Socioeconomic inequalities in accumulation of multimorbidity in England from 2019 to 2049: a microsimulation projection study.

BACKGROUND: There are socioeconomic inequalities in the prevalence of multimorbidity and its accumulation across the life course. Estimates of multimorbidity prevalence in English primary care increased by more than two-thirds from 2004 to 2019. We developed a microsimulation model to quantify current and projected multimorbidity inequalities in the English adult population. METHODS: We used primary care data for adults in England from the Clinical Practice Research Datalink Aurum database between 2004 and 2019, linked to the 2015 English Index of Multiple Deprivation (IMD), to model time individuals spent in four health states (healthy, one chronic condition, basic multimorbidity [two or more chronic conditions], and complex multimorbidity [three or more chronic conditions affecting three or more body systems]) by sex, age, IMD quintile, birth cohort, and region. We applied these transition times in a stochastic dynamic continuous-time microsimulation model to Office for National Statistics population estimates for adults aged 30-90 years. We calculated projected prevalence and cumulative incident cases from 2019 to 2049 by IMD quintile, age group (younger than 65 years vs 65 years and older), and years to be lived without multimorbidity at age 30 years. FINDINGS: Under the assumption that all chronic conditions were lifelong, and that once diagnosed there was no recovery, we projected prevalence of multimorbidity (basic or complex) increases by 34% from 53·8% in 2019 to 71·9% (95% uncertainty interval 71·8-72·0) in 2049. This rise equates to an 84% increase in the number of people with multimorbidity: from 19·2 million in 2019 to 35·3 million in 2049 (35·3 million to 35·4 million). This projected increase is greatest in the most deprived quintile, with an excess 1·07 million (1·04 million to 1·10 million) cumulative incident basic multimorbidity cases and 0·70 million (0·67 million to 0·74 million) complex multimorbidity cases over and above the projected cases for the least deprived quintile, largely driven by inequalities in those younger than 65 years. The median expected number of years to be lived without multimorbidity at age 30 years in 2019 is 15·12 years (14·62-16·01) in the least deprived IMD quintile and 12·15 years (11·61-12·60) in the most deprived IMD quintile. INTERPRETATION: The number of people living with multimorbidity will probably increase substantially in the next 30 years, a continuation of past observed increases partly driven by changing population size and age structure. Inequalities in the multimorbidity burden increase at each stage of disease accumulation, and are projected to widen, particularly among the working-age population. Substantial action is needed now to address population health and to prepare health-care and social-care systems for coming decades. FUNDING: University of Liverpool and National Institute for Health and Care Research School for Public Health Research.

Vacancy-Ordered Double Perovskite Cs2TeI6 Thin Films for Optoelectronics.

Alternatives to lead- and tin-based perovskites for photovoltaics and optoelectronics are sought that do not suffer from the disadvantages of toxicity and low device efficiency of present-day materials. Here we report a study of the double perovskite Cs2TeI6, which we have synthesized in the thin film form for the first time. Exhaustive trials concluded that spin coating CsI and TeI4 using an antisolvent method produced uniform films, confirmed as Cs2TeI6 by XRD with Rietveld analysis. They were stable up to 250 °C and had an optical band gap of ∼1.5 eV, absorption coefficients of ∼6 × 104 cm-1, carrier lifetimes of ∼2.6 ns (unpassivated 200 nm film), a work function of 4.95 eV, and a p-type surface conductivity. Vibrational modes probed by Raman and FTIR spectroscopy showed resonances qualitatively consistent with DFT Phonopy-calculated spectra, offering another route for phase confirmation. It was concluded that the material is a candidate for further study as a potential optoelectronic or photovoltaic material.

Band Alignments, Band Gap, Core Levels, and Valence Band States in Cu3BiS3 for Photovoltaics.

The earth-abundant semiconductor Cu3BiS3 (CBS) exhibits promising photovoltaic properties and is often considered analogous to the solar absorbers copper indium gallium diselenide (CIGS) and copper zinc tin sulfide (CZTS) despite few device reports. The extent to which this is justifiable is explored via a thorough X-ray photoemission spectroscopy (XPS) analysis: spanning core levels, ionization potential, work function, surface contamination, cleaning, band alignment, and valence-band density of states. The XPS analysis overcomes and addresses the shortcomings of prior XPS studies of this material. Temperature-dependent absorption spectra determine a 1.2 eV direct band gap at room temperature; the widely reported 1.4-1.5 eV band gap is attributed to weak transitions from the low density of states of the topmost valence band previously being undetected. Density functional theory HSE06 + SOC calculations determine the band structure, optical transitions, and well-fitted absorption and Raman spectra. Valence band XPS spectra and model calculations find the CBS bonding to be superficially similar to CIGS and CZTS, but the Bi3+ cations (and formally occupied Bi 6s orbital) have fundamental impacts: giving a low ionization potential (4.98 eV), suggesting that the CdS window layer favored for CIGS and CZTS gives detrimental band alignment and should be rejected in favor of a better aligned material in order for CBS devices to progress.

Core Levels, Band Alignments, and Valence-Band States in CuSbS2 for Solar Cell Applications.

The earth-abundant material CuSbS2 (CAS) has shown good optical properties as a photovoltaic solar absorber material, but has seen relatively poor solar cell performance. To investigate the reason for this anomaly, the core levels of the constituent elements, surface contaminants, ionization potential, and valence-band spectra are studied by X-ray photoemission spectroscopy. The ionization potential and electron affinity for this material (4.98 and 3.43 eV) are lower than those for other common absorbers, including CuInxGa(1-x)Se2 (CIGS). Experimentally corroborated density functional theory (DFT) calculations show that the valence band maximum is raised by the lone pair electrons from the antimony cations contributing additional states when compared with indium or gallium cations in CIGS. The resulting conduction band misalignment with CdS is a reason for the poor performance of cells incorporating a CAS/CdS heterojunction, supporting the idea that using a cell design analogous to CIGS is unhelpful. These findings underline the critical importance of considering the electronic structure when selecting cell architectures that optimize open-circuit voltages and cell efficiencies.