The study of 15.7 million patient records, funded by the National Institute for Health and Care Research and published in the prestigious Journal of the Royal Society of Medicine today, implies there could be scope to prescribe far fewer antibiotics. 

The researchers found the probability of being prescribed antibiotics for a lower respiratory tract or urinary tract infection was unrelated to hospital admission risk. 

And the probability of being prescribed an antibiotic for an upper respiratory tract infection was only weakly related to hospital admission risk. 

The study also showed that patient characteristics such as age and the presence of other health problems were only weakly associated with the probability of being prescribed an antibiotic treatment of common infection. 

The most elderly patients in the sample were 31% less likely than the youngest patients to receive an antibiotic for upper respiratory infections. 

That inevitably means, say the researchers, that because many younger people are being prescribed antibiotics, even though they are often fit enough to recover without them, potentially  leading to resistance. 

Conversely,  many older people may not be able to deal with infections without antibiotics are not  receiving them, with the potential of complication and hospital admissions. 

Patients with combinations of diseases were 7% less likely than people without major health problems  to receive an antibiotic for upper respiratory infections. 

Lead authors are  Professor Tjeerd van Staa and Dr Ali Fahmi, from The University of Manchester. 

Professor Tjeerd van Staa said: “Antibiotics are effective in treating bacterial infections, but they carry the risks of antimicrobial resistance (AMR) and loss of effectiveness when used inappropriately. 

“That is why AMR to antibiotics has been recognised as one of the biggest threats to global public health. 

“Given the threat of resistance, there is a need to better target antibiotics in primary care to patients with higher risks of infection-related complications such as sepsis. 

“But this study finds that antibiotics for common infections are commonly not prescribed according to complication risk and that suggests there is plenty of scope to do more on reducing antibiotic prescribing.” 

The study also showed that the probability of being prescribed an antibiotic for lower respiratory infections was even more unrelated to complication risk during the pandemic, however they were only minor changes for urinary tract infections. 

The research team accessed anonymised patient-level electronic health records of primary care data from The Phoenix Partnership (TPP) through OpenSAFELY, a secure platform for electronic health records in the NHS. 

They included adults registered at general practices in England from January 2019 to March 2023 diagnosed with upper respiratory, lower respiratory and urinary tract infections. 

Patient-specific risks of infection-related hospital admission were estimated for each infection using risk prediction scores for patients who were not prescribed an antibiotic. 

Dr Ali Fahmi added: “Rather than imposing targets for reducing inappropriate prescribing, we argue that it is far more viable for clinicians to focus on improving risk-based antibiotic prescribing for infections that are less severe and typically self-limiting. 

“Prognosis and harm should explicitly be considered in treatment guidelines, alongside better personalised information for clinicians and patients to support shared decision making.”

“A Knowledge Support System (KSS) led by Professor Tjeerd van Staa, which provides personalised information to clinicians is  now being tested in the North-West England

“We hope it could provide a workable solution to the problem of untargeted antibiotic prescribing.”

Antibiotics for common infections in primary care before, during and after the COVID-19 pandemic: cohort study of extent of prescribing based on risks of infection-related hospital admissions  is published in  Journal of the Royal Society of Medicine DOI: 10.1177/01410768251328997

Professor Ian Hall has been awarded an OBE for his services to public health, to epidemiology and to adult social care, particularly during Covid-19, Professor Richard Wakeford has been awarded an OBE for his for services to the advancement of the science of radiation protection, Professor Paul Klapper has been awarded an OBE for services to viral diagnostic testing, and Professor Paul Howarth has been awarded a CBE for his significant contribution and service to the nuclear industry and to UK research and development (R&D).

The list celebrates individuals who have had an immeasurable impact on the lives of people across the country - such as by creating innovative solutions or driving real change in public life.

Ian Hall is a Professor of Mathematical Epidemiology and Statistics at The University of Manchester. He is a long-standing member of SPI-M (the pandemic disease modelling advisory group) and played a critical role in the operations of this group during the swine flu and Covid-19 pandemics.

During the Covid-19 pandemic he was academic chair of the SAGE working group of Social Care and participated in the SAGE Environmental Modelling Group as well as attending SAGE itself. He was also involved in a number of research projects, including the national core study on transmission (PROTECT) and Project TRACK to understand and control the risks on public transport. He also helped analyse data from a new heat map, providing a national picture of the spread over time.

Since the pandemic, Professor Hall has continued working with UKHSA through an honorary contract, notably with Health Equity Division on vaccination strategies in prison and homeless settings.

His other research interests include the impact of diseases on vulnerable populations and the study of vector-borne infectious diseases and environmental infections, such as Legionnaires Disease.

Richard Wakeford is an Honorary Professor in Epidemiology in the Centre for Occupational and Environmental Health (COEH), having been Professor in Epidemiology at the Centre before retiring at the end of 2019. He specialises in the epidemiology of exposure to ionising radiation, particularly as related to radiological protection.

Professor Wakeford is a member of various committees, including the UN Scientific Committee on the Effects of Atomic Radiation and the International Commission on Radiological Protection. He was a member of the Scientific Advisory Group for Emergencies (SAGE) following the Fukushima nuclear accident in Japan, and for 25 years was Editor-in-Chief of the Journal of Radiological Protection.

Richard completed his PhD in high energy physics at the University of Liverpool in 1978 and worked for British Nuclear Fuels Ltd (BNFL) for nearly 30 years. It was the many challenges faced at BNFL where he developed his skills in radiation epidemiology and radiological protection. He was privileged to work with Sir Richard Doll during this time. After taking early retirement from BNFL, Richard joined the University, initially through an association with Dalton Nuclear Institute and then joining COEH.

Paul Klapper is Professor of Clinical Virology at The University of Manchester. He began his career in virology in 1976 working as a laboratory technician at Booth Hall Children’s Hospital. He completed his PhD while working at Manchester Royal Infirmary on the diagnosis of herpes simplex encephalitis - a topic he continued to work on for over 20 years and led to the development of a reliable molecular diagnostic test for the condition. He also helped establish independent quality assurance testing in the infancy of viral molecular diagnostic testing. 

Throughout his career, Professor Klapper has been at the forefront of several key developments of viral diagnostic testing. Notably, he worked with the Greater Manchester Hepatitis C testing strategy, developing community-based testing methods to aid control of the HCV pandemic. In 1981, he became an NHS Clinical Scientist, working in both Manchester and Leeds as a Consultant Clinical Scientist. Ten years later, in 1991 became a Fellow of the Royal College of Pathology. 

On retiring from the NHS in 2012, Professor Klapper joined The University of Manchester as a Professor of Clinical Virology.  Early in 2020, he volunteered to help with establishment of large scale Covid-19 testing and became the clinical lead for the Alderley Park testing facility. He also served as a Clinical Advisor for testing with the Department of Health.

 Professor Klapper continues to conduct vital research in blood-borne virus infection and in congenital human cytomegalovirus infection.

Paul Howarth is Professor of Nuclear Technology at The University of Manchester and Chief Executive of National Nuclear Laboratory. 

Professor Howarth has had a distinguished career working in and for the nuclear sector, building a reputation as one of the leading figures in the UK nuclear sector and around the global industry. After completing his degree in Physics and Astrophysics and PhD in Nuclear Physics, he started his career working on the European Fusion Programme. Early in his career he was awarded a prestigious Royal Society Fellowship to work in Japan on their nuclear programme. On returning to the UK he continued to work on nuclear fission leading the UK’s advanced reactor programme while working at British Nuclear Fuels, co-founding the Dalton Nuclear Institute at the University  and working closely with UK Government on building the case for new nuclear build.

Professor Howarth was appointed CEO for the National Nuclear Laboratory (NNL) in 2011 following its creation as a public corporation, having been instrumental in its establishment from British Nuclear Fuels Limited (BNFL). During his tenure as CEO, NNL has been transformed into a successful business and a true national laboratory, delivering profits to reinvest into nuclear science and technology and critical support to nuclear organisations in the public and private sectors. 

The birthday honours are awarded by the King following recommendations by the prime minister, senior government ministers, or members of the public.

The awards recognise active community champions, innovative social entrepreneurs, pioneering scientists, passionate health workers and dedicated volunteers who have made significant achievements in public life or committed themselves to serving and helping Britain.

To see the full Birthday Honours List 2024, visit: https://www.gov.uk/government/publications/the-kings-birthday-honours-list-2024  

In addition to the deaths from COVID-19, longstanding socioeconomic and geographical health inequalities for a range of other conditions also worsened during the pandemic, say the research team from the Universities of Manchester and York.

More people were estimated to have died from all-causes in deprived areas across all age-groups, but the differences between deprived and affluent areas were greatest amongst younger people.

For all-cause mortality in the most deprived areas, 15 to 44 year olds were estimated to have had 480 excess deaths, compared to 42 in the most affluent, or over 11 times as many.

And 45 to 64 year olds were estimated to have had 3,150 excess deaths in the most deprived areas , compared to 1,050 in the most affluent, or 3 times as many.

By comparison, estimated excess deaths for those aged 75 to 84 were 5,916 in the most deprived areas and 4,279 in the most affluent, or 40% higher; for those aged 85 or over they were 5,771 in the most deprived and a similar level of 6,094 in the most affluent.

For mortality caused by COVID-19 and respiratory illness, in the most deprived areas, 15 to 44 year olds were estimated to have had 268 excess deaths, compared to 51 in the most affluent, over 5 times as many.

Similarly, 45 to 64 year olds were estimated to have had 2008 excess deaths in the most deprived areas , compared to 681 in the most affluent, or 3 times as many.

By comparison, estimated excess deaths for those aged 75 to 84 were 5069 in the most deprived and 3655 in the most affluent, or 40% higher.

For those aged 85 or over they were 5,302 in the most deprived and a similar 5,636 in the most affluent.

To a degree, the differences were lessened when age structure within deprivation strata was taken into account as younger people live in more deprived areas. However, they remained significant.

The research team used ‘Years of Life Lost’ (YLL) as an alternative measure of premature mortality, measuring the ‘excess’ years lost during the pandemic compared with previous years.

The measure accounts for both the number of deaths and the age at which those deaths occurred and allows comparison between causes of death and across population groups

YLL adjusts for baselined levels across strata of interest such as different life expectancies for men and women.

There were an estimated 763,550 excess YLL in England and Wales in 2020 compared to 2019, 85% of which were directly attributed to COVID-19 or another respiratory disease.

Excess YLL varied widely across the regions, with per capita rates in the North West over three times as high as those in the South West of England

Rates also varied across social groups: the most deprived fifth of areas were 1.8 times those than in the least deprived fifth.

For every death, an average of 9.1 years of life were lost in the least deprived fifth of areas, compared to 10.8 years in the most deprived fifth. For COVID-19/respiratory deaths the numbers were 8.9 and 11.2 years, respectively.

More years of life were lost for men on average, 10.5 in COVID/respiratory deaths and 10.8 in all-cause deaths, compared to 9.5 and 8.2 for females, respectively.

The pandemic exacerbated longstanding socioeconomic inequalities, with the ratio of observed years of life lost for the most deprived fifth of areas compared to the most affluent increasing from 1.56 in 2019 to 1.64 in 2020.

Professor Evan Kontopantelis from The University of Manchester said: “The pandemic widened pre-existing health inequalities across England and Wales: regions and social groups with the highest baseline mortality rates experienced the greatest impact on years of life lost.

“Linked to this, we think the impact of the pandemic may have been higher than previously thought on the most deprived areas of England and Wales, with more younger people dying directly or indirectly from COVID-19 in these areas.”

Professor Tim Doran from the University of York said: “Our findings support the notion that Years of Life Lost can be more informative for determining unmet needs and informing policy for this or future pandemics.

“In particular, it could provide vital information to aid the targeting of vaccines, financial aid and social support during this and future pandemics.”

This paper is not yet peer reviewed, the authors felt its contents were sufficiently in the public interest to disseminate to the public

The paper Excess years of life lost to COVID-19 and other causes of death by sex, neighbourhood deprivation and region in England & Wales during 2020 is available via the pre-print server

The study of English data in the journal Epidemiology and Communality Health, shows how people in our towns and cities divided by deprivation are also divided by opioid use.

Lincolnshire East was the most unequal clinical commissioning group area in England: the level of prescribing for most deprived areas was twice as much as those in the least deprived areas. It contrasts markedly with nearby Lincolnshire North.

They also showed:

• Prescribing in the most deprived areas in North England was 1.2 times higher than the national average for areas with similar deprivation levels and 3.3 times higher than the most deprived areas in London.
• Prescribing in the most deprived areas was substantially higher than the least deprived areas. On average it was 9.70 Defined Daily Doses/1000 people/day higher.
• In the most unequal Clinical Commissioning Group area, prescribing in the most deprived areas was twice that of the least deprived areas.

Led by PhD researcher Magdalena Nowakowska, the team used sophisticated statistical analysis linking different datasets to observe GP prescribing in 32,844 geographical units, each representing an average of 1,500 people in England, across 195 CCG areas.

Deaths from overdosing and dependency on the class of drugs which include Fentanyl, Morphine, Oxycodone, Tramadol and Codeine have risen dramatically in the West over the past two decades.

Though researchers and policy makers know that prescribing is associated with higher deprivation levels, this is the first time the patterns of this relationship across the country have been fully mapped.

East and South Lincolnshire, Fylde and Wyre, East Riding and the Wirral were the top five CCG areas with the biggest differences in prescribing.

Significant differences in prescribing within CCGs may suggest that policies and interventions at a smaller level, addressing specific communities may be needed.

However, say the team, the observed variations in opioid prescribing may reflect wider issues with social, economic and health inequalities which also need to be addressed.

“Much is known about increasing opioid prescribing and opioid-related deaths, but this study adds greater understanding of its association with deprivation”, said Professor Evan Kontopantelis, from The University of Manchester

Magdalena Nowakowska said: “Knowing where exactly which populations are being prescribed more is a powerful way to guide policy responses and interventions so they can allocate resources to areas with highest levels of opioid prescribing.”

“CCG areas have populations of 100,000 to 500,000 people, so these large units can’t really describe the experience of the people who live there.”

“However, the smaller units we used, using some novel methodological approaches and datasets, can give a more accurate picture – which can be incredibly useful for policy makers.”

The team measured opioid prescribing in Defined Daily Dose, a statistical measure devised by the World Health Organisation which allows researchers to compare drug usage between different environments.

They modelled the effect of socioeconomic deprivation on opioid prescribing controlling for population demographics and the prevalence of specific health conditions using data from 2018 and 2019.

The Index of multiple deprivation used by the team is recognised as an accurate measure, and uses health, public services, education, crime, and other factors.

She added: “We didn’t look specifically at why there are such stark differences within relatively small geographical areas, people living in more deprived areas are more likely to experience more complex health needs and poorer access to alternatives for opioids are likely to help explain the disparities.

The study was funded by the NIHR School for Primary Care Research and the NIHR Greater Manchester Patient Safety Translational Research Centre.

The paper Association of Socioeconomic Deprivation with Opioid Prescribing in Primary Care in England: a Spatial Analysis is published in Epidemiology and Communality Health,

Children of women who reported domestic violence in pregnancy or during the first six years of the child’s life are almost 50% more likely to have a low IQ at age 8, research finds.

In the study by University of Manchester epidemiologists, 13% of children whose mothers did not experience domestic violence had an IQ of below 90 at 8 years of age.

If their mothers experienced physical violence from their partner either in pregnancy or during the first six years of the child’s life, the figure rises to 22.8%.

The team led by Dr Kathryn Abel from The University of Manchester show the chance of a low IQ rises to 34.6% if the mother was repeatedly exposed to domestic violence.

That means children with mothers who repeatedly suffer domestic violence during pregnancy and the first six years of their child’s life are almost three times more likely to have a low IQ at 8 years of age, find researchers.

Low IQ is defined as an IQ score less than 90, where a normal IQ is considered to be 100.

The study examined the link between domestic violence - also called Intimate partner violence (IPV) - and child intelligence at 8 year’s old, using 3,997 mother child pairs from The University of Bristol’s Avon Longitudinal Study of Parents and Children.

The study, funded by the Wellcome Trust and Medical Research Council, is published in Wellcome Open Research.

ALSPAC follows children from pregnancy, and measures emotional and physical domestic violence – also known as intimate partner violence - from pregnancy until eight years of age.

The intelligence of the children was measured at eight years using the Weschler standardised IQ test.

Dr Abel said: “We already know that 1 in 4 women age 16 and over in England and Wales will experience domestic violence in their lifetime and that their children are at greater risk of physical, social and behavioural problems.

“We also know that intelligence in childhood is strongly linked with doing well in adulthood, though there has been little evidence about the risk of low IQ for these children.

“While we cannot conclude that IPV causes low IQ, these findings demonstrate domestic violence has a measurable link, by mid-childhood, independent of other risk factors for low IQ.”

17.6% of the mothers in the study reported emotional violence and 6.8% reported physical violence.

The findings are independent of other risk factors for low IQ such as alcohol and tobacco use in pregnancy, maternal depression, low maternal education and financial hardship around the child’s birth.

There is some disagreement on whether the IQ test is a complete measure of intelligence, as it only considers verbal and non-verbal intelligence

However, it is regarded as useful by many experts because a high IQ has been demonstrated in many countries and cultures to associate with a broad range of improved social and health outcomes.

Dr Hein Heuvelman, from The University of Bristol added: “Exposure to domestic violence is common for children in the UK and an important and often overlooked risk factor in their life chances.

“So knowing the extent to which these already vulnerable children are further affected is a powerful argument for more, better and earlier intervention.

“Current support for women experiencing domestic violence is inadequate in some areas and absent in others.

“Early intervention with these families protects children from harm, but it may also prioritise their future development.”

The study, funded by The Wellcome Trust and Medical Research Council, was carried out by a team of experts at The University of Manchester, University of Bristol, Manchester Metropolitan University and Kings College London.

The paper ‘Intelligence in offspring born to women exposed to intimate partner violence: a population-based cohort study’, published in Wellcome Open Research, is available here

Based at the University of Bristol, Children of the 90s, also known as the Avon Longitudinal Study of Parents and Children (ALSPAC), is a long-term health research project that enrolled more than 14,0000 pregnant women in 1991 and 1992. It has been following the health and development of the parents, their children and now their grandchildren in detail ever since. It receives core funding from the Medical Research Council, the Wellcome Trust and the University of Bristol.

National helplines:

Women's Aid – for women experiencing IPV freephone national 24 hour helpline 0808 2000 247 https://www.womensaid.org.uk/

RESPECT helpline for perpetrators of IPV to stop using violence and abuse 0808 802 4040

http://respectphoneline.org.uk/

For media enquiries contact:

Around 1.7% of the UK population are affected by the chronic skin condition psoriasis, according to researchers at The University of Manchester and the University Medical Center Hamburg-Eppendorf.

The figures, which have never been compiled before, are published today in the world’s first Global Psoriasis Atlas, an interactive web platform which aims construct a global picture of psoriasis. It is published on World Psoriasis Day today (29 October)

The team carried out extensive search of all available evidence and used the data in a statistical model to generate estimates of the prevalence of psoriasis for every country of the world.

Previously, such detailed information has only been available for a very small number of countries.

Also according to the Atlas, the country most affected by psoriasis is Norway with a prevalence of 1.98% of the overall population. The lowest prevalence is across East Asia at 0.12%.

Around 2% of the West’s population are affected and the region with the lowest prevalence is East Asia with a prevalence of 0.12%.

The UK is ranked 21st in countries with the highest prevalence of psoriasis worldwide , corresponding to approximately 1·1 million people affected by the disease.

However, the research team say the estimates could increase to 1.8 million or 2.78% when taking self-reported and underdiagnosed psoriasis into account.

The Atlas was is supported by the International Federation of Psoriasis Associations (IFPA), the International League of Dermatological Societies (ILDS) and the International Psoriasis Council (IPC).

Professor Chris Griffiths from The University of Manchester said: “Our understanding of the epidemiology of this chronic condition is limited in many countries but we believe the Global Psoriasis Atlas will radically transform this in the future.

“It will uncover the true burden of the disease, ensuring those people living with psoriasis have access to the best available care, wherever they live in the world.

“That is why we believe the Global Psoriasis Atlas is a significant milestone: for the first time we will have robust information on how many people psoriasis affects worldwide which in turn will start to address inequalities in its care.

”It will serve as a valuable source of information about psoriasis for researchers, policy makers, patients and healthcare providers across the world.”

He added: “Our research shows that high-income countries have a prevalence of psoriasis higher than low-income countries.

“But that might be down to the fact that high-income countries have better healthcare systems, more awareness of the disease and better data quality.

“High-income countries also have a higher proportion of the elderly population and psoriasis is a chronic disease”

“Additionally many people with psoriasis in least developed countries do not have access to care.”

Ranking of the world regions according to prevalence of psoriasis