Background One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched. Methods We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation. Results We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years. Conclusions The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action.

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Background There are no consensus definitions for evaluating kidney function recovery after acute kidney injury (AKI) and acute kidney disease (AKD), nor is it clear how recovery varies across populations and clinical subsets. We present a federated analysis of four population-based cohorts from Canada, Denmark, and Scotland, 2011–2018. Methods We identified incident AKD defined by serum creatinine changes within 48 hours, 7 days, and 90 days based on KDIGO AKI and AKD criteria. Separately, we applied changes up to 365 days to address widely used e-alert implementations that extend beyond the KDIGO AKI and AKD timeframes. Kidney recovery was based on resolution of AKD and a subsequent creatinine measurement below 1.2x baseline. We evaluated transitions between non-recovery, recovery, and death up to one year; within age, sex, and comorbidity subgroups; between subset AKD definitions; and across cohorts. Results There were 464 868 incident cases, median ages 67–75 years. At one year, results were consistent across cohorts, with pooled mortalities for creatinine changes within 48 hours, 7 days, 90 days and 365 days (and 95% CI) of 40% (34–45%), 40% (34–46%), 37% (31–42%), 22% (16–29%) respectively; and non-recovery of kidney function of 19% (15–23%), 30% (24–35%), 25% (21–29%), 37% (30–43%) respectively. Recovery by 14 and 90 days was frequently not sustained at one year. Older males and those with heart failure or cancer were more likely to die than experience sustained non-recovery, whereas the converse was true for younger females and those with diabetes. Conclusion Consistently across multiple cohorts, based on one-year mortality and non-recovery, KDIGO AKD (up to 90 days) is at least prognostically similar to KDIGO AKI (7 days), and covers more people. Outcomes associated with AKD vary by age, sex and comorbidities such that older males are more likely to die, and younger females are less likely to recover.

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BackgroundAverage health in the UK is improving, yet geographical inequalities in health persist. The relative difference between the least and most deprived is also growing. Recent policy interventions to reduce these inequalities have not been effective. MethodsThis work compares Self-Rated Health using the ONS LS and SLS linked to an adjusted UK-consistent small-area Deprivation measure. This study aims to compare Nurses to the general population to assess whether they also exhibit a social gradient in health. Using a single occupational group adjusts for potential confounders and tests whether characteristics of Nurses, such a good health literacy, degree education and above average income, are protective against inequalities. ResultsIn Scotland, Nurses are more likely to be older, female, homeowners who live in less deprived areas with better Self-Rated Health than Non-Nurses. We will test whether the social gradient in health is observed for this occupational group.Forthcoming results from cross-national analysis will be presented at conference following disclosure checks. ConclusionThe relationship between area deprivation and health may remain even in relatively privileged groups. Results from this study may inform recommendations to improve the effectiveness of policy aimed at improving population health and reducing socio-economic inequalities in health