Inequality, infections and chronic disease in England: the interaction of risk factors and the dynamics of transmission

在英格兰，人与人之间感染的可能性是不同的。当人们被感染时，他们的病情也有所不同。同一群人更有可能被感染，更有可能变得非常不舒服。这些群体是少数民族背景的人，以及那些经历社会经济剥夺的群体。有些群体更容易感染有很多原因，例如，由于他们的工作或行为，他们有更多的社会接触，或者他们可能有不同类型的接触，例如，如果他们在医院工作或经常去那里治疗。其他因素包括人们居住的家庭规模，或者与他们住在一起的人的年龄不同。这一点很重要，因为很多传染病都是在家庭中传播的。人们被感染后更有可能感到非常不适的原因主要是因为他们的年龄以及他们是否有现有的健康状况，例如心脏病。其中一些情况在社会经济贫困人群和少数民族群体中更为常见。不同人群之间的健康差异被称为健康差异，这些差异存在的原因有很多，解决这些差异的难度有多大。这项研究的目的是更好地理解健康差异，以及传染病在造成和维持健康差异方面所起的作用。最终目的是制定更好的干预措施，试图减少生活在社会经济贫困中的人或少数民族群体所经历的健康差距。我将通过分析英国2000多万人的电子健康记录数据来研究这些问题。健康记录被安全地保存在一个名为opensafety的分析平台上，患者的个人健康数据永远不会有暴露的风险。为了增加健康记录，我将使用一款名为Airmid的智能手机应用，询问人们一天有多少社交联系人，以及联系人的年龄和职业。我还会用这个应用询问人们感染了多少次，有多严重，以及他们是否因为感染去了全科医生还是医院。收集这些数据将有助于了解不同群体之间的差异。在这个项目中，我将分析感染是如何在人口中不同群体中分布的，以及哪些因素与更多的感染有关。我将研究感染与不同的死亡原因之间的关系，以及这些联系是否在少数民族群体或经历贫困的人群中有所不同。在项目的后期，我将使用计算机模型来尝试了解是否有干预措施可以减少健康差距，例如接种疫苗或更好的治疗。该项目将有患者顾问参与，分享他们的经验并参与研究。

In England, there are differences between people in how likely they are to catch infections. There are also differences in how ill people get when they are infected. The same groups of people are more likely to get infected and more likely to get very unwell. Those groups are people of ethnic minority backgrounds, and those groups who experience socioeconomic deprivation. There are lots of reasons why some groups are more likely to catch infections, for example because they have more social contacts because of their job, or their behaviour, or they may have different types of contact, for example if they work in a hospital or have to go there frequently for treatment. Other factors include the size of households that people live in, or the different ages of people they live with. This is important because a lot of infectious disease transmission happens in households. The reasons why people are more likely to get very unwell if they are infected are mostly because of their age and if they have an existing health condition, for example, heart disease. Some of these conditions are more common amongst people who live with socioeconomic deprivation, and amongst ethnic minority groups. Differences in health between groups of people are called health disparities, and there are lots of reasons why these differences exist, and how difficult they are to solve. What this study aims to do is understand better the health disparities and the role that infectious diseases play in creating and sustaining them. Ultimately the aim is to develop better interventions to try to decrease the health disparities that people who live with socioeconomic deprivation or ethnic minority groups experience. I will study these problems by analysing electronic health records data for over 20 million people in England. The health records are held securely on an analysis platform called OpenSAFELY, and individual patient health data is never at risk of being exposed. To add to the health records, I will use a smartphone app called Airmid to ask people about how many social contacts they have in a day and the age and occupation of their contacts. I will also use the app to ask people about how many infections they get, how severe they are, and whether they go to the GP or hospital for that infection. Collecting these data will help understand the differences seen between groups. During the project, I will analyse how infections are distributed among different groups in the population and what factors are associated with having more infections. I will look at how infections are associated with different causes of death, and if those associations are different for ethnic minority groups or those experiencing deprivation. Later in the project I will use computer models to try to understand if there are interventions that could decrease the health disparities, such as vaccination or better treatment. The project will have patient advisors involved to share their experiences and participate in the research.