Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke: A 25-year individual patient level linkage study.

Background: Understanding trends in the incidence and outcomes of myocardial infarction and stroke, and how these are influenced by changes in cardiovascular risk factors can inform health policy and healthcare provision.

Methods: We identified all patients 30 years or older with myocardial infarction or stroke in Scotland. Risk factor levels were determined from national health surveys.

A critical reflection on the use of improvement science approaches in public health.

Objective: 'Improvement science' is used to describe specific quality improvement methods (including tests of change and statistical process control). The approach is spreading from clinical settings to population-wide interventions and is being extended from supporting the adoption of proven interventions to making generalisable claims about new interventions. The objective of this narrative review is to evaluate the strengths and risks of current improvement science practice, particularly in relation to how they might be used in population health.

Trends in disease incidence and survival and their effect on mortality in Scotland: nationwide cohort study of linked hospital admission and death records 2001-2016.

Objectives: Identify causes and future trends underpinning Scottish mortality improvements and quantify the relative contributions of disease incidence and survival.

Design: Population-based study.

Setting: Linked secondary care and mortality records across Scotland.

Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015.

Aims/hypothesis: The aim of the study was to examine trends in the incidence and case fatality of acute myocardial infarction (AMI) and in hospital admissions for angina and coronary revascularisation procedures in people with type 2 diabetes and in people without diabetes in Scotland between 2006 and 2015.

Methods: In this retrospective cohort study, AMI, angina and revascularisation event data were obtained for adults from hospital admissions and death records linked to a population-based diabetes register. Incidence by diabetes status was estimated using negative binomial models with adjustment or stratification by age, sex, deprivation and calendar year.

Trends and inequalities in the burden of mortality in Scotland 2000-2015.

Background: Cause-specific mortality trends are routinely reported for Scotland. However, ill-defined deaths are not routinely redistributed to more precise and internationally comparable categories nor is the mortality reported in terms of years of life lost to facilitate the calculation of the burden of disease. This study describes trends in Years of Life Lost (YLL) for specific causes of death in Scotland from 2000 to 2015.

Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997-2013.

Background: Developmental dysplasia of the hip (DDH) remains common. If detected early, DDH can usually be corrected with conservative management. Late presentations often require surgery and have worse outcomes.

Adverse events after first, single, mesh and non-mesh surgical procedures for stress urinary incontinence and pelvic organ prolapse in Scotland, 1997-2016: a population-based cohort study.

Background: Concerns have been raised about the safety of surgery for stress urinary incontinence and pelvic organ prolapse using transvaginal mesh. We assessed adverse outcomes after first, single mesh procedures and comparable non-mesh procedures.

Methods: We did a cohort study of women in Scotland aged 20 years or older undergoing a first, single incontinence procedure or prolapse procedure during 1997-98 to 2015-16 identified from a national hospital admission database.

Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013.

Aims/hypothesis: The relative contribution of increasing incidence and declining mortality to increasing prevalence of type 2 diabetes in Scotland is unclear. Trends in incidence and mortality rates are described for type 2 diabetes in Scotland between 2004 and 2013 by age, sex and socioeconomic deprivation.

Methods: Data for incident and prevalent cases of type 2 diabetes were obtained from the Scottish national diabetes register with number of deaths identified from linkage to mortality records.

Scottish Keep Well health check programme: an interrupted time series analysis.

Background: Effective interventions are available to reduce cardiovascular risk. Recently, health check programmes have been implemented to target those at high risk of cardiovascular disease (CVD), but there is much debate whether these are likely to be effective at population level. This paper evaluates the impact of wave 1 of Keep Well, a Scottish health check programme, on cardiovascular outcomes.

Impact of opioid substitution therapy for Scotland's prisoners on drug-related deaths soon after prisoner release.

Aim: To assess whether the introduction of a prison-based opioid substitution therapy (OST) policy was associated with a reduction in drug-related deaths (DRD) within 14 days after prison release.

Design: Linkage of Scotland's prisoner database with death registrations to compare periods before (1996-2002) and after (2003-07) prison-based OST was introduced.

Setting: All Scottish prisons.

Understanding extreme mortality among prisoners: a national cohort study in Scotland using data linkage.

Background: Mortality is known to be extremely high among people who have been imprisoned, but there is limited information about the factors that explain this increased risk.

Methods: Standard record linkage methods were used to link Scottish prison records and mortality data for all individuals imprisoned in Scotland for the first time between 1 January 1996 and 31 December 2007.

Results: Among 76 627 individuals there were 4414 deaths (3982 in men).

Ethnicity and first birth: age, smoking, delivery, gestation, weight and feeding: Scottish Health and Ethnicity Linkage Study.

Background: We linked census and health service data sets to address the shortage of information comparing maternal characteristics and pregnancy outcomes by ethnic group in Scotland.

Methods: Retrospective cohort study linking the 2001 National Census for Scotland and hospital obstetric data (2001-08), comparing maternal age, smoking status, gestational age, caesarean section rates, birthweight, preterm birth and breastfeeding rates by ethnic group.

Results: In all, 144 344 women were identified as having had a first birth between 1 May 2001 and 30 April 2008.

Ethnic differences in glycaemic control in people with type 2 diabetes mellitus living in Scotland.

Background And Aims: Previous studies have investigated the association between ethnicity and processes of care and intermediate outcomes of diabetes, but there are limited population-based studies available. The aim of this study was to use population-based data to investigate the relationships between ethnicity and glycaemic control in men and women with diabetes mellitus living in Scotland.

Methods: We used a 2008 extract from the population-based national electronic diabetes database of Scotland.

Measures of socioeconomic position are not consistently associated with ethnic differences in cardiovascular disease in Scotland: methods from the Scottish Health and Ethnicity Linkage Study (SHELS).

Background: Ethnic health inequalities are substantial. One explanation relates to socioeconomic differences between groups. However, socioeconomic variables need to be comparable across ethnic groups as measures of socioeconomic position (SEP) and indicators of health outcomes.

Changes in cardiovascular risk factors in relation to increasing ethnic inequalities in cardiovascular mortality: comparison of cross-sectional data in the Health Surveys for England 1999 and 2004.

Objectives: Reducing disease inequalities requires risk factors to decline quickest in the most disadvantaged populations. Our objective was to assess whether this happened across the UK's ethnic groups.

Design: Secondary analysis of repeated but independent cross-sectional studies focusing on Health Surveys for England 1999 and 2004.

Myocardial infarction incidence and survival by ethnic group: Scottish Health and Ethnicity Linkage retrospective cohort study.

Objective: Inequalities in coronary heart disease mortality by country of birth are large and poorly understood. However, these data misclassify UK-born minority ethnic groups and provide little detail on whether excess risk is due to increased incidence, poorer survival or both.

Design: Retrospective cohort study.

Socioeconomic deprivation increases the effect of winter on admissions to hospital with COPD: retrospective analysis of 10 years of national hospitalisation data.

Background: Admission to hospital with chronic obstructive pulmonary disease (COPD) is associated with deprivation and season. However, it is not known whether deprivation and seasonality act synergistically to influence the risk of hospital admission with COPD.

Aims: To investigate whether the relationship between season/temperature and admission to hospital with COPD differs with deprivation.

Cardiovascular disease and air pollution in Scotland: no association or insufficient data and study design?

Background: Coronary heart disease and stroke are leading causes of mortality and ill health in Scotland, and clear associations have been found in previous studies between air pollution and cardiovascular disease. This study aimed to use routinely available data to examine whether there is any evidence of an association between short-term exposure to particulate matter (measured as PM₁₀, particles less than 10 micrograms per cubic metre) and hospital admissions due to cardiovascular disease, in the two largest cities in Scotland during the years 2000 to 2006.

Methods: The study utilised an ecological time series design, and the analysis was based on overdispersed Poisson log-linear models.

Achieved levels of HbA1c and likelihood of hospital admission in people with type 1 diabetes in the Scottish population: a study from the Scottish Diabetes Research Network Epidemiology Group.

Objective: People with type 1 diabetes have increased risk of hospital admission compared with those without diabetes. We hypothesized that HbA(1c) would be an important indicator of risk of hospital admission.

Research Design And Methods: The Scottish Care Information-Diabetes Collaboration, a dynamic national register of diagnosed cases of diabetes in Scotland, was linked to national data on admissions.

Validity of self-reported smoking status: Comparison of patients admitted to hospital with acute coronary syndrome and the general population.

Many studies rely on self-reported smoking status. We hypothesized that patients with acute coronary syndrome (ACS), a smoking-related condition, would be more prone to misclassify themselves as ex-smokers, because of pressure to quit. We compared patients admitted with ACS with a general population survey conducted in the same country at a similar time.

Sex hormone-binding globulin and androgen levels in immigrant and British-born premenopausal British Pakistani women: evidence of early life influences?

In women, raised insulin levels are associated with low sex hormone-binding globulin (SHBG) and high androgen levels, which are in turn linked to infertility. Since insulin resistance and hyperinsulinemia are major health problems for South Asians living in Western countries, we predicted that British Pakistani women would have low SHBG and raised androgen levels compared to European women. Given low birth weights in Pakistan, and known links between low birth weight and insulin resistance in later life, we also predicted that immigrant women born in Pakistan would have lower levels of SHBG and higher levels of androgens than British-born British Pakistani women.

Self-reported work strain is lower in South Asian than European people: cross-sectional survey.

Objective: Jobs with high levels of demand and low levels of control have been linked to the risk of coronary heart disease (CHD). Limited evidence is available about the contribution of job characteristics to the increased risk of CHD in UK South Asian people. We aimed to describe psychosocial work characteristics in South Asian compared with European people.