Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis

Kontopantelis, Evangelos; Mamas, Mamas A.; Marwijk, Harm van; Ryan, Andrew M.; Bower, Peter; Guthrie, Bruce; Doran, Timothy

doi:10.1186/s12916-017-0996-0

Cited by 30 publications

(38 citation statements)

References 22 publications

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“…Access to health services in London might also be a factor, with some evidence that health services in the north east and north west of England are relatively underfunded compared with London. 41 The low mortality could be, at least partly, related to inaccurate population estimates for London as a consequence of high population turnover from high internal and international migration. Finally, IMD scores might function differently in London; for example, the housing deprivation domain includes a measure of housing affordability, for which London does particularly badly.…”

Section: Discussionmentioning

confidence: 99%

Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

et al. 2018

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SummaryBackgroundPrevious studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile.MethodsWe extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters.FindingsThe leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990–2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer's disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258–2356]) was higher than for ischaemic heart disease (1200 [1155–1246]) or lung cancer (660 [642–679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK...

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Section: Discussionmentioning

confidence: 99%

Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

et al. 2018

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“…The shortcomings of the Carr-Hill formula (see Box 1) to adequately adjust for population need related to deprivation is well recognised. 32,33,34 At practice level, an analysis of payments over time has found that for each 10% increase in deprivation score, practice payments increased by 0.06%. 35 Analysis of consultation rates from the London borough of Tower Hamlets estimated that a formula that allowed for additional workload in deprived areas would equate to 33% more funding for these practices.…”

Section: Discussionmentioning

confidence: 99%

“…We suggest that a review is needed, and should consider funding for PCNs (PCNs in deprived areas currently do not get extra funding to account for the likely increased needs of their populations 25 ) and also the underlying resource allocation formula (Carr-Hill). Previous research suggests that the Carr-Hill formula may under-weight for the increased health needs associated with deprivation, 32,33,34 and there is a case for further analysis of the impact of the formula across general practice in England.…”

Section: Considerations For Policymentioning

confidence: 99%

Level or not?

Fisher¹,

Dunn²,

Gershlick³

et al. 2020

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• GP practices serving more socioeconomically deprived patient populations receive similar funding per registered patient to those serving less deprived patient populations. Once these populations are adjusted to account for increased workload associated with greater health needs in poorer areas, practices serving more deprived populations receive around 7% less funding per need adjusted * registered patient than those serving less deprived populations. * Measuring health need directly is not possible. In our analysis we use workload as a proxy for need. This has limitations, but is consistent with the methodology used in the Carr-Hill resource allocation formula for general practice. Briefing: Level or not? 2 • GP practices serving more deprived patient populations on average earn fewer quality and outcomes framework (QOF) points, have worse Care Quality Commission (CQC) ratings and lower patient satisfaction scores than practices serving less deprived populations. These measures of assessing quality may themselves be affected by deprivation (for example increased patient deprivation may make it harder to achieve high QOF scores). Further research is needed across other aspects of quality to explore whether patients living in more deprived areas receive a systematically lower quality of care.

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“…In this context, the higher pay per patient in general practices serving rural areas may be relevant. 40 …”

Section: Discussionmentioning

confidence: 99%

Increasing socioeconomic gap between the young and old: temporal trends in health and overall deprivation in England by age, sex, urbanity and ethnicity, 2004–2015

Kontopantelis

Mamas

Marwijk

et al. 2018

J Epidemiol Community Health

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BackgroundAt a low geographical level, little is known about the associations between population characteristics and deprivation, and their trends, which would be directly affected by the house market, labour pressures and government policies. We describe temporal trends in health and overall deprivation in England by age, sex, urbanity and ethnicity.MethodsRepeated cross-sectional whole population study for England, 2004–2015, at a low geographical level (average 1500 residents). We calculated weighted medians of the Index of Multiple Deprivation (IMD) for each subgroup of interest.ResultsOver time, we observed increases in relative deprivation for people aged under 30, and aged 30–59, while median deprivation decreased for those aged 60 or over. Subgroup analyses indicated that relative overall deprivation was consistently higher for young adults (aged 20–29) and infants (aged 0–4), with increases in deprivation for the latter. Levels of overall deprivation in 2004 greatly varied by ethnicity, with the lowest levels observed for White British and the highest for Blacks. Over time, small reductions were observed in the deprivation gap between White British and all other ethnic groups. Findings were consistent across overall IMD and its health and disability subdomain, but large regional variability was also observed.ConclusionsGovernment policies, the financial crisis of 2008, education funding and the increasing cost of houses relative to real wages are important parameters in interpreting our findings. Socioeconomic deprivation is an important determinant of health and the inequalities this work highlights may have significant implications for future fiscal and healthcare policy.

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Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis

Cited by 30 publications

References 22 publications

Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Level or not?

Increasing socioeconomic gap between the young and old: temporal trends in health and overall deprivation in England by age, sex, urbanity and ethnicity, 2004–2015

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