Alastair H Leyland

• PhD, CStat, FFPH
• Professor at University of Glasgow

This study investigated the extent to which ethnic inequalities in severe COVID-19 (i.e. hospitalization or deaths) are mediated through occupational risk differences. We used a population-based cohort study linking the 2011 Scottish Census to health records. We included all individuals aged 30–64 years and living in Scotland on 1 March 2020. The s...

IntroductionThe early years are considered one of the most impactful points in the life course to intervene to improve population health and reduce health inequalities because, for example, both ill health and social disadvantage can track into adulthood. Scotland's outstanding systems for data linkage offer untapped potential to further our unders...

Background Territorial health inequalities are of growing concern in countries with universal health systems. From 2003, three successive national cancer plans were launched in France, aiming to improve prevention and treatment. Regions in France are responsible for strategic and financial management of healthcare within their boundaries, which, un...

Objective There is limited evidence on how the physical health of children and young people (CYP) who are care experienced (eg, in foster or out-of-home care) compares to the general population. UK research suggests that the prevalence of some chronic conditions may be similar for these groups. Design We undertook longitudinal population-wide data...

Background We explored the extent to which socioeconomic disadvantage contributed to ethnic inequalities in severe COVID-19 outcomes (hospitalisation or death) in Scotland. Methods We used linked 2011 Scottish Census and health records data. We applied marginal structural models to estimate ethnic inequalities in severe COVID-19, using the counter...

Background Area-based deprivation measures serve as a useful proxy for understanding and addressing health inequalities, especially in the absence of individual measures like income, education, or occupation. However, there is limited understanding in practice within epidemiology and health research regarding the influence of choice of geographical...

Background Studies have shown that COVID-19 disproportinately affected individuals based on their ethnic groups and occupation types. This study investigated the extent to which ethnic inequalities in COVID-19 hospitalisation or deaths could be reduced by eliminating differences by occupational risks. Methods We used a population-based cohort stud...

Importance Prenatal diet may be causally related to autism; however, findings are inconsistent, with a limited body of research based on small sample sizes and retrospective study designs. Objective To investigate the associations of prenatal dietary patterns with autism diagnosis and autism-associated traits in 2 large prospective cohorts, the No...

Objectives This study investigated sustainability and multimorbidity alongside barriers to employment including health and policy to demonstrate intersectional impact on return-to-work success within a UK welfare-to-work programme. Design Cohort study design: The study calculated the proportion of time spent employed after experiencing a job start...

Introduction Health system models in Latin American countries express differences in the state's role in regulating, financing and providing health services, as well as in the coexistence of different care arrangements involving public and private entities. This scoping review will seek to identify evidence on how the different public-private confi...

Preschool childcare is considered an important policy for reducing inequalities in children's cognitive and socio-emotional development, although the population-level benefits for children under three years, is less clear. We examined the potential for childcare across the whole early years' period to benefit mental health and reduce inequalities,...

Background Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We e...

Background Socioeconomic conditions are strongly associated with breast and cervical cancer incidence and mortality patterns; therefore, social protection programmes (SPPs) might impact these cancers. This study aimed to evaluate the effect of SPPs on breast and cervical cancer outcomes and their risk/protective factors. Methods Five databases wer...

Background Children from disadvantaged backgrounds are at greater risk of attention‐deficit hyperactivity disorder (ADHD)‐related symptoms, being diagnosed with ADHD, and being prescribed ADHD medications. We aimed to examine how inequalities manifest across the ‘patient journey’, from perceptions of impacts of ADHD symptoms on daily life, to the p...

Background Population mental health in the United Kingdom (UK) has deteriorated, alongside worsening socioeconomic conditions, over the last decade. Policies such as Universal Basic Income (UBI) have been suggested as an alternative economic approach to improve population mental health and reduce health inequalities. UBI may improve mental health (...

In this analysis we examine through an intersectionality lens how key social determinants of health (SDOH) are associated with health conditions among under-five children (<5y) residing in Nairobi slums, Kenya. We used cross-sectional data collected from Nairobi slums between June and November 2012 to explore how multiple interactions of SDoH shape...

This article critically reviews the literature on urban informality, inequity, health, well-being and accountability to identify key conceptual, methodological and empirical gaps in academic and policy discourses. We argue that critical attention to power dynamics is often a key missing element in these discourses and make the case for explicit att...

Background Ensuring housing interventions can contribute to improved living conditions which are strong socioeconomic determinants of leprosy. We estimated the association between the social housing programme Minha Casa Minha Vida (MCMVP) and leprosy new cases. Methods We followed families registered in the 100 Million Brazilian Cohort linked with...

Background Case-mix adjustment of patient reported experiences (PREMs) and outcomes (PROMs) of care are meant to enable fair comparison between units (e.g. care providers or countries) and to show where improvement is possible. It is important to distinguish between fair comparison and improvement potential, as case-mix adjustment may mask improvem...

Background Having a good start in life during pregnancy and infancy has been shown to be important for living both a healthy life and a longer life. Despite the introduction of many policies for the early-years age group, including voucher schemes, with the aim of improving nutrition, there is limited evidence of their impact on health. Objectives...

Background: Trade union presence within a workplace could potentially affect employees' working conditions and in turn health. We assessed the relationship between union (presence and membership) at the individual level and mental health in the context of COVID-19 employment disruptions. Methods: We analysed panel data from Understanding Society...

Background Though cardiac care in acute coronary syndrome (ACS) should be equitable, socioeconomic disparities in associated mortality persist. In this study we ask if problems in provision of cardiac care could be pinpointed by examining these disparities in mortality between different time-points of ACS care. Thus, we assessed how socioeconomic d...

Background Universal Basic Income (UBI) may improve mental health (MH), but no studies have trialled or modelled UBI in whole populations. We simulated the MH effects of UBI on UK working-age adults. Methods Adults aged 25-64 were simulated from 2022-26 with the SimPaths microsimulation model, using data from the UK Household Longitudinal Study. S...

Objective To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação – IBP). Methods Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capita...

Objective To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação – IBP). Methods Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capita...

Introduction There is a limited understanding of the early nutrition and pregnancy determinants of short-term and long-term maternal and child health in ethnically diverse and socioeconomically vulnerable populations within low-income and middle-income countries. This investigation programme aims to: (1) describe maternal weight trajectories throug...

Objectives: There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with r...

Background Prior research has shown that chronic physical conditions in children are associated with a higher burden of mental illness. However, not much is known about the nature of this association among care-experienced children and young people in Scotland. Methods The Children’s Health in Care in Scotland (CHiCS) is a population-wide study li...

Background Population mental health has deteriorated in many high-income countries over the last decade. Novel welfare policies such as Universal Basic Income (UBI) have been suggested as potential approaches to improve mental health. However, no studies have trialled or modelled UBI at a whole population level or considered impacts on mental healt...

Background: Status inequality is hypothesised to increase socioeconomic inequalities in health by creating an environment in which social cohesion erodes and social comparisons intensify. Such an environment may cause systemic chronic inflammation. Although these are often-used explanations in social epidemiology, empirical tests remain rare. Met...

Reducing health inequalities by addressing the social circumstances in which children are conceived and raised is a societal priority. Early interventions are key to improving outcomes in childhood and long-term into adulthood. Across the UK nations, there is strong political commitment to invest in the early years. National policy interventions ai...

Purpose The COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities. Methods Survey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n = 10,516), and January 2021 (loc...

Introduction: Housing-related factors can be predictors of health, including of diabetes outcomes. We analysed the association between subsidised housing residency and diabetes mortality among a large cohort of low-income adults in Brazil. Research design and methods: A cohort of 9 961 271 low-income adults, observed from January 2010 to Decembe...

Objectives: There are numerous, often single centre discussions of assorted medication-related problems after hospital discharge in patients who survive critical illness. However, there has been little synthesis of the incidence of medication-related problems, the classes of medications most often studied, the factors that are associated with grea...

Objective To analyze premature mortality due to noncommunicable chronic diseases (NCDs) in Brazilian capitals and the Federal District (DF) after redistribution of garbage causes and the temporal evolution according to social deprivation strata in the 2010 to 2012 and 2017 to 2019 triennia. Methods Corrections were applied to the Mortality Informa...

Objective: Interventions to tackle the social determinants of health can improve outcomes during pregnancy and early childhood, leading to better health across the life course. Variation in content, timing and implementation of policies across the 4 UK nations allows for evaluation. We conducted a policy-mapping review (1981-2021) to identify rele...

Background: Administrative data offer unique opportunities for researching experiences which pose barriers to participation in primary research and household surveys. Experiencing multiple social disadvantages is associated with very poor health outcomes, but little is known about how often this occurs and what combinations are most common. We lin...

Empirical evidence suggests that the health outcomes of children living in slums are poorer than those living in non-slums and other urban areas. Improving health especially among children under five years old (U5y) living in slums, requires a better understanding of the social determinants of health (SDoH) that drive their health outcomes. Therefo...

Introduction This protocol outlines aims to test the wider impacts of the COVID-19 pandemic on pregnancy and birth outcomes and inequalities in Scotland. Method and analysis We will analyse Scottish linked administrative data for pregnancies and births before (March 2010 to March 2020) and during (April 2020 to October 2020) the pandemic. The Comm...

Background: Adolescent loneliness and poor mental health represent dual public health concerns. Yet, associations between loneliness and mental health, and critically, how these associations vary in school settings are less understood. Aims: Framed by social-ecological theory, we aimed to identify key predictors of adolescent mental health and e...

Objetivos: Analisar a mortalidade prematura por doenças crônicas não transmissíveis (DCNT) nas capitais brasileiras e Distrito Federal (DF) segundo redistribuição das causas garbage e a evolução temporal segundo estratos de privação social nos triênios 2010 a 2012 e 2017 a 2019. Métodos: Foram aplicadas correções ao Sistema de Informação sobre Mort...

Background Addressing poverty through taxation or welfare policies is likely important for public mental health; however, few studies assess poverty’s effects using causal epidemiology. We estimated the effect of poverty on mental health. Methods We used data on working-age adults (25–64 years) from nine waves of the UK Household Longitudinal Surv...

Background: Employment and income are important determinants of mental health (MH), but the extent that unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income. Methods: We included adults 25-64 years from nine waves of t...

Linked administrative data offer a rich source of information that can be harnessed to describe patterns of disease, understand their causes and evaluate interventions. However, administrative data are primarily collected for operational reasons such as recording vital events for legal purposes, and planning, provision and monitoring of services. T...

Background The COVID-19 pandemic increased psychiatric distress and impacts differed by family structure. We aimed to identify mechanisms contributing to these inequalities. Methods Survey data were from the UK Household Longitudinal Study. Psychiatric distress (GHQ-12) was measured in April 2020 (first UK lockdown; n=10,516), and January 2021 (lo...

Background The economic and social disruptions caused by the COVID-19 pandemic and its mitigation measures may have affected fertility unequally across social strata. If a compositional change in maternal socioeconomic characteristics is confirmed, counterintuitive changes in future population health - the LoCo-effect - are likely. Methods We anal...

Background Employment and income are important determinants of mental health (MH), but the extent to which unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income. Methods We studied adults 25-64y from nine waves of the rep...

Objective: To compare the death counts from three sources of information on mortality available in Brazil in 2010, the Mortality Information System (SIM - Sistema de Informações sobre Mortalidade ), Civil Registration Statistic System (RC - Sistema de Estatísticas de Resgistro Civil ), and the 2010 Demographic Census at various geographical levels...

Objective: Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. Methods: This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of...

Background: Cardiovascular disease (CVD) has a disproportionate effect on mortality among the poorest people. We assessed the impact on CVD and all-cause mortality of the world's largest conditional cash transfer, Brazil's Bolsa Família Programme (BFP). Methods: We linked administrative data from the 100 Million Brazilian Cohort with BFP receipt...

Objective To evaluate the impact of persistent precarious employment (lasting 12+ months) on the health of working age adults, compared with more stable employment. Persistent precarity reflects a shift towards less secure forms of employment and may be particularly important for health. Methods Nine databases were systematically searched to ident...

Background: Small area age- and sex-specific mortality rates are useful measures for population projections, health, economic, and social planning. Mortality rate estimation in small areas can be difficult due the low number of events/exposure. If a country’s mortality registration has problems, such as incomplete information, then estimating morta...

Objectives Care experienced people have poorer health in UK and internationally, but the direction of causation is debated. Using longitudinal cross-sectoral data linkage we explore if inequalities in diabetes prevalence and hospitalisation are present before entering care or develop during or after leaving care. ApproachHealth and social care data...

Background A persistent research finding in industrialised countries has been regional variation in medical practices including elective primary hip and knee arthroplasty. The aim of the study was to examine regional variations in elective total hip and knee arthroplasties over time, and the proportions of these variations which can be explained by...

Introduction Government policies on taxation and social security are important determinants of population health outcomes and health inequalities. However, there is a shortage of evidence to inform policymakers of the health consequences of such policies. The Health Equity and Its Economic Determinants project aims to assess the potential impacts o...

Background Homelessness, opioid dependence, justice involvement, and psychosis are each associated with an increased risk of poor health and commonly co-occur in the same individuals. Most existing studies of mortality associated with this co-occurrence rely on active follow-up methods prone to selection and retention bias, and focus on a limited s...

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Background Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16–64 years). Methods For...

Introduction Several studies have shown that residents of urban informal settlements/slums are usually excluded and marginalised from formal social systems and structures of power leading to disproportionally worse health outcomes compared to other urban dwellers. To promote health equity for slum dwellers, requires an understanding of how their li...

Aim Mental wellbeing in the UK seems to have deteriorated significantly during the COVID-19 pandemic, with the rates of loneliness, life satisfaction and psychological distress taking longer to return to the pre-pandemic levels than elsewhere. Nevertheless, there is little knowledge about the interactions between these outcomes, or the factors that...

Background Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the eff...

Introduction Loneliness is prevalent among young people. But, there is little work exploring the association between loneliness with well‐being among this age group. Framed by social‐ecological theory, we examined demographic, interpersonal, and community factors associated with personal wellbeing and, critically, identified malleable moderators of...

Objectives The COVID-19 pandemic has substantially affected workers’ mental health. We investigated changes in UK workers’ mental health by industry, socioeconomic class and occupation and differential effects by UK country of residence, gender and age. Methods We used representative Understanding Society data from 6474 adults (41 207 observations...

Background Mental wellbeing in the UK seems to have deteriorated significantly during the COVID-19 pandemic, with the rates of loneliness, life satisfaction, and psychological distress taking longer to return to the pre-pandemic levels than elsewhere. Nevertheless, there is little knowledge about the interactions between these outcomes, or the fact...

Background Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using co...

Objective To determine the cost-effectiveness of a smoke-free prison policy in Scotland, through assessments of the trade-offs between costs (healthcare and non-healthcare-related expenditure) and outcomes (health and non-health-related non-monetary consequences) of implementing the policy. Design A health economic evaluation consisting of three a...

The relationship between social cohesion and health has been studied for decades. Yet, due to the contextual nature of this concept, measuring social cohesion remains challenging. Using a meta-analytical framework, this review's goal was to study the ecometric measurement properties of social cohesion in order to describe dissimilarities in its mea...

Adolescent loneliness and poor mental health represent dual public health concerns. Yet, associations between loneliness and mental health, and critically, how these unfold in school settings are less understood. Framed by social ecological theory, this study aimed to identify key predictors of adolescent mental health, and examine school-level var...

Background: Loneliness is a growing public health concern, yet little is known about loneliness in young people. The current study aimed to identify social ecological factors related to loneliness and examine the extent to which geographic region may account for differences in loneliness. Methods: The data come from a cross-sectional sample of 6...

Background Prisons had partial exemption from the UK’s 2006/7 smoking bans in enclosed public spaces. They became one of the few workplaces with continuing exposure to second-hand smoke, given the high levels of smoking among people in custody. Despite the introduction of smoke-free prisons elsewhere, evaluations of such ‘bans’ have been very limit...

Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020...

Objectives The COVID−19 pandemic has substantially affected workers mental health. We investigated changes in UK workers mental health by industry, social class, and occupation and differential effects by UK country of residence, gender and age. Methods We used representative Understanding Society data from 6,474 adults (41,207 observations) in pai...

Background Income is thought to be a major determinant of mental health, but we believe this literature has not been quantitatively synthesised in its entirety. We systematically reviewed studies assessing the effect of income changes on mental health in working-age adults (16–64 years). Methods We searched seven databases (MEDLINE, Embase, Web of...

Background There is little evidence in the UK on the mortality of those with care experience. Many studies lack the power to examine mortality outcomes of children who are still in, or have recently left, care. Research conducted elsewhere suggest that deaths are increased among those with care experience. Children's Health in Care in Scotland (CHi...

Background Internationally, there is little quantitative evidence on how the health of children who have experienced social care compares to children in the general population. Invariably, available evidence suggests that care experience is related to poorer health, but often this is based on small sample sizes or without comparison to children who...

Clear communication of scientific evidence remains important, as dramatically highlighted by COVID-19. But what does clear communication look like if the evidence keeps changing? Along with the known problems of fake news, disengagement and science scepticism, there is the problem of scientists presenting conflicting views on the same topic. Altern...

Background In many high-income countries cancer mortality rates have declined, however, socioeconomic inequalities in cancer mortality have widened over time with those in the most deprived areas bearing the greatest burden. Less is known about the contribution of specific cancers to inequalities in total cancer mortality. Methods Using high-quali...

Background Scotland was the first country to implement minimum unit pricing for alcohol nationally. Minimum unit pricing aims to reduce alcohol-related harms and to narrow health inequalities. Minimum unit pricing sets a minimum retail price based on alcohol content, targeting products preferentially consumed by high-risk drinkers. This study compr...

Objective Sickness absence (SA) is a significant problem for many workplaces, due to loss of productivity, increased workload on other staff, and resources spent to cover incapacity to work and restore health. To date, research on prison staff SA is still limited. High levels of SA related to mental health problems, including job-related stress, an...

Loneliness is particularly prevalent among young people, however less is known about loneliness and its associations with wellbeing among this age group. Framed by social ecological theory, we examined demographic, social, and community factors associated with personal wellbeing and, critically, identified malleable moderators of the relationship b...

Background Many population health research questions rely on observational data, where unmeasured confounding is a major source of bias. Sensitivity analyses for unmeasured confounding are increasingly applied, but often without sufficient consistency and transparency. We propose accessible recommendations to guide applied researchers in using two...