Reshaping Care for Older People: Trends in emergency admissions to hospital during a period of simultaneous interventions in Glasgow City, April 2011-March 2015.

This study describes trends in emergency admissions (EAs) in Glasgow City during a period when interventions were designed and implemented, aimed at shifting the balance from institutional to community-based care. Standardised monthly rates of EAs between April 2011 and March 2015 were calculated, for residents of Glasgow City aged 65 years and over. Multilevel zero-inflated Negative Binomial models for EAs nested by datazone were created, adjusting for sex, 5-year age group, area-level deprivation (SIMD quintile), season, month and month squared. Models were also run for EAs by cause, for three causes: chronic obstructive pulmonary disease (COPD), falls and dementia. The rate of EAs first rose then fell during the study period. When modelled, RRs for month (RR for month 12 relative to month 1 and 95% CI=1.02 (0.99, 1.06)) and month squared (RR=0.999 (0.998, 0.999)) indicated a rise in admissions until February 2012, followed by a fall. Risk of admission was greater for males and increased with increasing age group. The risk of going into hospital for those from SIMD 5 (most affluent) was 0.58 (0.56, 0.59) relative to those from SIMD 1 (most deprived). Socioeconomic inequalities were particularly great for COPD-related admissions, where RR for SIMD 5 was 0.25 (0.23, 0.28) times that of SIMD 1. An interaction term between month and SIMD was not significant for any outcome. For dementia-related EAs there was a suggestion that inequalities may be reducing over time. EAs for those aged 65 years and more reduced during the Change Fund period, with similar relative reductions observed across all deprivation quintiles.

The impact of age, sex and socioeconomic deprivation on outcomes in a colorectal cancer screening programme.

BACKGROUND: Population-based colorectal cancer screening has been shown to reduce cancer specific mortality and is used across the UK. Despite evidence that older age, male sex and deprivation are associated with an increased incidence of colorectal cancer, uptake of bowel cancer screening varies across demographic groups. The aim of this study was to assess the impact of age, sex and deprivation on outcomes throughout the screening process. METHODS: A prospectively maintained database, encompassing the first screening round of a faecal occult blood test screening programme in a single geographical area, was analysed. RESULTS: Overall, 395,096 individuals were invited to screening, 204,139 (52%) participated and 6079 (3%) tested positive. Of the positive tests, 4625 (76%) attended for colonoscopy and cancer was detected in 396 individuals (9%). Lower uptake of screening was associated with younger age, male sex and deprivation (all p<0.001). Only deprivation was associated with failure to proceed to colonoscopy following a positive test (p<0.001). Despite higher positivity rates in those that were more deprived (p<0.001), the likelihood of detecting cancer in those attending for colonoscopy was lower (8% most deprived vs 10% least deprived, p = 0.003). CONCLUSION: Individuals who are deprived are less likely to participate in screening, less likely to undergo colonoscopy and less likely to have cancer identified as a result of a positive test. Therefore, this study suggests that strategies aimed at improving participation of deprived individuals in colorectal cancer screening should be directed at all stages of the screening process and not just uptake of the test.

Screening for colorectal cancer: what is the impact on the determinants of outcome?

Colorectal cancer screening has been introduced across the UK following several large randomised control trials and a Cochrane review that have shown a reduction in cancer specific mortality with population based Faecal Occult Blood testing. This has been attributed to the detection of more early stage disease. It is well known that in addition to stage at presentation there are a variety of other key factors that determine a patient's outcome following a diagnosis of colorectal cancer. For example there are tumour-related factors, such the presence of venous invasion and tumour necrosis, and also host-related factors, both in terms of demographic profile and an elevated circulating host inflammatory response that have been shown to be predictive of a poorer outcome. The present review summarises both the background behind the current screening programme and the observed and anticipated impact that colorectal cancer screening will have on the key determinants of outcome.

Pre-notification increases uptake of colorectal cancer screening in all demographic groups: a randomized controlled trial.

OBJECTIVES: To assess whether pre-notification is effective in increasing uptake of colorectal cancer screening for all demographic groups. SETTING: Scottish national colorectal cancer screening programme. METHODS: Males and females aged 50-74 years received a faecal occult blood test by post to complete at home. They were randomized to receive in addition: the pre-notification letter, the pre-notification letter + information booklet, or the usual invitation. Overall, 59,953 subjects were included in the trial between 13/04/09 and 29/05/09 and followed to 27/11/09. Pre-notification letters were posted two weeks ahead of the screening test kit. Uptake was defined as the return of a screening test and chi-squared tests compared uptake between the trial arms. Logistic regression assessed the impact of the letter and letter + booklet on uptake independently of gender, age, deprivation and screening round. RESULTS: Uptake was higher with both the letter (59.0%) and the letter + booklet (58.5%) compared with the usual invitation (53.9%, p < 0.0001). This increased uptake was seen for males, females, all age groups and all deprivation categories including least deprived females (letter 69.9%, usual invitation 66.6%) and most deprived males (42.6% vs. 36.1%), the groups with the highest and lowest levels of uptake respectively in the pilot screening rounds conducted prior to the roll out of the programme. Uptake with the pre-notification letter compared with the usual invitation was higher both unadjusted and adjusted for demographic factors (odds ratio 1.24, 95% CI 1.193-1.294). CONCLUSIONS: Pre-notification is an effective method of increasing uptake in colorectal cancer screening for both genders and all age and deprivation groups.