Evidence from a Scottish community sample.

OBJECTIVES: This paper investigates the interplay between group identification (i.e., the extent to which one has a sense of belonging to a social group, coupled with a sense of commonality with in-group members) and four types of health behaviour, namely physical exercise, smoking, drinking, and diet. Specifically, we propose a positive relationship between one's number of group identifications and healthy behaviour. DESIGN: This study is based on the Scottish portion of the data obtained for Wave 1 of the two-wave cross-national Health in Groups project. Totally 1,824 patients from five Scottish general practitioner (GP) surgeries completed the Wave 1 questionnaire in their homes. METHODS: Participants completed measures of group identification, group contact, health behaviours, and demographic variables. RESULTS: Results demonstrate that the greater the number of social groups with which one identifies, the healthier one's behaviour on any of the four health dimensions considered. CONCLUSIONS: We believe our results are due to the fact that group identification will generally (1) enhance one's sense of meaning in life, thereby leading one to take more care of oneself, (2) increase one's sense of responsibility towards other in-group members, thereby enhancing one's motivation to be healthy in order to fulfil those responsibilities, and (3) increase compliance with healthy group behavioural norms. Taken together, these processes amply overcompensate for the fact that some groups with which people may identify can actually prescribe unhealthy behaviours.

Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis.

BACKGROUND: Influenza immunisation is recommended for all people aged ≥65 years and younger people with particular chronic diseases. The Quality and Outcomes Framework (QOF) has provided new financial incentives for influenza immunisation since 2004. AIM: To determine the impact of the 2004 UK General Medical Services contract on the overall uptake of, and socioeconomic inequalities associated with, influenza immunisation. DESIGN AND SETTING: Retrospective general-practice population database analysis in 15 general practices in Scotland, UK. METHOD: Changes in influenza-immunisation uptake for those in at-risk groups between 2003-2004 and 2006-2007 were measured, and variation in uptake examined using multilevel modelling. RESULTS: Uptake rose from 67.9% in 2003-2004 to 71.4% in 2006-2007. The largest increases were seen in those aged <65 years with chronic disease, with uptake rising from 49.6% to 58.4%, but rates remained considerably lower than in those aged ≥65 years. Differences between practices narrowed (median odds ratio [OR] for two patients randomly selected from different practices: 2.13 (95% confidence interval [CI] = 2.00 to 2.26) in 2003-2004 versus 1.44 (95% CI = 1.40 to 1.49) in 2006-2007. However, inequalities in uptake by patient socioeconomic status did not change: adjusted OR for most deprived versus most affluent was 0.75 (95% CI = 0.70 to 0.80) in 2003-2004 versus 0.72 (95% CI = 0.68 to 0.76) in 2006-2007. CONCLUSION: Overall uptake rose significantly and differences between practices narrowed considerably. However, socioeconomic and age inequalities in influenza immunisation persisted in the first 3 years of the QOF. This contrasts with other ecological analyses, which have concluded that the QOF has reduced inequalities. The impact of financial incentives on inequalities is likely to vary, and some kinds of care may require more targeted improvement activity and support.