(BRC) Access to care, the impact of inequalities, and mental health outcomes for young people with psoriasis, eczema, or acne in the UK


   Faculty of Biology, Medicine and Health

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  Dr Zenas Yiu, Prof Darren Ashcroft, Prof R Webb  No more applications being accepted  Competition Funded PhD Project (Students Worldwide)

About the Project

Illnesses in children and young people (CYP), defined as people aged 10-24 years old, can have a long-lasting impact on their development, and skin conditions are some of the most common diseases in this age group. These include eczema, which causes itch and cracks in the skin; psoriasis, which causes thickening and redness of the skin; and acne, which causes blackheads, whiteheads, and red or white spots with pus. These conditions may also adversely affect mental health. There are highly effective treatments for all three conditions, and therefore getting to see a General Practitioner (GP) and/or a skin specialist is crucial. However, little is known about how many adolescents suffer from these skin conditions, their healthcare needs, and the COVID-19 pandemic and its aftermath has made it harder for many people to access healthcare. There might also be differences or inequalities in how easy it is for CYP from different groups to access the treatment that they need. 

We want to know how many CYP are currently experiencing eczema, psoriasis and acne in the UK, how many present with these conditions each year for the first time, and whether this changed during the pandemic. We will do this by looking for CYP aged between 10 and 24 diagnosed with these conditions between 1st January 2010 and 31st December 2022 in anonymised patient records from general practices and calculate how many people had these conditions and/or presented with these conditions for the first time in any given year. We will tally up the recorded use of NHS services to assess access to care. We will investigate whether the overall results change according to factors that we know are associated with health inequalities, such as their ethnicity, immigration status, living arrangements, and information about where they live including index of multiple deprivation and level of urbanicity or rurality of their neighbourhood. We will compare the period between 26/03/2020 to 01/10/2020 versus the preceding period to understand the impact of the pandemic. We will evaluate mental health burden by tallying up recorded use of the NHS services for depression and anxiety and compare the death rate, including by suicide, of these patients to a group of young adults without these skin conditions.

We will broadcast our findings to patients and the public through blogposts and podcasts using both traditional and social media. We will share our results with public health bodies directly, especially in areas where we find evidence of a health inequality leading to poorer access to dermatological care.

Eligibility 

Applicants must have obtained or be about to obtain a First or Upper Second class UK honours degree, or the equivalent qualifications gained outside the UK, in a relevant discipline Masters degree in Epidemiology, Biostatistics, Public Health.

Before you Apply 

Applicants must make direct contact with the primary supervisor before applying to discuss their interest in the project. It is your responsibility to make arrangements to meet with potential supervisors, prior to submitting a formal online application.  

How to Apply 

To be considered for this project you MUST submit a formal online application form - full details on how to apply can be found on the BRC website https://www.bmh.manchester.ac.uk/study/research/funded-programmes/manchester-brc-phd-studentships/ 

Your application form must be accompanied by a number of supporting documents by the advertised deadlines. Without all the required documents submitted at the time of application, your application will not be processed and we cannot accept responsibility for late or missed deadlines. Incomplete applications will not be considered. If you have any queries regarding making an application please contact our admissions team.

Equality, Diversity and Inclusion  

Equality, diversity and inclusion is fundamental to the success of The University of Manchester, and is at the heart of all of our activities. The full Equality, diversity and inclusion statement can be found on the website https://www.bmh.manchester.ac.uk/study/research/apply/equality-diversity-inclusion/  

Computer Science (8) Mathematics (25) Medicine (26) Psychology (31)

Funding Notes

This studentship covers tuition fees and stipend and is open to both the UK and international applicants. We are able to offer a limited number of studentships to applicants outside the UK. Therefore, full studentships will only be awarded to exceptional quality candidates, due to the competitive nature of this scheme.

References

1. Patton GC, Sawyer SM, Santelli JS, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. Jun 11
2016;387(10036):2423-78. doi:10.1016/S0140-6736(16)00579-1
2. World Health Organization. Adolescent health. Accessed 05/10/2021, 2021. https://www.who.int/health-topics/adolescenthealth#tab=tab_1
3. Hagell A, Shah R. Key Data on Young People 2019. Association for Young People's Health; 2019. Accessed 05/10/2021.
https://www.youngpeopleshealth.org.uk/wp-content/uploads/2019/09/AYPH_KDYP2019_FullVersion.pdf
4. Mokdad AH, Forouzanfar MH, Daoud F, et al. Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. Jun 11 2016;387(10036):2383-401. doi:10.1016/S0140-6736(16)00648-6
5. de Lusignan S, Alexander H, Broderick C, et al. The epidemiology of eczema in children and adults in England: A population-based study using primary care data. Clin Exp Allergy. Mar 2021;51(3):471-482. doi:10.1111/cea.13784
6. Iskandar IYK, Parisi R, Griffiths CEM, Ashcroft DM, Global Psoriasis A. Systematic review examining changes over time and variation in the incidence and prevalence of psoriasis by age and gender. Br J Dermatol. Feb 2021;184(2):243-258. doi:10.1111/bjd.19169
7. Tan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. Jul 2015;172 Suppl 1:3-12. doi:10.1111/bjd.13462
8. De Vere Hunt I, Chapman K, Wali G, et al. Establishing and developing a Teenage and Young Adult dermatology clinic with
embedded specialist psychological support. Clin Exp Dermatol. Dec 2019;44(8):893-896. doi:10.1111/ced.13950
9. De Vere Hunt IJ, Howard E, McPherson T. The impact of chronic skin disease in adolescence and the need for specialist adolescent services. Clin Exp Dermatol. Jan 2020;45(1):5-9. doi:10.1111/ced.14021
10. Ibrahim LS, Venables ZC, Levell NJ. The impact of COVID-19 on dermatology outpatient services in England in 2020. Clin Exp
Dermatol. Mar 2021;46(2):377-378. doi:10.1111/ced.14547
11. Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health. Nov 2020;74(11):964-968. doi:10.1136/jech-2020-214401
12. Lynn RM, Avis JL, Lenton S, Amin-Chowdhury Z, Ladhani SN. Delayed access to care and late presentations in children during the COVID-19 pandemic: a snapshot survey of 4075 paediatricians in the UK and Ireland. Arch Dis Child. Feb 2021;106(2):e8.
doi:10.1136/archdischild-2020-319848
13. Hefferon C, Taylor C, Bennett D, et al. Priorities for the child public health response to the COVID-19 pandemic recovery in England. Arch Dis Child. Jun 2021;106(6):533-538. doi:10.1136/archdischild-2020-320214
14. Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolesc Psychiatry. Nov 2020;59(11):1218-1239 e3. doi:10.1016/j.jaac.2020.05.009
15. von Stulpnagel CC, Augustin M, Dupmann L, da Silva N, Sommer R. Mapping risk factors for cumulative life course impairment in patients with chronic skin diseases - a systematic review. J Eur Acad Dermatol Venereol. Nov 2021;35(11):2166-2184. doi:10.1111/jdv.17348
16. Norback D, Lampa E, Engvall K. Asthma, allergy and eczema among adults in multifamily houses in Stockholm (3-HE study)--associations with building characteristics, home environment and energy use for heating. PLoS One. 2014;9(12):e112960.
doi:10.1371/journal.pone.0112960
17. Sharpe RA, Thornton CR, Tyrrell J, Nikolaou V, Osborne NJ. Variable risk of atopic disease due to indoor fungal exposure in
NHANES 2005-2006. Clin Exp Allergy. Oct 2015;45(10):1566-78. doi:10.1111/cea.12549
18. Golics CJ, Basra MK, Finlay AY, Salek MS. Adolescents with skin disease have specific quality of life issues. Dermatology.
2009;218(4):357-66. doi:10.1159/000205524
19. Kimball AB, Wu EQ, Guerin A, et al. Risks of developing psychiatric disorders in pediatric patients with psoriasis. J Am Acad
Dermatol. Oct 2012;67(4):651-7 e1-2. doi:10.1016/j.jaad.2011.11.948
20. Smirnova J, von Kobyletzki LB, Lindberg M, Svensson A, Langan SM, Montgomery S. Atopic dermatitis, educational attainment and psychological functioning: a national cohort study. Br J Dermatol. Mar 2019;180(3):559-564. doi:10.1111/bjd.17330
21. Halvorsen JA, Stern RS, Dalgard F, Thoresen M, Bjertness E, Lien L. Suicidal ideation, mental health problems, and social
impairment are increased in adolescents with acne: a population-based study. J Invest Dermatol. Feb 2011;131(2):363-70.
doi:10.1038/jid.2010.264
22. Fleming M, McLay JS, Clark D, King A, Mackay DF, Pell JP. Health, educational and employment outcomes among children treated for a skin disorder: Scotland-wide retrospective record linkage cohort study of 766,244 children. PLoS One. 2020;15(12):e0243383. doi:10.1371/journal.pone.0243383
23. All-Party Parliamentary Group on Skin. Mental Health and Skin Diseases. 2020. https://www.appgs.co.uk/publication/view/mentalhealth-and-skin-disease-2020/
24. NHS England Outpatient Transformation Programme. Referral optimisation for people with skin conditions.
https://www.england.nhs.uk/long-read/referral-optimisation-for-people-with-skin-conditions/
25. Hargreaves DS, Viner RM. Children's and young people's experience of the National Health Service in England: a review of national surveys 2001-2011. Arch Dis Child. Jul 2012;97(7):661-6. doi:10.1136/archdischild-2011-300603
26. de Vere Hunt IJ, McNiven A, Roberts A, Parmar H, McPherson T. 'Not just a piece of skin in front of you'-a qualitative exploration of the experiences of adolescents with eczema and psoriasis with healthcare professionals. BMJ Open. Jan 29 2021;11(1):e041108. doi:10.1136/bmjopen-2020-041108
27. Saxena S, Eliahoo J, Majeed A. Socioeconomic and ethnic group differences in self reported health status and use of health services by children and young people in England: cross sectional study. BMJ. Sep 7 2002;325(7363):520. doi:10.1136/bmj.325.7363.520
28. de Lusignan S, Alexander H, Broderick C, et al. Patterns and trends in eczema management in UK primary care (2009-2018): A population-based cohort study. Clin Exp Allergy. Mar 2021;51(3):483-494. doi:10.1111/cea.13783
29. Ersser SJ, Cowdell F, Latter S, et al. Psychological and educational interventions for atopic eczema in children. Cochrane Database Syst Rev. Jan 7 2014;(1):CD004054. doi:10.1002/14651858.CD004054.pub3
30. Eczema Outreach Support. Time for change in the UK - the true impact of eczema and the experiences of chidlren, young people and their families in managing the condition. 2022. https://www.eos.org.uk/wp-content/uploads/2022/03/Time-for-Change-Report.pdf
31. Barbieri JS, Shin DB, Wang S, Margolis DJ, Takeshita J. Association of Race/Ethnicity and Sex With Differences in Health Care Use and Treatment for Acne. JAMA Dermatol. Mar 1 2020;156(3):312-319. doi:10.1001/jamadermatol.2019.4818
32. Fischer AH, Shin DB, Margolis DJ, Takeshita J. Racial and ethnic differences in health care utilization for childhood eczema: An analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol. Dec 2017;77(6):1060-1067. doi:10.1016/j.jaad.2017.08.035
33. Wan J, Oganisian A, Spieker AJ, et al. Racial/Ethnic Variation in Use of Ambulatory and Emergency Care for Atopic Dermatitis among US Children. J Invest Dermatol. Sep 2019;139(9):1906-1913 e1. doi:10.1016/j.jid.2019.02.024
34. Fischer AH, Shin DB, Gelfand JM, Takeshita J. Health care utilization for psoriasis in the United States differs by race: An analysis of the 2001-2013 Medical Expenditure Panel Surveys. J Am Acad Dermatol. Jan 2018;78(1):200-203. doi:10.1016/j.jaad.2017.07.052
35. Herrett E, Gallagher AM, Bhaskaran K, et al. Data Resource Profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol. Jun 2015;44(3):827-36. doi:10.1093/ije/dyv098
36. Wolf A, Dedman D, Campbell J, et al. Data resource profile: Clinical Practice Research Datalink (CPRD) Aurum. Int J Epidemiol. Dec 1 2019;48(6):1740-1740g. doi:10.1093/ije/dyz034
37. Abuabara K, Magyari AM, Hoffstad O, et al. Development and Validation of an Algorithm to Accurately Identify Atopic Eczema
Patients in Primary Care Electronic Health Records from the UK. J Invest Dermatol. Aug 2017;137(8):1655-1662. doi:10.1016/j.jid.2017.03.029
38. Jain A, van Hoek AJ, Walker JL, et al. Inequalities in zoster disease burden: a population-based cohort study to identify social determinants using linked data from the U.K. Clinical Practice Research Datalink. Br J Dermatol. Jun 2018;178(6):1324-1330. doi:10.1111/bjd.16399
39. Springate DA, Parisi R, Kontopantelis E, Reeves D, Griffiths CE, Ashcroft DM. Incidence, prevalence and mortality of patients with psoriasis: a U.K. population-based cohort study. Br J Dermatol. Mar 2017;176(3):650-658. doi:10.1111/bjd.15021
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