Deprivation and access to planned surgery

Fairness in access to healthcare is one of the founding principles of the NHS, yet there is some evidence that those with the greatest need are often the least likely to access medical care. We look at the relationship between treatment rate, as a proxy for access, and deprivation for selected surgical procedures.

How does the rate of NHS hip replacement operation vary by deprivation?

The chart shows the directly standardised rate of elective hip replacements per 100,000 population, adjusted for sex and age, by IMD deprivation decile. The data covers NHS funded treatment in 2012/13 and excludes privately funded treatment. Lower surgery rates can be observed in the most deprived areas, particularly in the bottom two deciles, with higher rates of treatment in the more affluent parts of the country. There is some evidence in the literature (Chaturvedi and Ben-Shlomo, 1995) that there is a higher prevalence of joint problems in more deprived areas, for example higher rates of GP consultation for osteoarthritis (the most common reason for requiring a hip replacement). The lower rates of procedures in the more deprived areas could be potentially indicative of some unmet need (and an example of the "inverse care law").

Source: 

Health & Social Care Information Centre, Hospital Episode Statistics

How has variation in the rates of hip replacements by deprivation changed over time?

The chart shows the directly standardised rate of elective hip replacements per 100,000 population, adjusted for sex and age, for years 2003/04 to 2012/13. The data is split by IMD decile. The rates of elective hip replacement have increased in all deprivation categories between 2003 and 2013, although the differences in rates between the most deprived and least deprived areas have been consistent over the data period, with the two most deprived deciles having much smaller treatment rates than the more affluent areas.

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics

How does the rate of NHS knee replacement operation vary by deprivation?

The chart shows the directly standardised rate of elective knee replacements per 100,000 population, adjusted for sex and age, by IMD deprivation decile. The data is shown for 2012/13 and excludes private treatment. Here the results are different to those observed for hip replacements, with lower knee replacement rates observed in the higher socioeconomic groups. Lower treatment rates in the less deprived areas could be associated with a greater uptake of privately funded treatment.

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics

How have the rates of knee replacements by deprivation changed over time?

The chart shows the directly standardised rate of elective knee replacements per 100,000 population, adjusted for sex and age, for years 2003/04 to 2012/13. The data is split by IMD decile. As with hip replacements, the rates of directly standardised knee replacements have increased across all deprivation deciles between 2003 and 2013, with the same differentials in treatment rate observed across deprivation categories. The least deprived decile has consistently shown the lowest knee replacement rates and could indicate that these patients are choosing to have this procedure done privately, although this cannot be shown using the available data. However the total number of NHS funded knee replacements seem to have levelled off in 2007/08.

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics

How does the rate of inguinal hernia repair vary by deprivation?

The chart shows the directly standardised rate of inguinal hernia repair per 100,000 population, adjusted for sex and age, by IMD deprivation decile. The data is shown for 2012/13 and excludes private treatment. It can be seen that there are similar rates of operations for deciles 3 to 10, with the two most deprived deciles showing lower rates of treatment than the others (although the difference is not as large as that observed for hip replacements). Some studies suggest that the need for hernia surgery is greater in more deprived areas but the finding here may suggest that patients in more deprived areas are having different patterns of treatment for these procedures than the rest of the country. Between 2003/04 and 2012/13 the rates of inguinal hernia repair fell, although the most deprived decile have consistently had lower rates of hernia repair over this period (data not shown).

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics

How does the rate of cataract operation vary by deprivation?

The chart shows the directly standardised rate of cataract surgery per 100,000 population, adjusted for sex and age, by IMD deprivation decile. The data is shown for 2012/13 and excludes private treatment. Here we see a very different pattern to the other three sets of procedures, with the highest treatment rates being observed in the most deprived areas. Studies suggest a higher prevalence of cataracts in more deprived areas, which would explain these results as the need for treatment would be higher in these areas. The differences in treatment rate between the deprivation deciles has been consistent over the last ten years (data not shown). Once again lower treatment rates in the least deprived areas may be due to people being more likely to use privately funded care.

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics

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