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A comparative analysis of the relationship between flood experience and private flood mitigation behaviour in the regions of England.

ABSTRACT: There has been a move towards a more integrated approach to flood risk management, which includes a stronger focus on property level measures. However, in England the uptake of these measures remains low. Flood experience has been found to influence preparedness (i.e., the uptake of measures), but even experience does not always result in an increase in preparedness. We investigate the variations in the relationship between experience and preparedness for the regions of England as defined by the Environment Agency. Analysis of survey data collected by the Environment Agency among the at risk population between 1997 and 2004 was undertaken to determine the differences between the seven regions. We find that in the South West, Southern and Anglian regions increases in preparedness with increasing experience are higher compared to other regions. In the Thames, Midlands and North West regions the preparedness increases less with increasing experience. We explore the influence of other factors influencing flood mitigation behaviour that have been previously found in the literature and find that the differences between regions are correlated with the severity of experienced flooding and whether English is the first language of the respondents.

SUBMITTER: Barendrecht MH

PROVIDER: S-EPMC8641382 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThere is little known about how payer status impacts clinical outcomes in a universal single-payer system such as the UK National Health Service (NHS). The aim of this study was to evaluate the relationship between payer status (private or public) and clinical outcomes following cardiac surgery from NHS providers in England.MethodsThe National Adult Cardiac Surgery Audit (NACSA) registry was interrogated for patients who underwent adult cardiac surgery in England from 2009 to 2018. Information on socioeconomic status were provided by linkage with the Iteration of the English Indices of Deprivation (IoD). The primary outcome was in-hospital mortality. Secondary outcomes included incidence of in-hospital postoperative cerebrovascular accident (CVA), renal dialysis, sternal wound infection, and re-exploration. To assess whether payer status was an independent predictor of in-hospital mortality, binomial generalized linear mixed models (GLMM) were fitted along with 17 items forming the EuroSCORE and the IoD domains.FindingsThe final sample consisted of 280,209 patients who underwent surgery in 31 NHS hospitals in England from 2009 to 2018. Of them, 5,967 (2.1%) and 274,242 (97.9%) were private and NHS payers respectively. Private payer status was associated with a lower risk of in-hospital mortality (OR 0.79; 95%CI 0.65 - 0.97;P = 0.026), CVA (OR 0.77; 95%CI 0.60 - 0.99; P = 0.039), need for re-exploration (OR 0.84; 95%CI 0.72 - 0.97; P = 0.017) and with non-significant lower risk of dialysis (OR 0.84; 95%CI 0.69 - 1.02; P = 0.074). Private payer status was found to be independently associated with lower risk of in-hospital mortality in the elective subgroup (OR 0.76; 95%CI 0.61 - 0.96; P = 0.020) but not in the non-elective subgroup (OR 1.01; 95%CI 0.64 - 1.58; P = 0.976).InterpretationIn conclusion, using a national database, we have found evidence of significant beneficial effect of payer status on hospital outcomes following cardiac surgery in favour of private payers regardless their socioeconomic factors.

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A comparative analysis of the relationship between flood experience and private flood mitigation behaviour in the regions of England.

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