joint strategic needs assessment foundation profile - JSNA

Interative Hull Atlas: www.hullpublichealth.org/Pages/hull_atlas.htm More information: www.jsnaonline.org and www.hullpublichealth.org
10.1.2.7 Inpatient Admissions and Treatment in Relation to Deprivation
Figure 188 illustrates the average annual directly age-standardised daycase and
inpatient admission rates which involve a primary diagnosis of CHD (any clinician
episode within that hospital stay) by local deprivation quintile over three financial years
2007/08 to 2009/10 (standardised to Hull‟s 2009 population). Figure 189 gives the
equivalent information for angiography and revascularisation. The 95% confidence
intervals are shown. There is a statistically significant difference in the rates among the
quintiles for admissions, investigation and treatment. The underlying data for both of
these figures is given in the APPENDIX on page 906.
As expected, given the higher prevalence of lifestyle and behavioural risk factors, people
living in the most deprived areas have a higher hospital admission rate for CHD as well as
a higher rate of investigation and treatment. However, it is difficult to ascertain if this
pattern is reflecting „need‟. It could be that the gradient between the most and least
deprived quintiles should be steeper or less steep than the gradient observed. However,
compared to the least deprived local quintile, the CHD admission rate is 57% higher in the
most deprived local quintile compared to the least deprived quintile, and 51% for
angiography and 42% for revascularisation. This may suggest the presence of some
inequalities. It is possible that patients in the most deprived quintile are not having
revascularisation as readily as people in the least deprived quintile based on the same
need, or that people in the least deprived areas are having angiography unnecessarily (as
the pattern of angiography and revascularisation differs over the deprivation quintiles).
There could be many reasons why this is the case, for example, people in the most
deprived quintiles may be less demanding in terms of obtaining investigation and
treatment, and may be less likely to visit their GP with their symptoms. They may also be
more likely to be admitted as an inpatient as an emergency case.
Figure 188: Age-gender standardised CHD annual daycase and inpatient admission rate
per 100,000 population for all ages by local deprivation quintile for Hull
Joint Strategic Needs Assessment Foundation Profile – Hull Health Profile: Release 3. March 2011. 460