Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health

Abstract

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).

Psychological distress, gender and dietary factors in South Asians: a cross-sectional survey

“…From univariate analysis and the published literature (28)(29)(30)(31)34) , age, marital status, education, annual family income, religion and living alone were identified as possible confounders.…”

“…Age, marital status, religion, living alone and highest qualification were the sociodemographic factors chosen a priori as they were believed to be related to both distress and diet based on previous literature (28)(29)(30)(31)(32)(33) . No information was collected on diagnosis or treatments for psychological disorders.…”

Editorial

“…The two most consistently identified risk factors for common mental disorders in community studies are low socio-economic status (Blaxter, 1990 ;Robins et al 1991 ;Rodgers, 1991 ;Power & Manor, 1992 ;Meltzer et al 1995 ;Eachus et al 1996) and female sex (Jenkins, 1985 b ;Paykel, 1991). Although inconsistencies have been reported in the association with occupational social class (Brown & Harris, 1978 ;Bebbington et al 1981 ;Dohrenwend, 1990 ;Power & Manor, 1992 ;Stansfeld & Marmot, 1992), associations have been identified with forms of socio-economic adversity that could conceivably be corrected, including low income and financial hardship (Platt et al 1990 ;Bruce et al 1991 ;Murphy et al 1991 ;Rodgers, 1991 ;Romans et al 1993 ;Bruce & Hoff, 1994), unemployment (Surtees et al 1983 ;Warr, 1987), poor housing (Brown & Harris, 1978 ;Huxley et al 1979 ;Birtchnell et al 1988 ;Goldberg et al 1990 ;Platt et al 1990) and lack of education (Blazer et al 1994).…”

“…Although inconsistencies have been reported in the association with occupational social class (Brown & Harris, 1978 ;Bebbington et al 1981 ;Dohrenwend, 1990 ;Power & Manor, 1992 ;Stansfeld & Marmot, 1992), associations have been identified with forms of socio-economic adversity that could conceivably be corrected, including low income and financial hardship (Platt et al 1990 ;Bruce et al 1991 ;Murphy et al 1991 ;Rodgers, 1991 ;Romans et al 1993 ;Bruce & Hoff, 1994), unemployment (Surtees et al 1983 ;Warr, 1987), poor housing (Brown & Harris, 1978 ;Huxley et al 1979 ;Birtchnell et al 1988 ;Goldberg et al 1990 ;Platt et al 1990) and lack of education (Blazer et al 1994). Conclusions about the aetiological importance of different types of socio-economic adversity are restricted, however, by the dearth of longitudinal population-based studies, in contrast to the literature on socio-economic inequalities in mortality and physical morbidity (Davey Smith et al 1990 ;Townsend & Davidson, 1992 ;Wilkinson, 1994 ;Eachus et al, 1996). This issue has been given added saliency recently by the suggestion that the association between relative poverty and increased mortality (Townsend & Davidson, 1992 ;Wilkinson, 1992 ;Davey Smith & Egger, 1993 ;McCarron et al 1994) may be mediated by adverse psycho-social health (Marmot & McDowall, 1986 ;Wilkinson, 1992).…”

Risk factors for cataract subtypes waterclefts and retrodots: two case–control studies

“…17 The source of potential subjects for the SAES was the Somerset and Avon Survey of Health (SASH), an age/gender stratified random sample of subjects aged at least 55 years registered at 40 general practices in Avon and Somerset. 19 The study was approved by the United Bristol Healthcare Trust Local Ethics Committee.…”