Have increased deaths at home during the pandemic returned to pre-pandemic levels? An analysis of publicly available Scottish death registrations.

BACKGROUND: Deaths at home increased in Scotland at the start of the Coronavirus disease 2019 (COVID-19) pandemic by ~35%. The majority did not involve COVID-19. This has implications for resource allocation and care at the end of life. METHODS: Publicly available weekly death registrations by National Records Scotland (NRS) between 2015 and week 25 of 2023 were summarized by place of death. Linear and logistic regressions of the number and proportion of deaths at home, respectively, between 2015 and 2019, were used to estimate the expected number and proportion of deaths in the period 2020-2023 had the pandemic not happened. RESULTS AND CONCLUSION: The number of deaths at home continues in 2023 at rates similar to the pandemic period and has not reverted to pre-pandemic levels. Had the pre-pandemic trend of growth in deaths at home continued, the number of deaths observed in 2020 would not be observed until 2025-2032. Deaths at home increased across Local Authorities but the scale of the increase varied. The impact of the increased number of deaths at home on quality of care and quality of death is not known and requires further study.

Early experience of a CT coronary angiography service in a Scottish regional centre.

BACKGROUND: CT coronary angiography (CTCA) is an emerging diagnostic tool in the assessment of patients with suspected coronary artery disease. It has several advantages over conventional coronary angiography (CCA); however, its use is not yet widespread in large teaching centres. AIMS: To determine what proportion of patients who have CTCA, do not require subsequent CCA. METHODS: A prospective analysis of all patients referred for CTCA from the start of the service in January 2008 to April 2010. RESULTS: CTCA provided definitive diagnostic images in 85% of patients. Overall only 12% (n = 33) of patients had subsequent CCA. The proportion of patients who subsequently had CCA reduced with time reflecting increasing confidence with the clinical service. CONCLUSIONS: A CTCA service can be successfully established out with a large teaching centre hospital. Close working between cardiologists and radiologists leads to increased confidence in the service and obviates the need for CCA in a large proportion of patients.

Differences in self-assessed health by socioeconomic group amongst people with and without a history of cancer: an analysis using representative data from Scotland.

INTRODUCTION: This paper considers socioeconomic inequalities in self-assessed health amongst people with and without a history of cancer using representative data from Scotland. METHODS: A cross-sectional analysis using the Scottish Health Survey was done. Cancer survivors were identified using linked Cancer Registry data. Bivariate and multivariate analysis was used to compare and contrast self-assessed health amongst those with a history of cancer to those without. RESULTS: Of the 17,505 survey participants, 432 (2.5 %) had a history of cancer. After taking into account potential confounders, those in the lowest socioeconomic group were more likely to report poor health than those in the highest group amongst those with a history of cancer [odds ratio, 2.96; confidence interval (CI), 1.82-4.80] and those with no history of cancer (odds ratio, 2.45; CI, 2.21-2.71). Those in the lowest socioeconomic group with no history of cancer had a greater propensity to report poor health than any of the highest groups that did have a history of cancer (p < 0.01). Differences in propensities to indicate poor health were particularly marked amongst those 4 years or more post-cancer diagnosis. CONCLUSIONS: Findings underline the scale of socioeconomic gradients in health. That disparities were so wide amongst those most temporally distant from initial diagnosis is particularly a concern given improving survival after a cancer diagnosis. IMPLICATIONS FOR CANCER SURVIVORS: Socioeconomic circumstances have a considerable influence on health and well-being. Practitioners and policy makers should consider socioeconomic circumstances in considering approaches to health and social care of cancer survivors.

Differences in 5-year survival after a 'homeless' or 'housed' drugs-related hospital admission: a study of 15--30-year olds in Scotland.

BACKGROUND: Young drug misusers and the homeless both have a greater risk of death than their peers. This study sought to estimate the additional impact of homelessness on the risk of death for young drugs misusers. METHODS: From all admissions to NHS hospitals in Scotland between 1986 and 2001, those that were: drug misuse related, for people born between 1970 and 1986 and aged over 15 years (n=13 303), were selected. All subsequent admissions and registrations of death were linked to this dataset. Each admission was coded as homeless if the health board of residence was coded as 'no fixed abode'. 5-year survival after an admission was modelled using (1) life table and (2) proportional hazard models and then (3) differences in causes of deaths were explored. RESULTS: Immediately after a drugs-related hospital admission there was no difference in survival between the homeless and those with a 'fixed address'. However, over a 3-year period the risk for those who were homeless was 3.5 times greater (CI 95% 1.2 to 12.8). This elevated risk seemed to be particularly focused on the second year after an admission. The causes of death were similar for the two groups. CONCLUSION: Although a homeless hospital admission is associated with a greater risk of death for young drug users, it is also a point in time when a young person is in contact with public services. An attempt to link their discharge with housing services would seem a potentially productive policy.