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Title: Socioeconomic inequalities in risk of, and exposure to, gastrointestinal infections in the UK
Author: Adams, N. L.
ISNI:       0000 0004 7428 5061
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Introduction: Gastrointestinal (GI) infections are a significant burden both to the NHS and to society; affecting around a quarter of the UK population each year at an estimated cost of £1.5 billion. Socioeconomic inequalities in health are a serious problem and reducing such inequalities is high on the public health agenda in this country. Many infections are socially patterned but the role of socioeconomic inequalities in the risk of and exposure to GI infections is unclear, with published studies providing conflicting results. This thesis aims to investigate whether risk of or exposure to GI infections in the UK is socially patterned and if so, which sectors of society experience a greater burden of infection and through what mechanisms. Methods: I undertook novel analyses of existing UK-based high-quality and comprehensive secondary data on GI infections to explore the relationship between GI infections and socioeconomic status (SES) using a variety of analytical techniques. Study 1 explores the role of SES in risk of GI infections in high income countries through a systematic review and meta-analysis of 102 published studies using random- and fixed-effects meta-analysis and random-effects meta-regression. Study 2 assesses the association between SES and GI infections in a community cohort of 6,836 participants, using a Cox proportional hazards survival analysis approach. Study 3 presents results from an observational study utilising two NHS telephone-based services to explore the role of SES amongst individuals accessing remote health advice. Finally, Study 4 presents results of a case-study of a severe GI infection, Shiga toxin-producing Escherichia coli (STEC), to investigate socioeconomic patterning of risk factors for infection and to explore the role of demographic and socioeconomic factors in progression from STEC to a severe outcome, Haemolytic Uraemic Syndrome (HUS) in a separate cohort of paediatric HUS cases. Results: In high income countries, disadvantaged children but not adults had a significantly higher risk of GI infection compared to less disadvantaged children. In England, odds of calls to NHS helplines about GI infection symptoms in disadvantaged children and adults were significantly higher compared to their less disadvantaged counterparts. Disadvantaged adults were found to have lower risk of GI infections in the community cohort and both children and adults were less likely to be reported as having STEC infection or developing HUS. Overall, the results provide strong evidence to suggest that risk of GI infection differs by SES across the life course, with disadvantaged children at highest risk of GI infections. Conclusions: Disadvantaged children are at greater risk of GI infections compared to their more advantaged counterparts in the UK. The relationship between deprivation and risk of GI infection in adults is less clear. This thesis found that increased risk may relate to differential exposure, vulnerability or healthcare-seeking behaviours, including symptom recognition, across socioeconomic groups. This work has provided further insight into relationship between SES and GI infections and sets the direction for policies to reduce inequalities in GI illness in children and for more focussed research to deepen the understanding of the relationship particularly between SES and GI infection in adults.
Supervisor: Whitehead, Margaret ; Taylor-Robinson, David ; O'Brien, Sarah ; Barr, Benjamin Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral