Understanding the impact of local authority resource allocation on gastrointestinal infections in England

BackgroundGastrointestinal infections are a substantial public health issue in England. Local authority environmental and regulatory (ER) services support the prevention and control of gastrointestinal infections with food safety and infection control functions. However, there have been significant and inequitable cuts to local authority budgets, with ER services seeing expenditure reduced by 2.4% per capita in the most deprived compared to 1.2% per capita in the least deprived authorities. It is therefore imperative to understand the impact local funding cuts to ER services may have on gastrointestinal infection outcomes. MethodsWe use longitudinal data in England, at local authority district level, between 2010 and 2019. Exposures of interest were ER spending lines of food safety expenditure, and aggregated spending lines of food safety and infection control (FSIC) expenditure, and the number of food hygiene full time equivalent staff (FTE) per 10,000 of the population. Primary outcomes of interest were the number of laboratory-confirmed Campylobacter, Salmonella, and E. coli O157 infections, emergency hospitalisations due to GI infection, and the number of calls to NHS 111, all at the local authority level. We use fixed effects negative binomial modelling to estimate the association between relative change in the incidence rate of gastrointestinal infection outcomes and increases in each of our exposures. NHS 111 and hospital admission data were desegregated by age group, and age-exposure interactions were used to understand differential effects. This was not possible for pathogen data due to the small number of observations per year by species. ResultsNo significant relationship was found between expenditure or staff and foodborne pathogen incidence overall. When considered as a whole, we find no significant relationship between expenditure or staff levels and the number of hospital admissions for all age groups. However, when disaggregated by age, an increase of {pound}1 per capita in food safety expenditure was associated with a 1.34 % decrease in the rate of hospitalisations among 20-59-year-olds (IRR = 0.9866: 0.9738, 0.9996). In addition, an increase in food hygiene staffing per 10,000 of the population was associated with a 36% decrease in the rate of hospitalisations in 60-64-year-olds (IRR =0.64: 0.48 0.86). Results also identified an increase in resource allocation was associated with increased rate in hospital admissions for some age groups. A {pound}1 per capita increase in food safety expenditure was associated with a 3% increase in hospitalisations for 5-9 (IRR=1.0300: 1.0001, 1.0607) and a 2.3 % increase for 10-19-year-olds (IRR=1.023:1.004,1.043). {pound}1 per capita increase in FSIC expenditure was associated with a 1% increase in admissions for 75+ (IRR=1.009:1.001,1.018). Finally, a one unit increase in staff per 10,000 of the population was associated with a 134% increase admission for 5-9-year-olds (IRR =2.34:1.60, 3.43) and 50% increase amongst 10-19-year-olds (IRR=1.50:1.14, 1.98), whilst no significant relationship was identified between the number of NHS 111 calls and exposures of interest. DiscussionOverall, no significant relationship was identified between expenditure or staff levels on the number of laboratory confirmed pathogens, hospital admissions or NHS 111 calls. However, age-specific patterns suggest an increased resource allocation may be protective for some groups in preventing hospital admissions. While increased rates of illness for children and 75+ years may reflect differences in exposure, detection or healthcare seeking behaviour or other unknown factors. Building on previous research evidencing the inequal reductions in service expenditure, and the impacts on service capacity, these results highlight the potential role of local funding cuts on GI infection health outcomes. Further research is warranted to understand the mechanisms driving different effects and to understand how service provision interacts with sociodemographic factors.