HEALTH AND DEPRIVATION: Inequality and the north

Background Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris primarily affecting postmenopausal women, with a predilection for the frontotemporal hairline. Objectives We sought to examine possible causal associations and review the clinical features, natural history, and response to treatment of patients with FFA attending a specialist hair clinic. Methods This was a case note review of 60 patients with FFA. Results The number of patients with FFA seen has increased over the last decade. All were Caucasian women, with significantly above-average affluence scores and were less likely to be smokers. The mean age at presentation was 64 years and average disease duration was 3.4 years (range: 6 months-30 years). Three patients were premenopausal. All patients had frontotemporal involvement, with follicular hyperkeratosis, scarring, and variable perifollicular erythema. Several patients had more unusual patterns: 8 had extensive parietal involvement, 4 had occipital involvement, 1 had asymmetric frontal involvement, and 5 had typical FFA associated with diffuse scalp lichen planopilaris. Eyebrow loss was documented in 73%, eyelash loss in 3%, and body hair loss in 25%. Almost all patients had been treated with superpotent topical steroids. Other treatments included topical calcineurin inhibitors; intralesional triamcinolone acetate; phototherapy; hydroxychloroquine; lymecycline; and prednisolone. Although some treatments may reduce inflammation, their efficacy in controlling the progress of the alopecia was uncertain. Limitations This is a retrospective review. Conclusions FFA is a clinically distinctive condition, the prevalence of which appears to be increasing. It has a generally poor response to treatment. The origin remains uncertain.

https://www.jaad.org/article/S0190-9622(12)00141-7/pdf

Frontal fibrosing alopecia: a review of 60 cases.

Women's Access to Political Power in Post-Communist Europe. Edited by Richard E. Matland and Kathleen A. Montgomery. New York: Oxford University Press, 2003. 400p. $85.00 cloth, $35.00 paper. It was something of a truism that within the political institutions of the Soviet bloc states, women and power were found in inverse proportion to each other. While women occupied roughly 30% of the seats within the faux-parliamentary bodies of the communist region, true power was never located in those institutions. Instead, political power was found at the Communist Party's zenith, where women were seen rarely, if at all.

Women's Access to Political Power in Post-Communist Europe

This study examines inequalities in life expectancy by educational status, age-standardised mortality rates, and age-at-death, using high-quality linked and supplementary unlinked data from 25 OECD countries in 2013-19. Absolute gaps in life expectancy at age 25 between high and low education groups are on average equal to 5.2 years and 8.2 years for women and men, respectively. Deaths of despair among women and men aged 25-64 contribute on average 7% and 11% to the total gap in life expectancy between high and low education groups, respectively. Comparing identical country-sources to the previous analysis, absolute gaps in life expectancy at age 25 have increased by 0.5 year and 0.4 year on average for women and men between 2011 and 2016. 

Educational inequalities in longevity among OECD countries around 2016

Objective To report on the extent of inequality in premature mortality as measured between geographical areas in Britain. Design Observational study of routinely collected mortality data and public records. Population subdivided by age, sex, and geographical area (parliamentary constituencies from 1991 to2007, pre-1974 local authorities over a longer time span). Setting Great Britain. Participants Entire population aged under 75 from 1990 to 2007, and entire population aged under 65 in the periods 1921-39, 1950-3, 1959-63, 1969-73, and 1981-2007. Main outcome measure Relative index of inequality (RII) and ratios of inequality in age-sex standardised mortality ratios under ages 75 and 65. The relative index of inequality is the relative rate of mortality for the hypothetically worst-off compared with the hypothetically best-off person in the population, assuming a linear association between socioeconomic position and risk of mortality. The ratio of inequality is the ratio of the standardised mortality ratio of the most deprived 10% to the least deprived 10%. Results When measured by the relative index of inequality, geographical inequalities in age-sex standardised rates of mortality below age 75 have increased every two years from 1990-1 to 2006-7 without exception. Over this period the relative index of inequality increased from 1.61 (95% confidence interval 1.52 to 1.69) in 1990-1 to 2.14 (2.02 to 2.27) in 2006-7. Simple ratios indicated a brief period around 2001 when a small reduction in inequality was recorded, but this was quickly reversed and inequalities up to the age of 75 have now reached the highest levels reported since at least 1990. Similarly, inequalities in mortality ratios under the age of 65 improved slightly in the early years of this century but the latest figures surpass the most extreme previously reported. Comparison of crudely age-sex standardised rates for those below age 65 from historical records showed that geographical inequalities in mortality are higher in the most recent decade than in any similar time period for which records are available since at least 1921. Conclusions Inequalities in premature mortality between areas of Britain continued to rise steadily during the first decade of the 21st century. The last time in the long economic record that inequalities were almost as high was in the lead up to the economic crash of 1929 and the economic depression of the 1930s. The economic crash of 2008 might precede even greater inequalities in mortality between areas in Britain.

Inequalities in premature mortality in Britain: observational study from 1921 to 2007

The creation and use of composite indices for capturing various complex or multidimensional concepts (eg, deprivation, geographic access, green space, sustainability, corruption, transparency) has become extremely popular. Measures are created at national, regional or small-area level. There is considerable literature on creating measures at the national level, much of it critical, discussing the different implicit (and potentially biassed) decisions taken by researchers or organisations creating the measures.1 Few researchers discuss the different choices available or the steps taken to create small-area measures and the subsequent effect of these decisions on the results.2–5 More often, measures are created with little discussion or justification of the methods, let alone validation or uncertainty.

We believe there is scope to review and evaluate the steps and options available when creating composite measures. As an example of the process of developing a small-area measure, we are focusing on deprivation measures in public health research. Small-area deprivation measures have been widely used to understand inequalities in health in the UK since the 1980s6–8 and have since become common in many other countries.9–12 They are appealing as they help summarise complex phenomena into a single numeric representation, are easy to use and allow robust national level analysis with aggregate data. Nevertheless, the seemingly simple composite measures belie many important decisions explicitly (or sometimes implicitly) taken by the researchers. Our aim is to outline the key stages and options available to researchers, and to discuss their potential merits and problems.

Historically, small-area deprivation measures have aimed to locate areas (and the people living in these) on a scale of material well-being,6 13 but more recently this has also extended to the physical environment.14 The measures generally cover multiple different dimensions of deprivation, often called domains. Common domains include employment, income, social class …

https://jech.bmj.com/content/jech/74/1/20.full.pdf

Creating small-area deprivation indices: a guide for stages and options

Carstairs deprivation scores, originally created in 1981, provide a measure of material deprivation. Four census variables (male unemployment, no car ownership, overcrowding and low social class) were used in the creation of the score. As near as possible the same four variables have been used to update Carstairs scores decennially, despite changes to the definition of some of the variables over time. Researchers at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow have now updated Carstairs scores for 2011 for Scottish postcode sectors and for the first time datazones and output areas.

Carstairs Scores for Scottish Postcode Sectors, Datazones and Output Areas from the 2011 Census

Increasing mortality among men from drugs, alcohol and suicides is a growing public health concern in many countries. Collectively known as “deaths of despair”, they are seen to stem from unprecedented economic pressures and a breakdown in social support structures. We use high-quality population wide Scottish data to calculate directly age-standardized mortality rates for men aged 15–44 between 1980 and 2018 for 15 leading causes of mortality. Absolute and relative inequalities in mortality by cause are calculated using small-area deprivation and the slope and relative indices of inequality (SII and RIIL) for the years 2001–2018. Since 1980 there have been only small reductions in mortality among men aged 15–44 in Scotland. In that period drug-related deaths have increased from 1.2 (95% CI 0.7–1.4) to 44.9 (95% CI 42.5–47.4) deaths per 100,000 and are now the leading cause of mortality. Between 2001 and 2018 there have been small reductions in absolute but not in relative inequalities in all-cause mortality. However, absolute inequalities in mortality from drugs have doubled from SII = 66.6 (95% CI 61.5–70.9) in 2001–2003 to SII = 120.0 (95% CI 113.3–126.8) in 2016–2018. Drugs are the main contributor to inequalities in mortality, and together with alcohol harm and suicides make up 65% of absolute inequalities in mortality. Contrary to the substantial reductions in mortality across all ages in the past decades, deaths among young men are increasing from preventable causes. Attempts to reduce external causes of mortality have focused on a single cause of death and not been effective in reducing mortality or inequalities in mortality from external causes in the long-run. To reduce deaths of despair, action should be taken to address social determinants of health and reduce socioeconomic inequalities.

/pdf/deaths-of-despair-cause-specific-mortality-and-socioeconomic-1rpjsqd4ah.pdf

Deaths of despair: cause-specific mortality and socioeconomic inequalities in cause-specific mortality among young men in Scotland.

Safety has been shown to be an important contributor to mental wellbeing and is often identified as a key element of sustainable communities. Drawing on the fear of crime literature this paper investigates the determinants of feelings of indoor and outdoor safety for people living in deprived areas, using both cross-sectional and longitudinal samples from household surveys in 15 communities in Glasgow. Across the different models social cohesion, satisfaction with services and perceived empowerment emerge as the most robust predictors of feeling very safe indoors and outside. Our findings suggest useful extensions to several theoretical models of the fear of crime: the vulnerability hypothesis should include social vulnerability more generally; environmental models should focus on local amenities and services as well as on disorder; and social-psychological models should consider not only informal social control but resident empowerment in relation to housing and neighbourhood issues.

/pdf/there-goes-the-fear-feelings-of-safety-at-home-and-in-the-4praqw6aax.pdf

“There goes the fear”: feelings of safety at home and in the neighborhood: The role of personal, social, and service factors

The literature on women's descriptive representation has looked at the debate on open and closed lists as a choice between electoral systems. This article instead focuses on whether voters or the parties are biased against female candidates. Using data from six Estonian elections, the article finds that voters are not consistently biased against female candidates and open lists do not necessarily decrease women's representation. However, unknown and non-incumbent female candidates fare significantly worse than similar men. The analysis also shows that parties do not place women in electable positions on closed lists, and closed lists do not improve women's representation.

/pdf/who-stands-in-the-way-of-women-open-vs-closed-lists-and-271ven8mx8.pdf

Who stands in the way of women? Open vs. closed lists and candidate gender in Estonia

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