Some of 'the best health data in the world' has been pulled together, for the first time, in a report which clearly demonstrates the link between material deprivation and ill health in Scotland. The report reveals that deprived Scots experience greater mental health problems and have a higher incidence of coronary heart disease, stroke and many cancers.Inequalities can be seen reflected in death rates, GP consultations and admissions to hospital. Older deprived people, in particular, are also more likely to undergo investigations and surgery following heart attacks.
The report, Deprivation and Health in Scotland, was compiled by public health experts Marion Bain and Gordon McLaren from the information and statistics division of the NHS in Scotland.'The government has set a clear priority for the NHS in Scotland to tackle health inequalities and to do this information was needed on the pattern and extent of such inequalities,' says Dr Bain. `This report provides an up-to-date picture of health inequalities for the major diseases that affect people in Scotland.'It does so by putting health data alongside the Carstairs index of deprivation.Greater Glasgow health board's area stands out as having by far the largest number and proportion of people living in the highest deprivation categories. Fifty two per cent of Scots living in deprivation categories 6 and 7 (the highest) and 80 per cent of those living in deprivation category 7 live within Greater Glasgow.In mental health, the report shows an increasing risk of suicide is linked with greater deprivation, particularly among the younger age groups. 'In the 15-29 age group people from the more deprived areas had three-and-a-half times the suicide rate of those who were least deprived,' says Dr McLaren, now senior registrar in public health medicine with Fife health board.For schizophrenia, incidence rates in general practice are `markedly higher' in people from the most deprived areas, while hospital data show clear gradients in first admission ratios for depression, anxiety and schizophrenia, with the most deprived having the highest admission rates, he adds.
First hospital admission rates and deaths from heart attacks in people under 65 are higher in people from more deprived areas, but death rates from heart attacks in the over 65s show no marked link with deprivation. This may be because people with the highest risk of coronary heart disease in the most deprived areas have died before the age of 65 or that other causes of death become greater in relation to CHD, says Dr McLaren.
Around twice as many deprived Scots are admitted to hospital with heart attacks than those in less deprived areas, yet the latter are three times more likely to get an angiography (for diagnosis) and a coronary heart bypass graft. The reason for this could be that the overall ill-health of the more deprived left them unfit for such procedures or that the more affluent made better use of the NHS, Dr McLaren suggests.
He wants to see further investigation into inequalities in procedure rates, by deprivation, especially for people prior to first heart attack when the greater proportion of these procedures are carried out.For stroke, the incidence of first hospitalised stroke in the over 55s shows a clear rising gradient with deprivation and there is a two-and-a-half times greater risk of death from stroke in the under 65s in the most deprived people.But for all ages, there is no deprivation link for rates of survival 30 days after the first hospitalised stroke or for hospitalised stroke patients discharged to their own home within 56 days of a stroke.The researchers looked at four cancers - lung, breast, cervical and large bowel. They found a three-fold difference for lung cancer and cervical cancer between the most and least deprived areas, no relationship with deprivation for large bowel cancer and a 15 per cent increase in breast cancer in women in more affluent areas.But for all four cancers there was decreasing survival with increasing deprivation - a 69 per cent survival rate after five years for people in the least deprived areas compared with 59 per cent in the most deprived areas.Dr Bain and Dr McLaren also looked at the place of death of cancer patients. 'It had been suggested that people from deprived areas were less likely to die in their own homes. We wanted to look at this in view of the widely held belief that more people from all sections of society suffering from cancer would, if possible, like to die in their own homes,' says Dr McLaren.
The results reveal no significant inequalities in the odds of dying at home by deprivation category. It is a finding Dr McLaren describes as `reassuring'.
Deprivation and Health in Scotland: insights from NHS data. Available from ISD Publications, Trinity Park House, Edinburgh EH 5 3SQ. 7.50
overmatter from Deprivation
Clear indications: Carstairs and Morris
The Carstairs and Morris index of deprivation was originally developed in the 1980s using 1981 census data.
It is made up of four indicators which were judged to represent material deprivation in the population:
overcrowding (private households living at a density of more than one person per room)
social class 4 or 5
The four indicators are combined to create a composite deprivation score. The deprivation score is divided into seven categories, ranging from very high to very low. Scores have since been recalculated using 1991 census data.
The Carstairs index fails on some counts particularly in its ability to measure rural deprivation. For instance, says Dr Bain, a car may be essential in a rural area and not represent the access to material resources that it appears.