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Biomedical subjects

R Balarajan

Publications and source records attributed to R Balarajan.

At least 19 recordsLinked to original sources
PubMed1992

Deprivation and general practitioner workload.

OBJECTIVES: To examine general practitioner consultations by demographic and socioeconomic variables and to derive a method of measuring the impact of relative deprivation on general practitioner workload. DESIGN: The study was based on general practitioner consultations reported in the general household surveys of 1983-7, covering a sample of 129,987 individuals in Great Britain. Odds ratios for general practitioner consultations were obtained for selected variables among children (0-15 years), men (16-64), women (16-64), and elderly people (greater than or equal to 65). These were then used to derive deprivation indices specific to electoral wards for use in general practice. SETTING: Great Britain, with particular findings illustrated by English electoral wards and the conurbations of London, Manchester, Merseyside, and the West Midlands. RESULTS: Council tenure increased the likelihood of consultation significantly in all four groups. Odds ratios were raised in children, men, and women with no access to a car. Birth in the New Commonwealth or Pakistan yielded high odds ratios in men, women, and elderly people but not in children. Marginally increased consultation rates were evident in the manual socioeconomic groups in women, elderly people, and children with a single parent mother. The deprivation indices for general practice derived using these odds ratios varied substantially among English electoral wards with, for example, anticipated general practitioner consultations in the electoral ward of Hulme, Manchester, being 24% higher than the average ward in England as a result of local attributes, and consultations in the Cheam South ward of Sutton, London, 11% lower than average. CONCLUSION: This deprivation index for general practice overcomes several shortcomings expressed about the underprivileged area score, which has been adopted in the 1990 contract as a basis for allocating deprivation supplements to general practitioners. The proposed index can be applied nationwide.

Adolescent↗
PubMed1992

Suicide and self-burning among Indians and West Indians in England and Wales.

Suicide levels in England and Wales during 1979-83 were low among males from the Indian subcontinent (SMR 73) and significantly high in young Indian women (age-specific ratios 273 and 160 at ages 15-24 and 25-34 respectively). Suicide levels were low in Caribbeans (SMRs 81 and 62 in men and women respectively) and high in East Africans (SMRs 128 and 148 in men and women respectively). The excess in East Africans (most of whom are of Indian origin) was largely confined to younger ages. Immigrant groups had significantly higher rates of suicide by burning, with a ninefold excess among women of Indian origin. The pressures leading to higher suicide levels among young women of Indian origin highlight the need for making appropriate forms of support and counselling available to this community.

Adolescent↗
PubMed1991

Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales.

OBJECTIVE: To examine mortality from ischaemic heart disease and cerebrovascular disease in England and Wales by country of birth of the deceased. DESIGN: Standardised mortality ratios were computed by country of birth groups for ischaemic heart disease and cerebrovascular disease for 1979-83 and 1970-2 by using the five year age-sex specific rates for England and Wales for 1979-83 as standard. SETTING: England and Wales 1970-2 and 1979-83. RESULTS: In 1979-83 mortality from ischaemic heart disease was highest in men and women born in the Indian subcontinent (standardised mortality ratio 136 and 146 respectively). Young Indian men suffered the greatest excess (313 at ages 20-29). Other groups with raised mortality included Irish, Scottish, and Polish born immigrants. Those born in the Caribbean, the old Commonwealth, west Europe, and the United States had low death rates. In England and Wales mortality from ischaemic heart disease declined by 5% in men and 1% in women between 1970-2 and 1979-83, with greatest percentage declines in immigrants born in the United States, South Africa, the old Commonwealth, the Caribbean, and France. immigrant groups with raised mortality in the earlier period showed little improvement, and mortality from ischaemic heart disease increased among Indians (6% in men and 13% in women). In 1979-83 mortality from cerebrovascular disease was highest in Caribbeans (standardised mortality ratios 176 in men and 210 in women), followed by Africans, Indians, and Irish. Rates were low in west Europeans. Mortality from stroke declined by 28% overall in this period, a rate of decline shared by most groups. Men from the Indian subcontinent showed a decline of only 3%. CONCLUSION: In the 1980s mortality from ischaemic heart disease and cerebrovascular disease differed significantly between ethnic groups in England and Wales. In general, ethnic groups that experienced lower mortality from ischaemic heart disease in the 1970s showed the greatest improvement over the following decade.

Adult↗
PubMed1990

Inequalities in health: socioeconomic differences in self-reported morbidity.

Socioeconomic differences in self-reported chronic and acute illness were investigated in men and women using data from the General Household Surveys (1981-4). Logit models were used to investigate the influence of age, socioeconomic group, tenure, access to cars, area of residence and marital status on these measures of morbidity. For both measures local authority tenants, whether male or female, reported the most morbidity as did those with no access to cars. Both males and females reported increasing levels of illness the lower their socioeconomic group but similar patterns were not observed with acute illness. The significance of these present day inequalities is discussed.

Adolescent↗
PubMed1990

Suicides among immigrants from the Indian subcontinent.

Suicides in England and Wales among immigrants of Indian ethnic origin were analysed for the period 1970-78. There were excess suicides among young Indian women, these being disproportionately more among the married. Burning was a common method of suicide among Indian women. Suicide rates were low in Indian men and the Indian elderly. A large proportion of the male suicides were among doctors and dentists.

Adolescent↗
PubMed1989

Ethnic differences in general practitioner consultations.

OBJECTIVE: To examine the levels of general practitioner consultations among the different ethnic groups resident in Britain. DESIGN: The study was based on the British general household surveys of 1983-5 and included 63,966 people aged 0-64. Odds ratios were derived for consultation by ethnic group by using logistic regression analysis adjusting for age and socioeconomic group. SETTING: The results relate to people living in private households in England, Scotland, and Wales. RESULTS: After adjustment for age and socioeconomic class, consultation among adults aged 16-64 was highest among people of Pakistani origin with odds ratios of 2.82 (95% confidence interval 1.86 to 4.28) for men and 1.85 (1.22 to 2.81) for women. Significantly higher consultations were also seen for men of West Indian and Indian origin (odds ratios 1.65 and 1.53 respectively). Ethnic differences were greatest at ages 45-64, when consultation rates in people of Pakistani, Indian, and West Indian origin were much higher in both sexes compared with white people. CONCLUSIONS: The ethnic composition of inner cities is likely to influence the workload and case mix of general practitioners working in these areas.

Adolescent↗
PubMed1989

Inequalities in health within the health sector.

Mortality among men employed in the health sector was examined using data surrounding the 1971 (1970-2) and 1981 (1979-83) censuses to assess the differences between social classes in the health service and to study changes over a decade. Relative to men in England and Wales, mortality in the 1980s was significantly lower among dentists (standardised mortality ratio 66), doctors (69), opticians (72), and physiotherapists (79) and significantly higher among hospital porters (151), male nurses (118), and ambulancemen (109). Mortality from lung cancer among hospital porters (185) was more than fivefold that seen in doctors (33) and dentists (37). Ischaemic heart disease varied twofold, being lowest in dentists (60) and doctors (70) and highest in hospital porters (138). Over the decade mortality from lung cancer and ischaemic heart disease declined in all groups except hospital porters, ambulancemen, and orderlies. Most groups showed excess deaths from suicides and cirrhosis of the liver. Differences in mortality between health workers in social class I and those in social class IV widened between the 1970s and 1980s and to a greater extent than among the general population. The high mortality of some groups within the NHS, and the fact that differentials between social classes have widened more than in the general population, suggest that the NHS needs to pay more attention to the health of its own staff.

Adolescent↗
PubMed1989

Unemployment and patterns of consultation with the general practitioner.

The relation between unemployment and consultations with the general practitioner was investigated among 13,275 economically active men aged 18-64 by using the British general household surveys. Men who were unemployed but seeking work consulted with doctors significantly more (odds ratio 1.83; 95% confidence interval 1.61 to 2.09) than those in employment, the highest consultation rate being among those who had been out of work for five years or more (odds ratio 2.12; 95% confidence interval 1.12 to 3.78). The high consultation rates persisted even after adjustment for self reported longstanding illness (odds ratio 1.53; 95% confidence interval 1.34 to 1.76). These findings suggest that in areas with high unemployment general practitioner workload is likely to be high.

Adolescent↗
PubMed1989

Sudden infant death syndrome and postneonatal mortality in immigrants in England and Wales.

To examine ethnic differences in postneonatal mortality and the incidence of sudden infant death in England and Wales during 1982-5 records were analysed, the mother's country of birth being used to determine ethnic group. Postneonatal mortality was highest in infants of mothers born in Pakistan (6.4/1000 live births) followed by infants of mothers born in the Caribbean (4.5) and the United Kingdom and Republic of Ireland (4.1). Crude rates were lower in infants of mothers born in India (3.9/1000), east and west Africa (3.0), and Bangladesh (2.8) than in infants of mothers born in the United Kingdom despite less favourable birth weights. Mortality ratios standardised separately for maternal age, parity, and social class were significantly higher in infants of mothers born in Pakistan and lower in those of mothers born in Bangladesh. The ratio for infants of Caribbean mothers was significantly higher when adjusted for maternal age. Ratios for infants of Indian and east African mothers did not show significant differences after standardisation. An important finding was a low incidence of sudden infant death in infants of Asian origin. This was paralleled by lower mortality from respiratory causes. During 1975-85 postneonatal mortality in all immigrant groups except Pakistanis fell to a similar or lower rate than that in the United Kingdom group; Pakistanis showed a persistent excess. During 1984-5 several immigrant groups (from the Republic of Ireland, India, west Africa, and the Caribbean) recorded an increase in postneonatal mortality. Surveillance of postneonatal mortality among ethnic communities should be continued, and research is needed to identify the causes underlying the differences.

Birth Weight↗
PubMed1989

Mortality from congenital malformations in England and Wales: variations by mother's country of birth.

Stillbirth and infant mortality from congenital malformations in England and Wales during 1981-5 was investigated according to the mother's country of birth. Significant differences remained after standardising for maternal age and social class. The highest overall mortality was in infants of mothers born in Pakistan (standardised mortality ratio 237), followed by infants of mothers born in India (standardised mortality ratio 134), East Africa (standardised mortality ratio 126), and Bangladesh (standardised mortality ratio 118). Caribbean and West African mothers showed an overall deficit. Mortality was inversely related to social class in all groups except the Afro-Caribbean. Infants of mothers born in Pakistan had the highest mortality in every social class except I, and for most anomalies investigated. Their ratios were particularly high for limb and musculoskeletal anomalies (standardised mortality ratio 362), genitourinary anomalies (standardised mortality ratio 268), and central nervous system anomalies (standardised mortality ratio 239). Our findings highlight the need for further research to identify the causes underlying these differences.

Africa↗
PubMed1989

Single mothers: their health and health service use.

STUDY OBJECTIVE: The aim of the study was to investigate differences in reported health and health service use in single mothers. DESIGN: The study was a survey of data derived from the General Household Surveys conducted by the Office of Population Censuses and Surveys (OPCS). SETTING: The OPCS data are derived from samples of households throughout Great Britain. PARTICIPANTS: OPCS data for 1983 and 1984 were used, comprising approximately 60,000 individuals, of whom 793 were single mothers. MEASUREMENTS AND MAIN RESULTS: Five different health outcomes were examined, two on perceived morbidity and three on the use of health services. The chief determinants of health and health services use among single mothers were housing tenure, employment status and the age of the youngest child. Single mother status did not consistently contribute to self reported morbidity and uptake of care when adjusted for other social variables, but there was a difference between categories of single mother, with those who were separated/divorced and those who were widowed reporting more acute illness than those who were married. CONCLUSION: The findings suggest that single mothers do not form a homogeneous group and that, if special consideration is to be given to them when planning and allocating health service resources, this needs to be taken into account in the context of other socioeconomic factors.

Adolescent↗
PubMed1988

Professional drivers in London: a mortality study.

A total of 3392 professional drivers in London were followed up in a prospective mortality study. There were significantly fewer deaths than expected from all causes (SMR 91, p less than 0.05), circulatory disease (SMR 75, p less than 0.05), and accidents (SMR 61, p less than 0.05). Lorry drivers showed excess deaths from stomach cancer (SMR 141, p less than 0.05), lung cancer (SMR 159, p less than 0.05), bronchitis, emphysema, and asthma (SMR 143, p less than 0.05), a pattern not evident among taxi drivers. Mortality from bladder cancers, leukaemia, and other lymphatic cancers were raised in taxi drivers, though the results did not achieve statistical significance. The importance of the findings is discussed.

Automobile Driving↗
PubMed1987

Socioeconomic differentials in the uptake of medical care in Great Britain.

Socioeconomic differentials in the uptake of medical care in men were investigated using data from the General Household Survey (1974-76 and 1979-80). Hospitalisation, attendance at out patient clinics, and consultation with doctors were higher in local authority tenants than in owner occupiers. Men belonging to the manual socioeconomic groups also used services and consulted doctors more often than those in the non-manual groups. Hospitalisation among men was highest among manual workers living in local authority properties without access to car(s) (OR 1.92). Highest attendance at outpatient clinics (OR 1.60) was seen among local authority tenants in urban areas belonging to manual groups. However, consultation with doctors was highest among urban manual workers living in local authority properties but with access to car(s) (OR 1.72). The implications of these findings for resource allocation are discussed.

Health Services↗