An alternative approach to quantifying and addressing inequity in healthcare provision: access to surgery for lung cancer in the east of England

Abstract

Study objective: Equitable access to healthcare services should be monitored routinely. This study compares provision of surgery for non-small cell lung cancer in the east of England with incidence of nonsmall cell lung cancer. In addition to conventional comparisons, process control charts are used to identify areas in which access seems to be significantly different from average. Design: Ecological comparison of surgery rates for non-small cell lung cancer between 1998 and 2000 and incidence of non-small cell lung cancer over the same time period. Setting: Population of Norfolk, Suffolk, Cambridgeshire. Participants: The denominator was the resident population. Numerators were 4092 deaths from non-small cell lung cancer and 387 surgical procedures for lung cancer. Main results: Incidence of non-small cell lung cancer by primary care trust (PCT) does not correlate with surgical procedure rate, in men r = 0.37 (95% confidence intervals 20.14 to 0.72), in women r = 0.07 (95% confidence intervals 20.43 to 0.53). Control charts indicate that the surgery rate is significantly different from average in three PCTs, high in one and low in two others. The optimum surgery rate is unclear but raising it from 9% to a theoretical level of 15% would mean no PCTs have above average rates while six PCTs have rates that are significantly low. Conclusions: There does not seem to be equity of access to surgery for patients with non-small cell lung cancer in the east of England. Control charts can help both to identify areas where access is particularly high or low, and also to monitor performance against a theoretical optimum surgery rate.

Inequities in access to healthcare: analysis of national survey data across six Asia-Pacific countries

“…There is a large research literature demonstrating that access to, quality of, and outcomes from healthcare are inequitable across a number of clinical areas including screening for a variety of cancers [13-16], surgical interventions [17-19] and primary care prescribing [20-22]. These examples provide evidence for the ‘inverse care law’ [23], whereby the groups with the greatest healthcare need receive the lowest levels of service.…”

Bidirectional associations between depression/anxiety and bowel disease in a population based cohort

“…This is an accepted methodology and is widely applied. 1 We did report that crude incidence of nonsmall lung cancer correlated with the IMD 2000 score. Moreover, when looking at mortality from all lung cancers during a similar period, there was good correlation between IMD 2000 score and age specific death rates for lung cancer, both for men r = 0.76 (95% CI 0.44 to 0.91), and women r = 0.59 (95% CI 0.15 to 0.83).…”

“…Battersby et al present a method of performing equity audit where data on incidence, deprivation, and surgical resection rates of non-small cell lung cancer are compared. 1 Deprivation was measured using the Index of Multiple Deprivation (IMD) 2000 2 and all analyses were performed at the primary care trust (PCT) level. Battersby et al report no statistically significant associations between their measure of deprivation and age and sex standardised incidence of non-small cell lung cancer.…”

The need for psychiatric care in England: a spatial factor methodology

“…The first involves a common univariate random effect with value u i in area i, and loading u j on u i in the model for the relative risk of outcome j. These effects may represent institutional features of (mental) health care, such as hospitalisation thresholds or local need-care mismatches (Battersby et al 2004;Thompson et al 2004), that do not necessarily vary smoothly over space, and so u i may be taken as spatially unstructured. In other applications, it may be more reasonable to take the u i as spatially structured, mainly representing unknown population risk factors.…”