Less educated and lower earning individuals with diabetes bear a larger burden of morbidity but use hospital care less. Health service resource allocation should reflect the distribution of chronic illness.
Objective-To investigate the association between cause specific morbidity and deprivation in order to inform the debates on inequalities in health and health services resource allocation.Design-Cross sectional postal questionnaire survey ascertaining self reported health status, with validation of a 20!/o sample through general practitioner and hospital records.Setting-Inner city, urban, and rural areas of Avon and Somerset.Subjects-Stratified random sample of 28 080 people aged 35 and over from 40 general practices.Main outcome measures-Age and sex standardised prevalence of various diseases; Townsend deprivation scores were assigned by linking postcodes to enumeration districts. Relative indices of inequality were calculated to estimate the magnitude of the association between socioeconomic position and morbidity.Results-The response rate was 85 3%. The prevalence of most of the conditions rose with increasing material deprivation. The relative index of inequality, for both sexes combined, was greater than 1 for all conditions except diabetes. The conditions most strongly associated with deprivation were diabetic eye disease (relative index of inequality 3*21; 95% confidence interval 184 to 5.59), emphysema (2.72; 167 to 4.43) and bronchitis (2.27; 1-92 to 2.68). The relative index of inequality was significantly higher in women for asthma (P< 0.05) and in men for depression (P<0.01). The mean reporting of prevalent conditions was 107 for the most deprived fifth of respondents and 0*77 in the most affluent fifth (P < 0.001).
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