Persistent regional variation in treatment of hypertension.

OBJECTIVES: To assess regional variation within England in the proportion of people with survey-defined hypertension who were on treatment, and hypothesize if this was due to chance or confounding. STUDY DESIGN: Data from three annual, cross-sectional health examination surveys, the Health Survey for England. METHODS: Nationally representative random samples of the free-living general population were visited by an interviewer and a nurse. Blood pressure was measured with an automated monitor using a standardized protocol (2005: n = 5321, 2006: n = 10,213, 2007: n = 4848). Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, and/or taking prescribed medication to lower blood pressure. RESULTS: In London, a higher proportion of participants with survey-defined hypertension were on anti-hypertensive medication in each separate year's sample compared with the rest of England [2005-2007 average: 61% men, 66% women in London; 43% men, 55% women in England (P for London vs rest of England <0.001 for each sex)]. Regression analysis showed that this regional effect [odds ratio (OR) 1.47 95% confidence interval (CI) 1.94-2.47, P = 0.031] was no longer significant after adjustment for demographic and socio-economic factors (OR 1.37, 95% CI 0.94-1.98, P = 0.101), but was strengthened (OR 1.69, 95% CI 1.09-2.60, P = 0.018) by including longstanding illness, diabetes, cardiovascular disease and health behaviours in the model. CONCLUSIONS: The proportion of hypertensive patients on anti-hypertensive medication was consistently above the national average in London, and this was associated with personal characteristics. Comorbidities increased the effect, even after adjustment for personal characteristics. This result may be due to greater population mobility in London, with more people having new patient health checks. Understanding this variation could enhance treatment nationally and internationally.

Comparison of scoring methods and thresholds of the General Health Questionnaire-12 with the Edinburgh Postnatal Depression Scale in English women.

OBJECTIVES: To compare the scoring methods and thresholds of the 12-item General Health Questionnaire (GHQ-12) and the Edinburgh Postnatal Depression Scale (EPDS) in English women, and to determine which threshold and scoring method provides the closest correlation of caseness of postnatal depression in a nationally representative sample of English women. STUDY DESIGN: Health Survey for England 2002 health examination survey. METHODS: Self-completion booklet containing the EPDS and the GHQ-12. Participants were mothers with at least one child under 1 year of age at the time of interview. RESULTS: Both the scoring method and cut-off affected the estimates of prevalence of postnatal depression in English women. The best threshold and scoring method for the GHQ-12 using sensitivity/specificity analysis against the EPDS was a standard scale with a cut-off of 3+. This matched the cut-off using the GHQ-12 mean scores. The cut-off using comparative prevalence of the GHQ-12 with the EPDS was higher at 4+. There was a significantly lower estimate of prevalence of postnatal depression at 4 months using the GHQ-12. CONCLUSIONS: Care needs to be taken measuring postnatal depression. The GHQ-12 mean score cut-off matched the cut-off using sensitivity and specificity; this supports using the GHQ-12 mean scores as cut-offs. The standard scale was most closely correlated with the EPDS. Although there was strong correlation between the GHQ-12 and the EPDS, a significantly lower proportion of women were measured as having possible postnatal depression at 4 months using the GHQ-12. This may be due to the lack of a question on blame in the GHQ-12. Four months coincided with the duration of maternity leave entitlement and recommended age for weaning in 2002. These events may be particularly stressful for mothers, and practitioners need to be mindful of similar milestones for diagnosis if using the GHQ-12.

The epidemiology of fractures in England.

INTRODUCTION: Fractures are a considerable public health burden in the United Kingdom but information on their epidemiology is limited. OBJECTIVE: This study aims to estimate the true annual incidence and lifetime prevalence of fractures in England, within both the general population and specific groups, using a self-report methodology. METHODS: A self-report survey of a nationally representative general population sample of 45,293 individuals in England, plus a special boost sample of 10,111 drawn from the ethnic minority population. RESULTS: The calculated fracture incidence is 3.6 fractures per 100 people per year. Lifetime fracture prevalence exceeds 50% in middle-aged men, and 40% in women over the age of 75 years. Fractures occur with reduced frequency in the non-white population: this effect is seen across most black and minority ethnic groups. CONCLUSIONS: This study suggests that fractures in England may be more common than previously estimated, with an overall annual fracture incidence of 3.6%. Age-standardised lifetime fracture prevalence is estimated to be 38.2%. Fractures are more commonplace in the white population.