{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T01:50:13Z","timestamp":1773798613838,"version":"3.50.1"},"reference-count":64,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T00:00:00Z","timestamp":1664323200000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012349","name":"NIHR School for Public Health Research","doi-asserted-by":"crossref","award":["PD-SPH-2015"],"award-info":[{"award-number":["PD-SPH-2015"]}],"id":[{"id":"10.13039\/501100012349","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["Clinician Scientist Fellowship (MR\/P008577\/1) to D"],"award-info":[{"award-number":["Clinician Scientist Fellowship (MR\/P008577\/1) to D"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,8,23]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Reductions in local government spending may have impacts on diets and health which increase the risk of hospital admissions for nutritional anaemias. Mechanisms include potential impacts of changes to local authority (LA) services (eg, housing services) on personal resources and food access, availability and provision. We therefore investigated the association between changes in LA spending and nutritional anaemia-related hospital admissions. Specifically, we address whether greater cuts to LA spending were linked to increased hospital admissions for nutritional anaemias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Longitudinal analysis of LA panel data using Poisson fixed effects regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>312 LAs in England (2005\u20132018).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main exposure<\/jats:title>\n                    <jats:p>Total LA service expenditure per capita per year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome<\/jats:title>\n                    <jats:p>Principal and total nutritional anaemia hospital admissions, for all ages and stratified by age (0\u201314, 15\u201364, 65+ years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>LA service expenditure increased by 9% between 2005 and 2009 then decreased by 20% between 2010 and 2018. Total nutritional anaemia hospital admissions increased between 2005 and 2018 from 173 to 633 admissions per 100\u2009000 population. A \u00a3100 higher LA service spending was associated with a 1.9% decrease in total nutritional anaemia hospital admissions (adjusted incidence rate ratio (aIRR): 0.98, 95%\u2009CI: 0.96 to 0.99). When stratified by age, this was seen only in adults. A \u00a3100 higher LA service spending was associated with a 2.6% decrease in total nutritional anaemia hospital admissions in the most deprived LAs (aIRR: 0.97, 95%\u2009CI: 0.95 to 1.0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increased LA spending was associated with reduced hospital admissions for nutritional anaemia. Austerity-related reductions had the opposite effect, increasing admissions, with greater impacts in more deprived areas. This adds further evidence to the potential negative impacts of austerity policies on health and health inequalities. Among other impacts, re-investing in LA services may prevent hospital admissions associated with nutritional anaemias.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-059739","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T11:46:01Z","timestamp":1664451961000},"page":"e059739","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Local area public sector spending and nutritional anaemia hospital admissions in England: a longitudinal ecological study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4600-2258","authenticated-orcid":false,"given":"Rosemary","family":"Jenkins","sequence":"first","affiliation":[{"name":"Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus; The Reynolds Building; St Dunstan's Road, London W6 8RP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eszter P","family":"Vamos","sequence":"additional","affiliation":[{"name":"Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus; The Reynolds Building; St Dunstan's Road, London W6 8RP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5020-5256","authenticated-orcid":false,"given":"Kate E","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool; Waterhouse Building Block F, 2nd Floor, Liverpool L69 3BX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4573-4628","authenticated-orcid":false,"given":"Konstantinos","family":"Daras","sequence":"additional","affiliation":[{"name":"Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool; Waterhouse Building Block F, 2nd Floor, Liverpool L69 3BX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Taylor-Robinson","sequence":"additional","affiliation":[{"name":"Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool; Waterhouse Building Block F, 2nd Floor, Liverpool L69 3BX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Bambra","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, NE1 4LE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Millett","sequence":"additional","affiliation":[{"name":"Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus; The Reynolds Building; St Dunstan's Road, London W6 8RP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1318-8439","authenticated-orcid":false,"given":"Anthony A","family":"Laverty","sequence":"additional","affiliation":[{"name":"Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, Charing Cross Campus; The Reynolds Building; St Dunstan's Road, London W6 8RP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"key":"2025120600265558000_12.9.e059739.1","unstructured":"World Health Organisation . 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