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
inpatient admission rate and mortality rates appear to be considerably higher relative to
the prevalence rate for the most deprived areas compared to the least deprived areas.
Within the Diabetes Equity Audit conducted for Hull and East Riding of Yorkshire, a
similar pattern was observed (Table 280). In addition, mortality with a secondary cause
of death as diabetes was examined. The information presented is not the latest
available information as the equity audit was completed during 2007/2008.
Furthermore, the equity audit covered Hull and East Riding of Yorkshire so the
prevalence, hospital admissions and resident mortality rates are presented in relation to
national deprivation quintiles, and as the mortality rates where diabetes was a (primary
or) secondary cause of death are only available for Hull GPs, the final two columns are
presented in relation to local Hull deprivation quintiles. As the prevalence, hospital
admission rates and mortality rates are all provided using different scales, e.g.
percentages and rates per 100,000 population, an index is provided which relates all
other deprivation quintiles to the most deprived quintile which has a fixed index of 100.
Thus, where the index is higher than 100 it implies that the figure is higher than the most
deprived quintile group. It can be seen that the prevalence on the GP registers and the
modelled prevalence based on the population as at October 2006 are both higher for the
second most deprived and middle quintile groups and for the second least deprived
quintile group for the register prevalence compared to the most deprive quintile (as the
index is higher than 100). However, the inpatient and daycase admission rate and the
mortality rates for the most deprived quintile is the highest and the relationship between
deprivation quintile and both inpatient admissions and mortality is relatively strong. This
suggests that: (i) there is inequalities present such that for the same level of „need‟ (as
defined by the prevalence), there is a much higher inpatient admission rate and a higher
mortality rate; and/or (ii) the prevalence on the GP registers and the modelled
prevalence do not accurately reflect the actual prevalence or „need‟, in that there are
more patients with undiagnosed diabetes in the more deprived quintile and the model
may be a poor fit for more deprived areas (see Diabetes Equity Audit for more
discussion and section 10.3.2 on page 564 above for briefer discussion of this point). It
is likely that both of these points are reasons for the discrepancy between prevalence,
inpatient admissions and mortality. People living in the most deprived areas will be
more likely to have additional co-morbidities and risk factors (such as smoking) which
will increase their risk of hospital admission and mortality. There was also a suggestion
that general practices in the most deprived areas tended to have higher rates of
undiagnosed diabetes. The Diabetes Equity Audit report is available at
www.hullpublichealth.org.
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