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combined, those in the most deprived national quintile have a higher inpatient admission
rate compared to those in the least deprived national quintile.
It is not possible to examine cancer mortality rates for most types of cancer as the
number of deaths is too small. For those cancers where it is possible, there is strong
evidence of an association between deprivation and mortality for all cancers, lung
cancer, all cancers excluding lung cancer, and colorectal cancer. There is no evidence
locally of an association between deprivation and breast cancer mortality.
For specific types of cancer, one would expect that the incidence would be related to
mortality through survival, and if no inequalities were present one would expect that the
relationship would be relatively constant over the different deprivation quintiles. The
relationship is relatively constant for lung cancer as the mortality rate is high regardless
of deprivation group. However, for most other types of cancer there appears to be
inequity present as there is a higher mortality rate relative to the incidence rate for the
most deprived quintiles compared to the least deprived quintiles. This is the case for all
cancers combined, colorectal cancer, breast cancer and prostate cancer. Again, it is not
possible to examine incidence relative to mortality for the majority of cancer types due to
the small number of deaths. It is not know why there is a difference in the incidence to
mortality ratio across the deprivation quintiles, and whether this reflects excess mortality
in the most deprived group relative to incidence or under-diagnosis in the most deprived
groups (a similar figure has been reproduced but using more up-to-date information; see
Figure 208). It is likely that there are many complex reasons for this difference, and the
reasons may include differences in risk factors, stage at diagnosis, co-morbidity,
treatment options, type of cancer, survival or other factors.
10.2.1.10 Diagnosed Prevalence in Relation to Deprivation
It is possible to assign a deprivation score to each general practice using the Index of
Multiple Deprivation 2007 score assigned to each patient (based on their postcode) and
calculate the mean IMD 2007 score for each practice (i.e. weighted by patient
population). Table 241 shows the prevalence of diagnosed cancer on the practice
disease registers for 2009/10; grouping the practices into five groups. Figure 204
shows the practice IMD 2007 scores and the prevalence of diagnosed cancer for each
practice. It can be seen from the figure that there is an association between the
diagnosed prevalence of cancer and deprivation measured at practice level (p=0.034).
However, the relationship is the reverse to what might be expected with a lower
prevalence in more deprived areas. Furthermore, among the quintiles the relationship is
not consistent with the most deprived quintile having a higher prevalence compared to
the second least deprived and middle deprivation categories. One would expect that
cancer was more prevalent in the more deprived groups. There are a number of
possible reasons why there is a lack of a relationship such as survival rates are lower in
the more deprived groups which could be related to the type of cancers (such as lung
cancer being more prevalent with its low survival rate), poor recording in relation to
cancer for certain types of patients or within certain practices which could mean that the
patients are not included on the register or that people are not removed from the register
Joint Strategic Needs Assessment Foundation Profile – Hull Health Profile: Release 3. March 2011. 524