Unemployment rates: an alternative to the Jarman index?

Campbell, Doreen A; Radford, JM; Burton, Paul J.

doi:10.1136/bmj.303.6805.750

Cited by 75 publications

(18 citation statements)

References 12 publications

(2 reference statements)

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“…Unemployment in a city district is not only a good predictor for hospitalization in general [8] but also for psychiatric hospitalization [7]. Unemployment tends to predict, at least for men, also the utilization of beds by alcoholics in internal medical wards.…”

Section: Discussionmentioning

confidence: 99%

“…Based on knowledge about the utilization behavior of psychiatric patients, it is recommended that, among the characteristics of the investigated areas, besides some service variables like the spatial availability of the existing stationary facilities [4,5], the supply of psychiatrists within a given area [5,6], and the density of the social support network, some other variables describing the social status of the inhabitants of a given city district should also be considered. Among the markers of social deprivation, unemployment has generally proved to be the best predictor for hospitalization [7,8].…”

mentioning

confidence: 99%

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Inequity in the Hospital Care of Patients with Alcoholism and Medication Addiction

Maylath

Seidel²

2000

Eur Addict Res

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In a psychiatric/ecological study, the authors investigated which aspects of a town district would provide an explanation to the fact that alcoholics are treated above average in addiction-psychiatric wards in a given city district, while in other districts treatment is carried out in internal medical wards. The research was based on data collected between 1988 and 1994 from approximately 77% of all patients suffering from alcohol and legal drug abuse (n = 15,473) in 41 hospitals in Hamburg. It was established that in somatic departments, mainly internal medicine, 70% of male and 67% of female patients were admitted for alcohol and legal drug abuse. The results of a geographical analysis of hospitalization risks showed that the addiction-psychiatric facilities of psychiatric wards are mainly utilized by inhabitants from nearby districts. Risks of above-average hospitalization for alcoholics and legal drug abusers in internal wards, as well as insufficient addiction-psychiatric care, are to be expected in town districts where a shortage of psychiatrists exists, and where the unemployment rate is high. In these crucial areas, addiction-specific facilities, such as qualified programs for detoxication or techniques for short intervention, should be established within the framework of an addiction-specific liaison service in general hospitals.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Inequity in the Hospital Care of Patients with Alcoholism and Medication Addiction

Maylath

Seidel²

2000

Eur Addict Res

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“…17,18 Various composite indices have been developed to measure geographical deprivation such as the Jarman index, the Townsend index, and Carstairs index. 1 Some of the components of these indices are unstable over time and change in their meaning, for example not owning a car may be as a result of choice rather than being unable to afford one. However, unemployment alone has been shown to be a good single predictor of deprivation.…”

Section: Social Deprivation and Mortality In Adults With Diabetes Melmentioning

confidence: 99%

“…1 Previous work has shown that unemployment is a particular problem for people with diabetes, 2,3 and in terms of health and social outcomes, this may have serious consequences. 4,5 Unemployment does not only mean loss of income but can also result in loss of social status for individuals, can affect personal attachments, and is associated with other factors such as poor diet and housing.…”

Section: Introductionmentioning

confidence: 99%

“…6 It has also been demonstrated that unemployment is a good marker of both material and social deprivation and is highly correlated with hospital admission rates. 1 The aim of this paper was to investigate the relationship between measures of deprivation and mortality in a population of adults with diabetes in eight different geographical areas in the UK, over an 8.5-9-year followup period.…”

Section: Introductionmentioning

confidence: 99%

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Social deprivation and mortality in adults with diabetes mellitus

1998

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To investigate the relationship between measures of social deprivation and mortality in adults with diabetes, data from 2104 randomly selected adults (> 16 years of age) with Type 1 and Type 2 diabetes mellitus from 8 hospital out-patient departments were analysed. A total of 38% of subjects had Type 1 (diagnosed before the age of 36 years and treated with insulin), 55% were male and 85% Caucasian. During a follow-up period (mean (SD) of 8.4 (0.9) years), 293 (14%) of the subjects died, the most commonly recorded cause of death being cardiovascular disease. Duration adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated separately for Type 1 and Type 2 subjects. The mortality rates for men were higher than for women (Type 1: OR 1.27, CI 0.61-2.62; Type 2: OR 1.79, CI 1.27-2.52); were higher for those of lower vs higher social class (Type 1: OR 1.34, CI 0.61-2.96; Type 2: OR 2.0, CI 1.41-2.85); and were higher for those who left school before 16 years of age compared to those who left school at or after 16 years of age (Type 1: OR 3.98, CI 1.96-8.06; Type 2: OR 2.86, CI 1.93-4.25). Subjects who were unemployed had a higher mortality rate than those employed at the time of the study (Type 1: OR 3.10, CI 1.67-5.79; Type 2: OR 2.88, CI 2.12-3.91) and those living in council housing had a greater mortality than those who were living in other types of housing (Type 1: OR 2.57, CI 1.35-4.91, Type 2: OR 2.76, CI 2.05-3.73). Also for both Type 1 and Type 2 subjects mortality was significantly higher in those subjects who had a least one diabetic complication at baseline and reported one or more hospital admissions in the previous year and in Type 2 subjects with poor glycaemic control. After adjusting for duration of diabetes, hospital admissions, and the presence of diabetic complications, being unemployed, male, in poor glycaemic control (Type 2 only), and less educated were significant risk factors for mortality (p<0.001). These results suggest that there are important indicators of social deprivation which predict mortality over and above diabetic health status itself. Locally targeted action will be required if these inequalities in health experienced by people with diabetes are to be reduced.

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The NHS internal market: Economic aspects of its medium‐term development

Whynes

1993

Health Planning & Management

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With the re-election of the Conservative Party in the United Kingdom in April 1992, it is now likely that the major reforms of its National Health Service as outlined in the 1989 White Paper--Working for Patients--and embodied in the 1990 National Health Service and Community Care Act will be implemented to completion. This article examines the reforms as a re-structuring of incentives facing agencies within the internal market for health care, and forecasts how agency behaviour is likely to change as a result of such re-structuring. Medium-term implications of the reforms for hospitals, general practitioners and patients are derived. A number of problems in the continued development of the internal market are anticipated.

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Unemployment rates: an alternative to the Jarman index?

Cited by 75 publications

References 12 publications

Inequity in the Hospital Care of Patients with Alcoholism and Medication Addiction

Inequity in the Hospital Care of Patients with Alcoholism and Medication Addiction

Social deprivation and mortality in adults with diabetes mellitus

The NHS internal market: Economic aspects of its medium‐term development

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