We examined the prevalence of type 2 diabetes and social deprivation in one urban district in Liverpool from October 1995 to September 1996 inclusive. This area has a stable Caucasian population of 176, 682. Lists were made of all known diabetics attending six different medical points of contact during the year, and were condensed and aggregated to eliminate duplicates. From postcode data, each patient was assigned to residence in one of the 14 electoral wards in the district, for which demographic structure and standardized measures of social deprivation were known (Townsend index). The crude period prevalences of type 1 and type 2 diabetes were estimated for each ward. Crude prevalence data were then corrected by applying capture-recapture (CR) techniques to the different patient datasets to allow for undercount. The crude period prevalence (95%CI) of diabetes was 1.5% (1.4-1.5%), or 2585/176, 682. The mean age of people with diabetes was not significantly different between electoral wards. The crude period prevalence of type 2 diabetes within individual wards ranged from 0.4% (0.3-0.6%) in the least deprived area to 4.1% (3.6-4.6%) in the most deprived area. The corresponding range of CR-adjusted period prevalence rates of type 2 diabetes was from 3.2% (2.8-3.6%) to 6.7% (6.1-7.4%), and there was strong correlation between both crude and CR-adjusted prevalence and social deprivation in each ward (r=0.76, p<0.001 for crude; and r=0. 49, p<0.005 for CR-adjusted prevalence). There was no correlation between the crude or CR-adjusted period prevalence rates of type 1 diabetes and Townsend index (r=0.14, p=NS). This strong correlation between the prevalence of type 2 diabetes and social deprivation has important implications for the planning of health-care delivery.

SUMMARY C-reactive protein and four other acute phase reactant proteins of non-cardiac origin (orosomucoid, alphal-antitrypsin, haptoglobin, and alpha2-macroglobulin) were studied serially by laser immunonephelometric assay in sera from 17 patients with myocardial infarction. A similar comparison was made in 57 patients undergoing surgery and 72 patients with acute infection. C-reactive protein was consistently the most sensitive acute phase reactant in all three conditions. After myocardial infarction, a raised serum C-reactive protein level was found on admission in four patients before a rise in creatine kinase MB isoenzyme (CK MB). The peak C-reactive protein level was reached on the third post-infarct day and it then declined over seven days with a half-life similar to myocardial tropomyosin. Serial monitoring of serum C-reactive protein, in parallel with cardiac proteins of short half-life (CK MB) and long half-life (tropomyosin), provides maximal information for diagnosis and for detecting post-infarct complications.Acute phase reactant proteins are synthesised by the liver in response to acute tissue damage. Serial estimation of these proteins, C-reactive protein in particular,' has been used to monitor the progress of a variety of clinical disorders and the recent introduction of rapid assays, using laser ixmunonephelometric,2 rate immunonephelometric,3 and immunoradiometric4 techniques, will increase their clinical application.The original observation5 that C-reactive protein could be detected in serum after myocardial infarction was followed by a number of studies using semiquantitative immunoprecipitation techniques6-9 and, later, electroimmunoprecipitation'0 and radial immunodiffusion"I assays. These studies, and a more recent immunoradiometric assay,4 indicate the potential clinical value of measuring acute phase reactants in serum after myocardial infarction. There is, however, a need to determine whether C-reactive protein estimation has advantages over other acute phase proteins for cardiac studies and to investigate the time course of its rise and fall in serum after myocardial infarction in comparison with proteins of cardiac origin. Laser immunonephelometric assays ofC-reactive protein and

In a Western population, the only demographic data required for matching patients on lists used for CR methods are first name, family name and date of birth, if unique identifiers such as social security numbers are not available. Two lists alone do not produce reliable data, and at least three lists are needed to allow for modelling for 'dependence' between datasets. The use of more than three lists does not substantially alter the absolute value or confidence of enumeration, and multiple lists (if available) should be condensed into three lists for use in CR calculations.

No abstract

This study assessed the contribution of immigration and deprivation to the changes in tuberculosis notifications in Liverpool over the last 20 yrs. Ethnic origin was retrospectively assigned to all named cases from 1974 to 1995. Average tuberculosis rates were calculated for the 33 council wards in Liverpool for 1981-1985 and 1991-1995. Multiple regression was used to determine the independent effects of socioeconomic and population measures from the 1981 and 1991 censuses in explaining these ward-based rates. Since 1974, there has been a steady increase in the percentage of non-Caucasian cases of tuberculosis, from 8.7% in 1975-1977, 15.1% in 1981-1983, 17.5% in 1987-1989 to 28.0% in 1993-1995. Multiple regression analysis showed that in 1981 only unemployment had a significant independent relationship with tuberculosis rates, but in 1991 two indices of deprivation and ethnicity had a significant influence. The increasing proportion of non-Caucasian tuberculosis cases, both while the number of notifications was declining before 1987 and increasing afterwards, is not necessarily consistent with the concept that immigration has influenced the recent increase. However, the fact that ethnicity now independently explains some of the council ward variations but did not in the early 1980s suggests that immigration does influence the distribution of disease within the city.