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Monitoring healthcare equity trends in England – a longitudinal small area analysis

Thursday 5 November 2015, 2.00PM to 3.15pm

Speaker(s): Richard Cookson, Professor, Centre for Health Economics, University of York

Objectives: Between 2004 and 2011 the English NHS made sustained efforts to reduce health inequalities by strengthening primary care. We provide the first comprehensive assessment of healthcare equity trends during this period, examining socioeconomic inequalities in primary care access, quality and outcomes.

Design: Whole-population small area longitudinal study.

Setting: England from 2004/5 to 2011/12.

Participants: 32,482 neighbourhoods (lower super output areas) of 1,500 people on average.

Main outcome measures: Estimated inequality gaps between the most and least deprived neighbourhoods, based on linear association with Index of Multiple Deprivation 2010 rank, for: (i) primary care supply (ii) primary care quality (iii) rate of emergency hospitalisation for chronic ambulatory care sensitive conditions and (iv) rate of mortality amenable to healthcare.

Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators but smaller proportional improvements in preventable hospitalisation and amenable mortality. Inequality gaps decreased by: 193 patients per family doctor (95% confidence interval 173 to 213), 3.29 percentage points of primary care quality (3.13 to 3.45), 0.42 preventable hospitalisations per 1,000 (0.29 to 0.55) and 0.23 amenable deaths per 1,000 (0.15 to 0.31). By 2011/12 there were slightly more family doctors relative to measured need in deprived than less deprived neighbourhoods. However, if all neighbourhoods had outcomes as good as the least deprived neighbourhood there would have been 158,396 fewer preventable hospitalisations and 37,983 fewer deaths amenable to healthcare.

Conclusions: Between 2004 and 2011 the NHS succeeded in reducing socioeconomic inequities in primary care access and quality but outcomes improved more slowly in deprived neighbourhoods. Our equity indicators could be used to monitor the NHS duty, introduced in 2012, to consider reducing inequalities in healthcare access and outcomes.

Location: ARRC Auditorium A/RC/014

Who to contact

For more information on these seminars, contact:

Adrian Villasenor
Adrian Villasenor-Lopez
Dacheng Huo
Dacheng Huo

If you are not a member of University of York staff and are interested in attending the seminar, please contact Adrian Villasenor-Lopez or Dacheng Huo so that we can ensure we have sufficient space

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