̽��ֱ�� of Cambridge - Andres Roman-Urrestarazu

Likelihood of receiving an autism diagnosis may depend on where you live

cjb250 — Mon, 24 Oct 2022 22:30:39 +0000

̽��ֱ��latest findings, from researchers from the ̽��ֱ�� of Cambridge in collaboration with researchers from the London School of Economics and Political Science and Newcastle ̽��ֱ��, are published today in ̽��ֱ��Lancet Child & Adolescent Health.

After analysing all new autism cases across England using NHS health service boundaries for possible hotspots, some areas stand out. For example, 45.5% of the NHS Rotherham catchment area had higher-than-average new autism diagnoses clusters. For NHS Heywood, this amounted to 38.8% of its catchment area and 36.9% for NHS Liverpool, pointing at a possible health service effect towards who receives an autism diagnosis.

̽��ֱ��research team used four years’ worth of data from the Summer School Census, which collected data from individuals aged 1-18 years old in state-funded schools in England. Of the 32 million pupils studied, more than 102,000 new autism diagnoses were identified between 2014 and 2017.

After adjusting for age and sex, the researchers found that one in 234 children were given a new autism diagnosis during that four-year period. New diagnoses tended to happen when children were transitioning to a new school, whether that was into nursery (1-3 years), primary school (4-6), and secondary school (10-12 years).

Particular communities appeared to have different rates, varying by ethnicity and deprivation.

Lead researcher Dr Andres Roman-Urrestarazu from the Department of Psychiatry and Cambridge Public Health at the ̽��ֱ�� of Cambridge said: “Autism diagnoses are more common among Black students and other minority ethnic groups. Why this is the case is not clear and so we need to explore the role played by social factors such as ethnicity and area deprivation as well as the nature of local services.”

̽��ֱ��likelihood of receiving an autism diagnosis more than tripled among girls depending on their ethnicity and social and financial situation compared to white girls without financial disadvantages who speak English as their first language.

In contrast, boys’ likelihood of receiving an autism diagnosis increased more than five-fold depending on their ethnicity and social and financial situation compared to white boys without financial disadvantages who speak English as their first language.

Boys and young men are already known to be more likely to receive autism diagnoses, but the social determinants that could affect a diagnosis remained an open question.

Dr Robin van Kessel, co-lead researcher from the Department of Health Policy at the London School of Economics and Political Science said: “These new findings show how social determinants interact and can combine to significantly increase the likelihood of an autism diagnosis. As a result, individuals from a minority ethnic background experiencing economic hardship may be significantly more likely to receive an autism diagnosis than their peers.”

Professor Carol Brayne from Cambridge Public Health said: “There are clear inequalities in an individual’s likelihood of receiving an autism diagnosis, whether they are socioeconomic factors, ethnicity or even which NHS region or local authority someone lives in.”

This work was supported by the Commonwealth Fund Harkness Fellowship, Institute for Data Valorization, Fonds de recherche du Québec—Santé, Calcul Quebec, Digital Research Alliance of Canada, Wellcome Trust, Innovative Medicines Initiative, Autism Centre of Excellence at Cambridge, Simons Foundation Autism Research Initiative, Templeton World Charitable Fund, Medical Research Council, NIHR Cambridge Biomedical Research Centre, and the NIHR Applied Research Collaboration East of England—Population Evidence and Data Science.

Reference
Roman-Urrestarazu, A et al. Autism incidence and spatial analysis in more than 7 million pupils in English schools: a retrospective, longitudinal, school registry study. Lancet Child & Adolescent Health; 25 Oct 2022; DOI: 10.1016/S2352-4642(22)00247-4

New autism diagnoses tend to be clustered within specific NHS service regions, suggesting that where an individual lives may influence whether they receive an autism diagnosis and access to special education needs support.

There are clear inequalities in an individual’s likelihood of receiving an autism diagnosis, whether they are socioeconomic factors, ethnicity or even which NHS region or local authority someone lives in

Carol Brayne

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Autistic child

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Autism rates have increased and show differences in ethnic minorities and links to social disadvantage

cjb250 — Mon, 29 Mar 2021 15:00:20 +0000

Black and Chinese pupils were 26% and 38% more likely to be autistic respectively and autistic children were much more likely to face significant social disadvantage. ̽��ֱ��results are published today in JAMA Pediatrics.

̽��ֱ��team drew on data from the School Census from the National Pupil Database, collected by the Department for Education from individuals aged 2-21 years old in state-funded schools in England. Of more than seven million pupils studied, 119,821 pupils had a diagnosis of autism in their record in the English state educational system, of whom 21,660 also had learning difficulties (18.1%). Boys showed a prevalence of autism of 2.8% and girls showed a prevalence of 0.65%, with a boy-to-girl ratio of 4.3:1.

Prevalence was highest in pupils of black ethnicity (2.1%) and lowest in Roma/Irish Travellers (0.85%), with these estimates being the first to be published for these populations. Pupils with a record of autism in schools were 60% more likely to also be socially disadvantaged, and 36% less likely to speak English. ̽��ֱ��findings reveal significant differences in autism prevalence, as recorded in formal school systems, across ethnic groups and geographical location.

̽��ֱ��lead researcher of the study, Dr Andres Roman-Urrestarazu from the Autism Research Centre (ARC) and Cambridge Public Health at the ̽��ֱ�� of Cambridge, said: “We can now see that autism is much more common than previously thought. We also found significant variations in autism diagnosis in different ethnic minorities, though the reason why this should be the case isn’t clear and warrants further research.”

Previous estimates of the prevalence of autism in the UK by the same research group in Cambridge, and based on a school-based survey, suggested that one in 64 children (1.57%) were autistic. ̽��ֱ��new study, based on school records that usually underestimate the actual proportion of children who meet diagnostic criteria, shows a considerable increase in the autism prevalence in England. ̽��ֱ��researchers say the increase is likely to be because autism has become better recognised by both parents and schools in recent years.

Professor Carol Brayne, Co-chair of Cambridge Public Health and Professor of Public Health Medicine, said: “This study shows how we can draw on large datasets in a way that is rigorous and valuable for our understanding of autism.”

Professor Fiona Matthews from Newcastle ̽��ֱ�� added: “This study highlights the need for more attention to the unrecognised and differing needs of autistic children from disadvantaged and diverse backgrounds.”

Professor Simon Baron-Cohen, Director of the ARC, said: “We can now see a snapshot of how many autistic children there are, and can drill down into local and ethnic variation, and reveal links with vulnerability. It is important that we safeguard the rights of children to access diagnostic services and education, tailored to their needs.”

This research was made possible by a generous donation for a Global Public Health Leadership programme by Dennis and Mireille Gillings Fellowship awarded to Dr Andres Roman-Urrestarazu. This study was also supported by the Autism Research Trust, the Wellcome Trust, the Innovative Medicines Initiative 2 Joint Undertaking (JU), the NIHR Cambridge Biomedical Research Centre and the NIHR Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust.

Reference
Roman-Urrestarazu, R et al. Association of Race/Ethnicity and Social Disadvantage With Autism Prevalence in 7 Million School Children in England. JAMA Pediatrics; 29 March 2021; DOI: 10.1001/jamapediatrics.2021.0054

Around one in 57 (1.76%) children in the UK is on the autistic spectrum, significantly higher than previously reported, according to a study of more than seven million children carried out by researchers from the ̽��ֱ�� of Cambridge’s Department of Psychiatry, in collaboration with researchers from Newcastle ̽��ֱ�� and Maastricht ̽��ֱ��.

It is important that we safeguard the rights of children to access diagnostic services and education, tailored to their needs

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Brexit puts UK’s ability to tackle drug-related crime at risk, say experts

cjb250 — Fri, 03 May 2019 06:21:20 +0000

̽��ֱ��decision to leave the European Union comes at a time when parts of the UK are experiencing a marked rise in gun and knife crimes. Many of these crimes are linked to gangs fighting for control of parts of the illicit drug markets. In 2015, the UK experienced 3,070 drug-related deaths, a 13% increase from 2014.

While illicit drugs are usually regarded as an issue for the criminal justice system, this view has been changing in recent years. ̽��ֱ��Commissioner of the Metropolitan Police has joined calls for a public health, rather than criminal justice response. This approach was successful in tackling violent crime in Scotland where the Violence Reduction Unit, created in 2005, confronted what was then the second highest murder rate in western Europe by establishing collaborations between education, social services, child and adolescent mental health teams, and community groups.

Collaboration between the police and public health community depends on access to accurate and timely intelligence on the market for illicit drugs, including street price, prevalence of use, volumes of seizures, and the activities of organised crime networks.

However, local intelligence is of limited value if it is not linked to information from elsewhere, including other parts of Europe, say the researchers. ̽��ֱ��EU plays an important role in assembling the evidence and intelligence to tackle drug-related harm linked to serious and organised crime, but access to this vital information could be threatened by the UK leaving the EU.

A key player in the fight against drug-related crime is the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). However, this agency is accountable to the European Commission, Council, and Parliament, and is subject to the judicial oversight of the European Court of Justice; these are all provisions that the UK government is currently ruling out of any future agreement.

̽��ֱ��UK Focal Point on Drugs, based in Public Health England, works closely with the Home Office, other government departments to provide information to EMCDDA and, in return, receives intelligence on emerging developments from agencies across the EU. This information exchange is only possible because of existing EU legislation, especially on data protection.

In addition, the researchers argue, the UK would also lose access to EU-wide databases such as European Dactyloscopy (EURODAC), an information system containing finger-print information on asylum seekers and illegal migrants, and the European Criminal Records Information System.

A particular concern expressed is access to intelligence on newly developed drugs. ̽��ֱ��European Union Early Warning System on new psychoactive substances, in which Europol and EMCDDA play a major role, provides a means to detect new psychoactive drugs, assess their characteristics, and share information to inform decisions of member states on measures that they might wish to take. Exclusion from this process would undermine a crucial part of the UK’s current drug strategy, they say.

“ ̽��ֱ��scale of collaboration between the UK and European institutions in the field of illicit drugs is extensive, and it is not at all obvious how it might be replicated after any transition period given the UK government’s position on key elements of any future relationship,” says Dr Andres Roman-Urrestarazu from the Institute of Public Health at the ̽��ֱ�� of Cambridge, one of the authors of today’s policy brief.

“We will need an alternative framework of collaboration between the UK and the EU to facilitate data sharing and drug surveillance after Brexit,” said Christina Gray from the Faculty of Public Health Special Interest Group in Mental Health. “But it is not possible to develop meaningful solutions until the UK can make credible, workable proposals for its future relationships with European institutions and, in particular, its willingness to accept oversight of the European Court of Justice.”

̽��ֱ��researchers point out that the problem goes beyond the UK’s engagement with the EU. Just as in international trade, the UK benefits from a series of international collaborations with EMCDDA. New provisions will be required for the UK to continue to participate in these arrangements and these will take time to agree.

“Given the enormous challenges posed by Brexit to almost every aspect of life in the UK, it is easy to overlook areas such as tackling drug-related crime,” adds Professor John Middleton, President of the Faculty of Public Health, London. “At a time when European trade in illicit drugs is changing rapidly and when the often-fatal consequences of this trade are seen on the streets of British cities every week, this would be a mistake.”

Reference
Brexit threatens the UK's ability to tackle illicit drugs and organised crime: what needs to happen now? Health Policy; DOI: 10.1016/j.healthpol.2019.04.005

Brexit could threaten the UK’s ability to tackle drug-related crime linked to serious and organised crime, according to public health experts writing today in the journal Health Policy.

̽��ֱ��scale of collaboration between the UK and European institutions in the field of illicit drugs is extensive, and it is not at all obvious how it might be replicated after any transition period

Andres Roman-Urrestarazu

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