Evaluating effects of recent changes in NHS resource allocation policy on inequalities in amenable mortality in England, 2007–2014: time-series analysis

Currie, Jonny; Castillo, M Guzman; Adekanmbi, Victor; Barr, Ben; O’Flaherty, Martı́n

doi:10.1136/jech-2018-211141

Cited by 19 publications

(14 citation statements)

References 24 publications

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“…In a context of an increasing shortage of resources in both primary and secondary care sectors [ 67 ], the COVID-19 pandemic has exacerbated the inequalities [ 68 , 69 ]. It also emphasised that the suboptimal distribution of resources between areas according to their deprivation level [ 70 , 71 ] is likely to play an important role in the inequalities in accessing optimal healthcare [ 72 ] and, ultimately, in cancer outcomes [ 73 ]. The inequities component should be systematically and carefully considered in any policies aiming at improving cancer outcomes (including for earlier detection or new treatment) before their implementation in order to reduce these inequalities or even avoid further widening.…”

Section: Discussionmentioning

confidence: 99%

Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost?

et al. 2022

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Background We aimed to investigate the impact of socio-economic inequalities in cancer survival in England on the Number of Life-Years Lost (NLYL) due to cancer. Methods We analysed 1.2 million patients diagnosed with one of the 23 most common cancers (92.3% of all incident cancers in England) between 2010 and 2014. Socio-economic deprivation of patients was based on the income domain of the English Index of Deprivation. We estimated the NLYL due to cancer within 3 years since diagnosis for each cancer and stratified by sex, age and deprivation, using a non-parametric approach. The relative survival framework enables us to disentangle death from cancer and death from other causes without the information on the cause of death. Results The largest socio-economic inequalities were seen mostly in adults <45 years with poor-prognosis cancers. In this age group, the most deprived patients with lung, pancreatic and oesophageal cancer lost up to 6 additional months within 3 years since diagnosis than the least deprived. For most moderate/good prognosis cancers, the socio-economic inequalities widened with age. Conclusions More deprived patients and particularly the young with more lethal cancers, lose systematically more life-years than the less deprived. To reduce these inequalities, cancer policies should systematically encompass the inequities component.

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Section: Discussionmentioning

confidence: 99%

Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost?

et al. 2022

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“…These laudable aims have been tempered by the global macroeconomic situation. Health investment in the UK since 2010 has increased at lower rates than previously, with proportionally less being allocated to deprived areas [30].…”

Section: Introductionmentioning

confidence: 99%

Disparities in glycaemic control, monitoring, and treatment of type 2 diabetes in England: A retrospective cohort analysis

et al. 2019

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BackgroundDisparities in type 2 diabetes (T2D) care provision and clinical outcomes have been reported in the last 2 decades in the UK. Since then, a number of initiatives have attempted to address this imbalance. The aim was to evaluate contemporary data as to whether disparities exist in glycaemic control, monitoring, and prescribing in people with T2D.Methods and findingsA T2D cohort was identified from the Royal College of General Practitioners Research and Surveillance Centre dataset: a nationally representative sample of 164 primary care practices (general practices) across England. Diabetes healthcare provision and glucose-lowering medication use between 1 January 2012 and 31 December 2016 were studied. Healthcare provision included annual HbA1c, renal function (estimated glomerular filtration rate [eGFR]), blood pressure (BP), retinopathy, and neuropathy testing. Variables potentially associated with disparity outcomes were assessed using mixed effects logistic and linear regression, adjusted for age, sex, ethnicity, and socioeconomic status (SES) using the Index of Multiple Deprivation (IMD), and nested using random effects within general practices. Ethnicity was defined using the Office for National Statistics ethnicity categories: White, Mixed, Asian, Black, and Other (including Arab people and other groups not classified elsewhere). From the primary care adult population (n = 1,238,909), we identified a cohort of 84,452 (5.29%) adults with T2D. The mean age of people with T2D in the included cohort at 31 December 2016 was 68.7 ± 12.6 years; 21,656 (43.9%) were female. The mean body mass index was 30.7 ± SD 6.4 kg/m2. The most deprived groups (IMD quintiles 1 and 2) showed poorer HbA1c than the least deprived (IMD quintile 5). People of Black ethnicity had worse HbA1c than those of White ethnicity. Asian individuals were less likely than White individuals to be prescribed insulin (odds ratio [OR] 0.86, 95% CI 0.79–0.95; p < 0.01), sodium-glucose cotransporter-2 (SGLT2) inhibitors (OR 0.68, 95% CI 0.58–0.79; p < 0.001), and glucagon-like peptide-1 (GLP-1) agonists (OR 0.37, 95% CI 0.31–0.44; p < 0.001). Black individuals were less likely than White individuals to be prescribed SGLT2 inhibitors (OR 0.50, 95% CI 0.39–0.65; p < 0.001) and GLP-1 agonists (OR 0.45, 95% CI 0.35–0.57; p < 0.001). Individuals in IMD quintile 5 were more likely than those in the other IMD quintiles to have annual testing for HbA1c, BP, eGFR, retinopathy, and neuropathy. Black individuals were less likely than White individuals to have annual testing for HbA1c (OR 0.89, 95% CI 0.79–0.99; p = 0.04) and retinopathy (OR 0.82, 95% CI 0.70–0.96; p = 0.011). Asian individuals were more likely than White individuals to have monitoring for HbA1c (OR 1.10, 95% CI 1.01–1.20; p = 0.023) and eGFR (OR 1.09, 95% CI 1.00–1.19; p = 0.048), but less likely for retinopathy (OR 0.88, 95% CI 0.79–0.97; p = 0.01) and neuropathy (OR 0.88, 95% CI 0.80–0.97; p = 0.01). The study is limited by the nature of being observational and defined using retrospect...

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“…Currie et al. (2018) shows that an increase in funding to the most deprived areas was associated with reductions in amenable mortality among men [38] . A Health in all Policies approach is needed to take seriously the potential impact that such changes in spending could have on health outcomes and to provide evidence on the trade-offs involved.…”

Section: Discussionmentioning

confidence: 99%

Age specific trends in mortality disparities by socio-economic deprivation in small geographical areas of England, 2002-2018: A retrospective registry study

Kraftman

Hardelid

Banks

2021

The Lancet Regional Health - Europe

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Summary Background Disparities in mortality rates according to socioeconomic position (SEP) have been rising in England. We describe the association between recent changes in socioeconomic inequality and trends in mortality disparities for different age and sex groups at small-area level in England. Methods Vital registration data from the Office for National Statistics on resident population size and number of deaths in each Lower Super Output Area (LSOA) in England from 2002 to 2018 were stratified by sex and 5-year age group. We grouped LSOA into ventiles of the Index of Multiple Deprivation (IMD), our indicator of SEP. We examined time trends in smoothed mortality rates, using 3 year moving averages for the period 2003-2017, by age across the IMD distribution. We measured mortality inequalities using the ratio of mortality rates between different deprivation groups. We calculated mortality rate ratios between the most and the least deprived 10% of areas (Total Inequality) and between the median and least deprived (Lower Inequality) 10% of areas by year, gender and age group, to examine where in the distribution of deprivation trends in mortality inequality arose. Findings Among <1 year olds, the inequality in mortality rates between the poorest 10% of LSOAs and the richest 10% of LSOAs fell between 2003 and 2017 by 22•7% for men and 22•8% for women. The largest inequalities were observed among 40 to 54 year olds. This inequality increased over the study period – from 3•2 times higher mortality rates for men in the most as opposed to the least deprived 10% of LSOAs in 2003 to 3•3 times in 2017. The rise was from 2•4 to 2•6 for women. Age groups ≥65 years, who experience the highest mortality risk, had low but rising inequality. Men and women aged 65 to 79 living in the most deprived LSOAs had a mortality rate 1•9 times higher than the least deprived in 2003 but this had increased to 2•2 times higher for women and 2•3 times higher for men by 2017. This was due to rising inequality in both halves of the distribution – between the top 10% of LSOA and the middle, and between the middle and the bottom 10% of LSOA. Interpretation Overall mortality inequality rose in England but there were substantial differences in the trends for specific age and sex groups. Infant and child mortality inequality fell. At older ages, mortality inequality rose across cohorts, although in different ways, as each cohort's exposure to life-course to labour market inequality has differed. Policy goals of reducing mortality inequality will be best met by a focus on the risk factors that are specific to particular age and deprivation groups. Funding Economic and Social Research Council, through the ESRC Centre for the Microeconomic Analysis of Public Policy at the IFS. We gratefully acknowledge the support of the Nuffield Foundation, grant reference WEL/43603. The project has been funded by the Nuff...

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Evaluating effects of recent changes in NHS resource allocation policy on inequalities in amenable mortality in England, 2007–2014: time-series analysis

Cited by 19 publications

References 24 publications

Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost?

Socio-economic inequalities in cancer survival: how do they translate into Number of Life-Years Lost?

Disparities in glycaemic control, monitoring, and treatment of type 2 diabetes in England: A retrospective cohort analysis

Age specific trends in mortality disparities by socio-economic deprivation in small geographical areas of England, 2002-2018: A retrospective registry study

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