
Richard FrySwansea University | SWAN · Swansea University Medical School
Richard Fry
Doctor of Philosophy
About
174
Publications
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Introduction
Additional affiliations
January 2012 - November 2016
January 2009 - December 2011
Education
October 2005 - January 2009
October 2003 - October 2004
October 1999 - June 2002
Publications
Publications (174)
Introduction Pregnant women and their babies are a highly vulnerable population to health effects from air pollution. This scoping review aims to understand the extent and type of evidence concerning the mediating and moderating factors between air pollution and birth outcomes. By gathering and synthesising this evidence, this review aims to identi...
Purpose
Bikeability is an emerging concept that quantifies the perceived comfort and convenience of accessing important destinations by bike. Existing bikeability indices are limited to adults, single, large cities and use restricted GIS sources. The aims of this study are to (1) identify environment characteristics related for a bikeable neighbour...
Background
Child poverty remains a major global concern and a child's experience of deprivation is heavily shaped by where they live and the stability of their local neighbourhood. This study examines frequencies and patterns of residential mobility in children and young people (CYP) at a population level using novel geospatial techniques to assess...
Objective and ApproachThe study aimed to utilise multiple population-wide linked administrative, health, and survey data sources to identify victims from violence across various sociodemographic groups using healthcare service interactions. We calculated violence rates for the population of Wales to identify groups of people that experience higher...
Objective
We hypothesised that adults living in overcrowded households were more likely to be diagnosed with Serious Mental Illness (SMI) or depression after accounting for individual, household and area-level factors. ApproachWe linked primary care records of adults currently registered with all general practices in the north-east London region on...
Background
The natural environment offers a plethora of health benefits and may mitigate the risk of contracting SARS-CoV-2. However, they are also sites where interpersonal contact is frequent, amplifying the risk of transmission. Previous research has typically focused on green space or a measure of greenness. Greenness is often associated with f...
Background
The COVID-19 pandemic caused significant disruption to healthcare services and changed patterns of healthcare resource utilisation in Wales, but the geographic variation of this disruption is not known. Objective/Approach We aimed to examine geo-spatial variation in the impact of the pandemic on healthcare service use, and identify socio...
Objective
Coverage for the measles, mumps and rubella (MMR) vaccination in north-east London (NEL) is the lowest in the United Kingdom. It has been hypothesised that children who move home frequently are less likely to receive vaccinations. We examined the association between number of addresses in the first two years of life, and receipt of MMR va...
Objective
To address the challenge of linking identifiable but low-sensitivity place-based data with high-sensitivity, de-identified, health and socio-economic records. While also minimising the financial and carbon costs of computationally intensive environmental modelling. ApproachFor domain and legal experts, TRE leads and public contributors to...
Background
Australia possesses valuable population health data, yet its potential for advancing medical product development remains largely untapped. Transformative growth in the use of linked data in clinical trials will support Australia’s therapeutic development sector to be more responsive in the development of new therapeutics and the monitori...
Background and Objectives
The health impacts from changing climate, including increasing frequency, severity, and duration of heat are projected to worsen. The MAGENTA study will explore the impact of heat on pregnancy-related outcomes for deprived communities in Wales and London. ApproachMAGENTA will create linked data cohorts capturing some of th...
Background and Objective
Healthcare research faces challenges in developing metrics that resonate with the general public or policymakers. We created a Desirable Health Service Utilisation Indicator (DHSUI) to address this gap, centred around New Year’s wishes for survival and non-occurrence of undesired events in the following year, for the popula...
Background
Cases of measles are rising in the United Kingdom (UK). While children are eligible for the first measles, mumps and rubella (MMR) vaccination at 12 months in the UK, coverage in the north-east London (NEL) region is the lowest in the UK, well below the 95% recommended to achieve herd immunity. It has been hypothesised that children who...
Background
While there is evidence to suggest that household overcrowding is associated with higher levels of psychological distress, associations with serious mental illness (SMI) or depression remain unclear. We used a measure of household overcrowding derived from linked primary care and housing records across North East London and hypothesised...
Objective
This study aims to create a national ethnicity spine based on all available ethnicity records in linkable anonymised electronic health record and administrative data sources.
Design
A longitudinal study using anonymised individual-level population-scale ethnicity data from 26 data sources available within the Secure Anonymised Informatio...
Background
Routine monitoring of Body Mass Index (BMI) in general practice, and via national surveillance programmes, is essential for the identification, prevention, and management of unhealthy childhood weight. We examined and compared the presence and representativeness of children and young people’s (CYPs) BMI recorded in two routinely collecte...
IntroductionHouseholds are increasingly studied in population health research as an important context for understanding health and social behaviours and outcomes. Identifying household units of analysis in routinely collected data rather than traditional surveys requires innovative and standardised tools, which do not currently exist. Objectives
To...
Background
Exposure to green space can protect against poor health through a variety of mechanisms. However, there is heterogeneity in methodological approaches to exposure assessments which makes creating effective policy recommendations challenging.
Objective
Critically evaluate the use of a satellite-derived exposure metric, the Enhanced Vegeta...
Background
Multimorbidity is one of the greatest challenges facing health and social care systems globally. It is associated with high rates of health service use, adverse healthcare events, and premature death. Despite its importance, little is known about the effects of contextual determinants such as household and area characteristics on health...
Background
Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited.
Objectives
To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use.
Design
A retrospective, dynamic longitudinal panel study.
Setting...
Reducing the burden of falls and fall-related admissions to hospital and care homes is an important policy area. Falls cause significant injury leading to a reduced quality of life. We wanted to know if the environment around people’s homes changes the risk of falls for older people in Wales. We linked routinely collected, anonymised health data on...
Objectives
Youth obesity has increased substantially in recent decades; however, the potential role of the built environment in mitigating these trends is unclear. This study examines whether more walkable neighbourhoods are associated with lower levels of overweight/obesity for adolescents compared to less walkable neighbourhoods, after considerin...
Objectives
Active travel to school (ATS), such as walking and cycling, not only reduces carbon emissions and air pollution but also contributes to a myriad of health benefits. Understanding the ‘potential’ for ATS across Wales is poorly understood yet vital to inform policy and practice aimed at increasing ATS. Methods
Using geospatial techniques,...
Objectives
We have developed a dynamic method for identifying household members from Electronic Health Records (EHR). We compared the 2021 Census estimates of household number and demography with similar estimates derived from primary care EHRs on the Census date using primary care EHRs for the population of north east London (NEL). Method
We inclu...
Background
Routine monitoring of Body Mass Index (BMI) in general practice, and via national surveillance programmes, is essential for the identification, prevention, and management of low or excess childhood weight. We examined and compared the presence and representativeness of children and young people’s (CYPs) BMI recorded in two routinely coll...
Background Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality...
Background:
Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortali...
Transactional theory and the coercive family process model have illustrated how the parent-child relationship is reciprocal. Emerging research using advanced statistical methods has examined these theories, but further investigations are necessary. In this study, we utilised linked health data on maternal mental health disorders and explored their...
Objectives:
We investigated SARS-CoV-2 infection trends, risk of SARS-CoV-2 infection and COVID-19 vaccination uptake among school staff, students and their household members in Wales, UK.
Design:
Seven-day average of SARS-CoV-2 infections and polymerase chain reaction tests per 1000 people daily, cumulative incidence of COVID-19 vaccination upt...
Natural environments can promote well-being through multiple mechanisms. Many studies have investigated relationships between residential green/blue space (GBS) and well-being, fewer explore relationships with actual use of GBS. We used a nationally representative survey, the National Survey for Wales, anonymously linked with spatial GBS data to in...
Air pollution (AP) is a significant environmental risk to human health. Historically, the impact of AP exposure has focused upon the physical health effects, yet the implications of AP on mental health have received limited attention. Despite this, recent research has highlighted emerging evidence supporting a possible aetiological link. The purpos...
The uptake of COVID-19 vaccination in Wales is high at a population level but many inequalities exist. Household composition may be an important factor in COVID-19 vaccination uptake due to the practical, social, and psychological implications associated with different living arrangements. In this study, the role of household composition in the upt...
Introduction
Gypsies and Travellers have poorer physical and mental health than the general population, but little is known about mental health service use by Gypsy and Traveller children and young people. Finding this group in routine electronic health data is challenging, due to limited recording of ethnicity. We assessed the feasibility of using...
Background
dementia may increase care home residents’ risk of COVID-19, but there is a lack of evidence on this effect and on interactions with individual and care home-level factors.
Methods
we created a national cross-sectional retrospective cohort of care home residents in Wales for 1 September to 31 December 2020. Risk factors were analysed us...
Introduction Ethnicity information is recorded routinely in electronic health records (EHRs); however, to date, there is no national standard or framework for harmonisation of the existing records.
Methods and analysis The national ethnicity-spine uses anonymised individual-level population-scale ethnicity data from 26 EHR available through the Sec...
Introduction:
Childhood obesity and physical inactivity are two of the most significant modifiable risk factors for the prevention of non-communicable diseases (NCDs). Yet, a third of children in Wales and Australia are overweight or obese, and only 20% of UK and Australian children are sufficiently active. The purpose of the Built Environments An...
There is a need for better understanding of the risk of thrombocytopenic, haemorrhagic, thromboembolic disorders following first, second and booster vaccination doses and testing positive for SARS-CoV-2. Self-controlled cases series analysis of 2.1 million linked patient records in Wales between 7th December 2020 and 31st December 2021. Outcomes we...
Objectives
Examine if pre-COVID-19 pandemic (prior March 2020) health-related behaviours during primary school are associated with (1) being tested for SARS-CoV-2 and (2) testing positive between 1 March 2020 and 31 August 2021.
Design
Retrospective cohort study using an online cohort survey (January 2018 to February 2020) linked with routine PCR...
Objectives
In Wales almost a quarter of adults and 1 in 8 reception age children are obese. Linked data is a key tool to understanding the role of the built environment on obesity rates and is an important part of developing strategies to combat the obesity epidemic in Wales. ApproachWe set out to develop an analytical platform for generating evide...
The COVID-19 pandemic has placed a spotlight on existing and enduring health inequalities experienced by different ethnic groups. There has been a longstanding call to generate and improve the use of ethnicity data available across different data sources, in order to improve our understanding of health risks, behaviours and outcomes. We used multip...
Objectives
Research on bi-directional associations between self-reported caregiver mental health and child development is mixed. Through linkage of a cohort study and primary care data, we examine whether maternal mental health diagnoses, treatment and symptoms are bi-directionally associated with child development, namely emotional and conduct pro...
Objectives
Physical inactivity directly contributes to the global issue of obesity. Small-scale garden-based interventions have positively impacted on children’s physical activity levels. However, no studies have objectively measured household gardens and assessed associations with childhood obesity on a population scale. We linked garden measures...
Objectives
Mental wellbeing can deteriorate throughout adolescence; females and children from low-income families more likely to experience mental health conditions. Views of greenspace from home positively impact cognition, but links with wellbeing has not been explored in children. We linked environment and survey data for 14 year olds in Wales,...
ObjectivesA defining feature of the COVID-19 pandemic in many countries were the tragic extent to which care home residents were affected and the difficulty in preventing the introduction and subsequent spread of infection. ApproachUtilising linked data in the SAIL Databank we set out to develop a linked data platform as part of the ‘One Wales’ app...
Purpose:
Understanding which physical activity (PA) and sedentary behavior correlates cluster in children is important, particularly in the home, where children spend significant time. Therefore, this study aimed to assess clustering of physical and social activity-related factors at home, and whether these clusters are related to home-based sitti...
Background
falls are common in older people, but associations between falls, dementia and frailty are relatively unknown. The impact of the COVID-19 pandemic on falls admissions has not been studied.
Aim
to investigate the impact of dementia, frailty, deprivation, previous falls and the differences between years for falls resulting in an emergency...
Objectives
To better understand the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers, leading to recommendations for the prioritisation of personal protective equipment, testing, training and vaccination.
Design
Observational, longitudinal, national cohort study.
Setting
Our cohort were secon...
Background
Spatiotemporal modelling techniques allow one to predict injury across time and space. However, such methods have been underutilised in injury studies. This study demonstrates the use of statistical spatiotemporal modelling in identifying areas of significantly high injury risk, and areas witnessing significantly increasing risk over tim...
Background
COVID-19 vaccinations have been prioritised for high risk individuals.
Aim
Determine individual-level risk factors for care home residents testing positive for SARS-CoV-2.
Study design
Longitudinal observational cohort study using individual-level linked data from the Secure Anonymised Information Linkage (SAIL) databank.
Setting
Four...
Background
The burden of traumatic injury among workers in agriculture is substantial. Surveillance can inform injury prevention efforts to reduce farmworkers' risk. We posited that the regional trauma registry can provide surveillance for agricultural injury requiring trauma-center care.
Methods
The Northeast Texas regional trauma registry was qu...
Background
A defining feature of the COVID-19 pandemic in many countries was the tragic extent to which care home residents were affected, and the difficulty preventing introduction and subsequent spread of infection. Management of risk in care homes requires good evidence on the most important transmission pathways. One hypothesised route at the s...
Introduction
School-based COVID-19 mitigation strategies have greatly impacted the primary school day (children aged 3–11) including: wearing face coverings, two metre distancing, no mixing of children, and no breakfast clubs or extra-curricular activities. This study examines these mitigation measures and association with COVID-19 infection, respi...
RATIONALE Previous studies indicate active living environments (ALEs) are associated with higher physical activity levels across different geographic contexts, and could lead to reductions in hospital burden. Both Wales UK and Canada have advanced data infrastructure that allows record linkage between survey data and administrative health informati...
Objectives
Examine if prior health-related behaviours during primary school are associated with being tested for SARS-CoV-2 and testing positive during adolescence.
Design
Retrospective cohort study using an online cohort survey (1 April 2014 to 28 February 2020) linked to routine PCR SARS-CoV-2 test results (1 March 2020 to 31 August 2021)
Setti...
Background
While population estimates suggest high vaccine effectiveness against SARS-CoV-2 infection, the protection for health care workers, who are at higher risk of SARS-CoV-2 exposure, is less understood.
Methods
We conducted a national cohort study of health care workers in Wales (UK) from 7 December 2020 to 30 September 2021. We examined up...
Introduction
Post-discharge healthcare needs are complex and persistent for people following major trauma. A number of geographic barriers to accessing healthcare exist, particularly for people in regional areas. The aim of this study was to explore regional variation in the distances travelled to access health services and identify patterns of hea...
Background
Deprivation can impact the access to health interventions in publicly funded health systems where cost is not the dominant barrier. In this study we examined whether deprivation affected the access to disease modifying therapies (DMTs) for multiple sclerosis (MS).
Methods
All English adults on the UK MS register with relapsing remitting...
Background: Spatiotemporal modelling techniques allow one to predict injury across time and space. However, such methods have been underutilised in injury studies. This study demonstrates the use of statistical spatiotemporal modelling in identifying areas of significantly high injury risk, and areas witnessing significantly increasing risk over ti...
Background
vaccinations for COVID-19 have been prioritised for older people living in care homes. However, vaccination trials included limited numbers of older people.
Aim
we aimed to study infection rates of SARS-CoV-2 for older care home residents following vaccination and identify factors associated with increased risk of infection.
Study Desi...
Background
Growing cross-sectional evidence links access to green-blue spaces with mental health benefits, but studies at an individual level and at a national population scale are scarce. This gap can be addressed through the Secure Anonymised Information Linkage (SAIL) Databank, which allows household-level green-blue spaces access and exposure d...
Background
Evidence that greenspaces are related to mental health and wellbeing mostly relies on residential exposure and few studies have considered actual use. We aimed to link the National Survey for Wales (NSW) to environmental metrics to determine whether there is an association between increased residential exposure to greenspace and subjecti...
Background
falls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited.
Aim
determine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood of falls.
Study Design
retrospective longitudinal cont...
This study used linear regression analyses to investigate the influence of parent-reported home-specific social and individual factors on: (i) 235 children's home-based objectively measured overall sitting time, breaks in sitting, and PA, and; (ii) the home physical environment via an audit. Parental importance assigned to active play for children...
Objectives: Determine individual level risk factors for care home residents testing positive for SARS-CoV-2.
Study Design: Longitudinal observational cohort study using individual-level linked data.
Setting: Care home residents in Wales (United Kingdom) between 1st September 2020 and 1st May 2021.
Participants: 14,786 older care home residents (age...
Introduction
School-based COVID-19 mitigation strategies have greatly impacted the primary school day (children aged 3-11) including: wearing face coverings, 2-metre distancing, no mixing of children, and no breakfast clubs or extra-curricular activities. This study examines these mitigation methods and association with COVID-19 infection, respirat...
Background
Children growing up in poverty are less likely to achieve in school and more likely to experience mental health problems. This study examined factors in the local area that can help a child overcome the negative impact of poverty.
Method
This retrospective cohort study included 159,131 children who lived in Wales and completed their age...
Background
Better understanding of the role that children and school staff play in the transmission of SARS-CoV-2 is essential to guide policy development on controlling infection while minimising disruption to children’s education and well-being.
Methods
Our national e-cohort (n=464531) study used anonymised linked data for pupils, staff and asso...