Aims: We describe the epidemiology of sexually transmitted infections (STIs) and HIV in people aged ⩾45 years in England and provide future projections about the burden of STIs in this age group. Methods: Analysis of national surveillance data in England from 2014 to 2019 for chlamydia, gonorrhoea, herpes, syphilis, anogenital warts and HIV was carried out. Time trends were assessed by the Poisson regression and reported using incidence rate ratios (IRRs). Two scenarios were modelled to predict the number of new STI diagnoses and associated costs in 2040. Results: In 2019, there were 37,692 new STI diagnoses in people ⩾45 years in England. Between 2014 and 2019, there was a significant increase in the rate of new STI diagnoses in men (IRR = 1.05, p = .05) and those aged 45–64 years (IRR = 1.04, p = .05). Absolute numbers of new STI diagnoses in men who have sex with men increased by 76% between 2014 and 2019 (IRR = 1.15, p < .001). In adults aged ⩾50 years, the number of episodes of care for HIV increased over time (age = 50–64 years, IRR = 1.10; age = 65+ years, IRR = 1.13; p <.001). The modelled scenarios predicted an increase in STI diagnoses and costs in older people by 2040. Conclusion: STI rates in England are increasing in people aged ⩾45 years. The population is ageing and older people will contribute an increasing burden to STI costs if this trend continues. The reasons for this trend are not fully understood and further longitudinal epidemiological research is needed. Sexual health promotion campaigns and healthcare interventions targeted at older people should be prioritised.

Deaths of Despair (DoD) are socially patterned fatalities encompassing those attributable to drug and alcohol misuse and suicide. DoD occur much more frequently in socially deprived communities. This ecological study aimed to yield new knowledge on the spatial distribution of DoD, and socioeconomic factors that predict DoD risk in England. Via ICD-10 coding, deaths nationally during 2019-2021 were classified to non-overlapping categories of drug-related death, alcohol-specific death, and suicide. The proportion of DoD from each of these causes was calculated and age standardised DoD rates were generated for local authorities. A multivariable regression model for DoD risk was developed using 25 socioeconomic indicators. In 2019-2021, an estimated 46,200 people lost their lives due to DoD. Rates were higher in the North and in coastal areas (p < 0.001), ranging regionally from 25.1/100,000 (SD 6.3) in London to 54.7/100,000 (SD 9.5) in the North East. Alcohol-specific deaths were the largest contributor of DoD, accounting for 44.1% (95%CI 43.5-44.8%) of all such deaths. Living in the North, unemployment, White British ethnicity, living alone, economic inactivity, employment in elementary occupations, and living in urban areas were significantly associated with elevated DoD risk. DoD in England are spatially patterned, with northern regions experiencing a much higher burden of mortality from these avoidable causes. This study provides novel insights into the area-level factors associated with DoD in England. Potential ecological error is a key limitation.

Community resilience results from complex interactions between people, places, and environments. Measuring community resilience aligns with policy objectives to enhance resilience to adverse events and address spatial disparities. The Baseline Resilience Indicators for Communities (BRIC) is a composite index used to measure resilience. This study adapts the BRIC approach to develop a Community Resilience Index (CRI) for England. A systematic review informed indicator selection, and principal components analysis was used to define sub-indices and allocate weightings. The resulting CRI comprised 44 indicators across five domains, quantifying the resilience of English local authorities. Geographical comparisons were made using t-tests and ANOVA, and the CRI was validated against the Index of Multiple Deprivation (IMD). The mean CRI score for local authorities in England was 83.1, ranging from 53.3 to 108.9. Resilience scores showed spatial patterning, with London and the South East scoring highest. The North had lower CRI scores than the Midlands and South (p = 0.022). Coastal and rural areas also showed lower resilience (p < 0.001). CRI and IMD were inversely correlated (r = −0.564, p < 0.0001). This study contributes to the literature by providing the first detailed assessment of community resilience in England using an adapted BRIC framework. The CRI provides a framework for measuring community resilience in England and could be used to explore associations with health outcomes and guide funding allocation.

Objectives The aim of this study is to develop a predictive risk model (PRM) for school readiness measured at age 3 years using perinatal and early infancy data. Design and participants This paper describes the development of a PRM. Predictors were identified from the UK Millennium Cohort Study wave 1 data, collected when participants were 9 months old. The outcome was school readiness at age 3 years, measured by the Bracken School Readiness Assessment. Stepwise selection and dominance analysis were used to specify two models. The models were compared by the area under the receiver operating characteristic curve (AUROC) and integrated discrimination improvement (IDI). Results Data were available for 9487 complete cases. At age 3, 11.7% (95% CI 11.0% to 12.3%) of children were not school ready. The variables identified were: parents’ Socio-Economic Classification, child’s ethnicity, maternal education, income band, sex, household number of children, mother’s age, low birth weight, mother’s mental health, infant developmental milestones, breastfeeding, parents’ employment, housing type. A parsimonious model included the first six listed variables (model 2). The AUROC for model 1 was 0.80 (95% CI 0.78 to 0.81) and 0.78 (95% CI 0.77 to 0.79) for model 2. Model 1 resulted in a small improvement in discrimination (IDI=1.3%, p<0.001). Conclusions Perinatal and infant risk factors predicted school readiness at age three with good discrimination. Social determinants were strong predictors of school readiness. This study demonstrates that school readiness can be predicted by six attributes collected around the time of birth.