Domains Of Deprivation Research Articles

Association of deprivation and its individual domains on outcomes in people with chronic kidney disease.

Due to the high correlation of chronic kidney disease (CKD) with other comorbidities, the sole effect of CKD on deprived people is not clear. In addition, there is a paucity of evidence in the literature linking isolated domains of deprivation to outcomes. This study aimed to examine whether deprivation was associated with adverse outcomes in patients with CKD, independent of cardiometabolic morbidities. Individual domains of deprivation were also evaluated. A retrospective study of patients with non-dialysis-dependent CKD (ND-CKD) in the Salford Kidney Study to investigate the association of deprivation with outcomes. The English Indices of Deprivation was used for the comparative analysis of the five quintiles of deprivation. Two propensity score methods were used to attenuate the confounding effect of cardiometabolic morbidities between the least and the most deprived groups. People living in the least deprived areas (n=319) had a lower risk of combined outcomes (all-cause mortality and renal replacement therapy) when compared with the most deprived group (n=813) [hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.71-0.98]. The negative association of deprivation remained after matching but with mixed statistical significance when using different propensity methods (HR 0.85; 95% CI 0.70-1.03 for propensity score matching and HR 0.77; 95% CI 0.61-0.98 for inverse probability weighting). The association of combined outcomes varied across component index of multiple deprivation domains with wide CIs. However, areas with lower scores for education, income and employment were significantly associated with a higher risk. This study has identified that in people with ND-CKD, unemployment, poor educational attainment and lower household income were associated with poor outcomes. The association of deprivation with adverse outcomes persists despite adjustment for cardiometabolic morbidities.

Empirically-derived dimensions of childhood adversity and cumulative risk: associations with measures of depression, anxiety, and psychosis-spectrum psychopathology

ABSTRACT Background: Investigating different approaches to operationalizing childhood adversity and how they relate to transdiagnostic psychopathology is relevant to advance research on mechanistic processes and to inform intervention efforts. To our knowledge, previous studies have not used questionnaire and interview measures of childhood adversity to examine factor-analytic and cumulative-risk approaches in a complementary manner. Objective: The first aim of this study was to identify the dimensions underlying multiple subscales from three well-established childhood adversity measures (the Childhood Trauma Questionnaire, the Childhood Experience of Care and Abuse Interview, and the Interview for Traumatic Events in Childhood) and to create a cumulative risk index based on the resulting dimensions. The second aim of the study was to examine the childhood adversity dimensions and the cumulative risk index as predictors of measures of depression, anxiety, and psychosis-spectrum psychopathology. Method: Participants were 214 nonclinically ascertained young adults who were administered questionnaire and interview measures of depression, anxiety, psychosis-spectrum phenomena, and childhood adversity. Results: Four childhood adversity dimensions were identified that captured experiences in the domains of Intrafamilial Adversity, Deprivation, Threat, and Sexual Abuse. As hypothesized, the adversity dimensions demonstrated some specificity in their associations with psychopathology symptoms. Deprivation was uniquely associated with the negative symptom dimension of psychosis (negative schizotypy and schizoid symptoms), Intrafamilial Adversity with schizotypal symptoms, and Threat with depression, anxiety, and psychosis-spectrum symptoms. No associations were found with the Sexual Abuse dimension. Finally, the cumulative risk index was associated with all the outcome measures. Conclusions: The findings support the use of both the empirically-derived adversity dimensions and the cumulative risk index and suggest that these approaches may facilitate different research objectives. This study contributes to our understanding of the complexity of childhood adversity and its links to different expressions of psychopathology.

Measuring small-area level deprivation in Belgium: The Belgian Index of Multiple Deprivation

BackgroundIn the past, deprivation has been mostly captured through simple and univariate measures such as low income or poor educational attainment in research on health and social inequalities in Belgium. This paper presents a shift towards a more complex, multidimensional measure of deprivation at the aggregate level and describes the development of the first Belgian Indices of Multiple Deprivation (BIMDs) for the years 2001 and 2011. MethodsThe BIMDs are constructed at the level of the smallest administrative unit in Belgium, the statistical sector. They are a combination of six domains of deprivation: income, employment, education, housing, crime and health. Each domain is built on a suite of relevant indicators representing individuals that suffer from a certain deprivation in an area. The indicators are combined to create the domain deprivation scores, and these scores are then weighted to create the overall BIMDs scores. The domain and BIMDs scores can be ranked and assigned to deciles from 1 (the most deprived) to 10 (the least deprived). ResultsWe show geographical variations in the distribution of the most and least deprived statistical sectors in terms of individual domains and overall BIMDs, and we identify hotspots of deprivation. The majority of the most deprived statistical sectors are located in Wallonia, whereas most of the least deprived statistical sectors are in Flanders. ConclusionThe BIMDs offer a new tool for researches and policy makers for analyzing patterns of deprivation and identifying areas that would benefit from special initiatives and programs.

The role of socioeconomic deprivation in explaining neighborhood and clinic effects in the effectiveness of psychological interventions.

Treatment outcomes are known to vary according to therapist and clinic/organization (therapist effect, clinic effect). Outcomes may also vary according to the neighborhood where a person lives (neighborhood effect), but this has not previously been formally quantified. Evidence suggests that deprivation may contribute to explaining such cluster effects. This study aimed to (a) simultaneously quantify neighborhood, clinic, and therapist effects on intervention effectiveness and (b) determine the extent to which deprivation variables explain neighborhood and clinic effects. The study used a retrospective, observational cohort design with a high intensity psychological intervention sample (N = 617,375), and a low intensity (LI) psychological intervention sample (N = 773,675). Samples each included 55 clinics, 9,000-10,000 therapists/practitioners, and over 18,000 neighborhoods in England. Outcomes were postintervention depression and anxiety scores and clinical recovery. Deprivation variables included individual employment status, domains of neighborhood deprivation, and clinic-level mean deprivation. Data were analyzed using cross-classified multilevel models. Unadjusted neighborhood effects of 1%-2% and unadjusted clinic effects of 2%-5% were detected, with proportionally larger effects for LI interventions. After controlling for predictors, adjusted neighborhood effects of 0.0%-0.1% and clinic effects of 1%-2% remained. Deprivation variables were able to explain a significant proportion of the neighborhood effect (80%-90% of neighborhood variance) but not clinic effect. The majority of neighborhood variance could only be explained by a shared effect of baseline severity and socioeconomic deprivation variables. People in different neighborhoods respond differently to psychological intervention, and this clustering effect was mainly explained by socioeconomic factors. People also respond differently according to the clinic they access, but this could not be completely explained by deprivation in the present study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Measuring the accessibility deprivation of concentrated resettlement communities in China: An integrated approach of space syntax and multi-criteria decision analysis

China's rapid urbanization involves the large-scale relocation of rural villagers and the production of concentrated resettlement communities in urban areas. This new urban population's post-resettlement adaptation and socio-economic situations raise concerns for urban scholars and policymakers alike. This paper invokes the concept of deprivation and aims to establish indices of multiple deprivations (IMDs) for such communities. In doing so, this research use accessibility as a proxy and integrates the space syntax approach with multi-criteria decision analysis to construct the IMDs of concentrated resettlement communities in Hangzhou, China. The findings suggest that material deprivation may not be the primary concern for residential segregation of resettlement communities in urban areas. Besides, the accessibility to different services reflects diverse deprivation patterns among resettlement communities. Moreover, various stakeholder groups' perceptions of deprivation may lead to different results of the IMDs. The diverse criteria or domains of deprivation contribute differently to the deprivation, which requires a tailored treatment strategy when constructing IMDs, such as the sensitivity analysis used in this research. The proposed measurement of deprivation has important policy implications for sustainable urban development in China.

Influence of maternal socioeconomic deprivation and living environment on newborn bloodspot 25-hydroxyvitamin D levels.

Vitamin D deficiency in neonates can have life-threatening consequences, hence the knowledge of risk factors is essential. This study aimed to explore the effect of maternal socioeconomic status (SES) on newborn 25-hydroxyvitamin D (25OHD) concentrations. Over two 1-week periods (winter and summer of 2019), 3000 newborn heel prick dried blood spots (DBS) and additional data of newborns, from a regional newborn screening laboratory (52° N) in the West Midlands, UK, were gathered. Post code was replaced with lower layer super output area (LSOA). Index of Multiple Deprivation (IMD) quintiles for the corresponding LSOA was used to assess SES [quintile one (Q1): most deprived 20%, quintile five (Q5): least deprived 20%]. Each of the seven domains of deprivation were examined (income, employment, education, health, barriers to housing and services, crime and living environment). 25OHD was measured on 6mm sub-punch from DBS using quantitative liquid chromatography tandem mass spectrometry and equivalent plasma values were derived. In total 2999 (1500 summer-born, 1499 winter-born) newborn DBS (1580 males) were analysed. Summer-born newborns had significantly higher 25OHD (IQR) concentrations [49.2 (34.3; 64.8) nmol/l] than winter-born newborns [29.1 (19.8; 40.6) nmol/l, p<0.001].25OHD levels varied significantly between the different IMD quintiles in the whole (p<0.001) and summer-born cohort (p<0.001), but not in the winter-born cohort (p=0.26), whereby Q1 had the lowest 25OHD concentrations. Among the domains of deprivation, living environment had a significant influence on 25OHD levels (β=0.07, p=0.002). In this subdomain, 25OHD levels varied significantly between quintiles in the whole (p<0.001) and summer-born cohort (mean 25OHD Q1 46.45 nmol/l, Q5 54.54 nmol/l; p<0.001) but not in the winter-born cohort (mean 25OHD Q1 31.57 nmol/l, Q5 31.72 nmol/l; p=0.16). In a regression model, living environment was still significant (p=0.018), albeit less than season of birth and ethnicity. Among the seven domains of deprivation, maternal living environment had the greatest effect on newborn 25OHD levels. Whilst improved living environment positively influenced vitamin D status in the summer-born babies, winter-born had low 25OHD levels irrespective of the environment. Strategies such as enhanced supplementation and food fortification with vitamin D should be considered to overcome the non-modifiable main risk factors for vitamin D deficiency.

Disparities in the survival of endometrial cancer patients in a public healthcare system: A population-based cohort study

ObjectiveSocial determinants of health (SDH) have been shown to correlate with adverse cancer outcomes. It is unclear if their impact goes beyond behavioral risk or healthcare access. We aimed to evaluate the association of SDH with endometrial cancer outcomes in a public healthcare system. MethodsA retrospective cohort study of endometrial cancer patients diagnosed between 2009 and 2017 in Ontario, Canada. Clinical and sociodemographic variables were extracted from administrative databases. Validated multifactorial marginalization scores for domains of material deprivation, residential instability and ethnic concentration were used. Associations between marginalization and survival were evaluated using log-rank testing and Cox proportional hazards regression. Results20228 women with endometrial cancer were identified. Fewer patients in marginalized communities presented with early disease (70% vs. 76%, p < 0.001) and received surgery (89% vs. 93%, p < 0.001). Overall survival was shorter among marginalized patients (p < 0.001). On multivariable analysis adjusted for patient and disease factors, overall marginalization (HR = 1.22, 95% CI 1.03–1.08), material deprivation (HR = 1.22, 95% CI 1.10–1.35) and residential instability (HR = 1.32, 95% CI 1.19–1.46) were associated with increased risk of death (p < 0.001). ConclusionsSocioeconomic marginalization is associated with an increased risk of death in endometrial cancer patients. Targetable events in the cancer care pathway should be identified to improve health equity. FundingThis study was supported by a grant (#RD-196) from the Hamilton Health Sciences Juravinski Hospital and Cancer Center Foundation.

Socioeconomic status is not associated with unfavorable outcomes in patients with acute limb ischemia.

Whether socioeconomic status (SES) is associated with health outcomes in patients with acute limb ischemia (ALI) is largely unknown. We aimed to determine whether SES is associated with worse presentations and outcomes for patients with ALI. We performed a retrospective medical record review of patients who presented with ALI between April 2016 and October 2020 at a single tertiary care center. SES was quantified using individual variables (median household income, level of education, and employment) and a composite endpoint, the neighborhood deprivation index (NDI). The NDI is a standardized and reproducible index that uses census tract data (higher number indicates lower SES status). The NDI summarizes 8 domains of socioeconomic deprivation. ALI severity was categorized using the Rutherford classification. The association between SES and the severity of ALI at presentation and between SES and other health outcomes were analyzed using bivariate analysis of variance, independent t test, and multivariate logistic regression. During the study period, 278 patients were treated for ALI, of whom 211 had complete SES data available. The mean age was 64 years, 55% were men, and 57% were White. The Rutherford classification of disease severity was grade 1, 2a, 2b, and 3 for 6%, 54%, 32%, and 8% of patients, respectively. Patients with a low SES status per the NDI were more likely to have a history of peripheral arterial disease and chronic kidney disease at presentation. The ALI etiology (thrombotic vs embolic) was not associated with SES. No significant differences were seen between SES and the severity of ALI at presentation (p = 0.96) or the treatment modality (p = 0.80). No associations between SES and 30-day or 1-year mortality were observed (mean NDI, 0.15 vs 0.26, p = 0.58, and 0.20 vs 0.26, p = 0.71, respectively) or between SES and 30-day or 1-year limb loss (mean NDI, 0.06 vs 0.30, p = 0.18, and 0.1 vs 0.32, p = 0.17, respectively). Lower SES (higher NDI) was associated with increased 30-day readmission (mean NDI, 0.49 vs 0.15, p = 0.021). However, this association was not significant on multivariate analysis (odds ratio 1.4, 95% CI 0.9-2.1, p = 0.06). SES was not associated with the severity of ALI at patient presentation. Although SES was associated with the presence of peripheral arterial disease and chronic kidney disease at presentation, SES was not a predictor of short-term or 1-year limb loss and mortality. Overall, ALI presentation and treatment outcomes were independent of SES.

The Older Persons' Index of Multiple Deprivation: Measuring the deprivation circumstances of older populations in Aotearoa New Zealand.

Existing indices of multiple deprivation exclude indicators specifically relevant to the population aged ≥65 years. In this study we create a whole-of-population cohort of people aged ≥65 years living in private dwellings and who completed the 2013 New Zealand Census of Populations and Dwellings to create an Older Persons' Index of Multiple Deprivation (OPIMD). We combined 22 indicators representing 6 domains of deprivation (Income, Housing, Health, Assets, Connectedness and Geographic access) to establish this individual-level measure of deprivation. We used smoking data from the census to validate the OPIMD and describe the geography of the OPIMD by District Health Board, contrasting these patterns with a conventional area deprivation index. The OPIMD has the potential to inform policies concerning resource allocation for the older population. An accompanying website with an interactive atlas and an online OPIMD calculator is available for wider use of the data. Further research is required to explore associations between the OPIMD and other major health and social outcomes affecting this population.

Multimorbidity is associated with the income, education, employment and health domains of area-level deprivation in adult residents in the UK

Evidence suggests that there are social inequalities in multimorbidity, with a recent review indicating that area levels of deprivation are consistently associated with greater levels of multimorbidity. Definitions of multimorbidity, the most common of which is the co-occurrence of more than one long term condition, can include long term physical conditions, mental health conditions or both. The most commonly used measure of deprivation in England and Wales is the Index of Multiple Deprivation (IMD), an index of seven different deprivation domains. It is unclear which features of IMD may be mediating associations with multimorbidity. Thus, there may be associations because of the individual characteristics of those living in deprived areas, characteristics of the areas themselves or overlap in definitions. Data from over 25,000 participants (aged 16+) of Understanding Society (Wave 10, 1/2018–3/2020) were used to understand the most salient features of multimorbidity associated with IMD and whether physical or mental conditions are differentially associated with the seven domains of IMD. 24% of participants report multimorbidity. There is an increased prevalence of multimorbidity composed of only long-term physical conditions in the most deprived decile of deprivation (22%, 95% CI[19,25]) compared to the least deprived decile (16%, 95% CI[14,18]). Mental health symptoms but not reporting of conditions vary by decile of IMD. Associations with multimorbidity are limited to the health, income, education and employment domains of IMD. We conclude that multimorbidity represents a substantial population burden, particularly in the most deprived areas in England and Wales.

Socioeconomic Status and Clinical Stage of Patients Presenting for Treatment of Chronic Venous Disease

The association between socioeconomic status (SES) and chronic venous insufficiency has not been rigorously studied. This study aimed to determine the influence of SES on the clinical stage of patients presenting for chronic venous disease therapy. We performed a retrospective study of a prospectively collected data from the Vascular Quality Initiative Varicose Vein Registry at our tertiary referral center. Medical records of patients who underwent therapy for chronic venous disease between January 2015 and June 2019 were queried. SES was quantified using the neighborhood deprivation index (NDI), which summarizes 8 domains of socioeconomic deprivation and is based on census tract data derived from the patients' addresses at the time of the treatment. High NDI scores correspond with lower SES. The association between SES and severity of vein disease at presentation was assessed with bivariate analysis of variance and linear regression analysis. A total of 449 patients with complete SES and clinical-etiology-anatomy-pathophysiology (CEAP) class data were included in the study. The mean age was 58 years, 67% were female, and 60% were White. CEAP classes were distributed as follows C2, 22%; C3, 50%; C4, 15%; C5, 5%; and C6, 8%. Patients with lower SES (higher NDI score) tended to have a higher CEAP class at presentation (P < 0.05). SES was not associated with history of deep venous thrombosis, use of compression therapy, or venous clinical severity score. At our institution, patients with more advanced venous disease tended to belong to a lower SES group. This may reflect that patient with a lower SES have a longer time to presentation due to delay in seeking medical help for venous disease.

Socioeconomic Disparities Do Not Affect Outcomes in Acute Limb Ischemia

The association between socioeconomic status (SES) and outcome after acute limb ischemia (ALI) is largely unknown. We aimed to determine whether SES is associated with worse presentations and outcomes for patients with ALI. We performed a retrospective review of a prospectively collected database containing all patients who had presented with ALI between April 2016 and October 2020 to a tertiary care center. SES was quantified using individual variables (median household income, level of education, employment) and a composite endpoint, the neighborhood deprivation index (NDI). The NDI is a standardized and reproducible index that uses census tract data, with a higher number indicating lower SES status. The NDI summarizes eight domains of socioeconomic deprivation. ALI severity was categorized using the Rutherford classification. The associations between SES and the severity of ALI at presentation and between SES and the outcomes were analyzed using bivariate analysis of variance, an independent t test, and multivariate logistic regression, as appropriate. During the study period, 278 patients were treated for ALI, of whom 211 had complete SES data available. Their mean age was 64 years; 55% were men and 57% were white. The Rutherford classification of disease severity was grade 1, 2a, 2b, and 3 for 6%, 54%, 32%, and 8%, respectively. Patients with a low SES status using the NDI were more likely to have a history of peripheral arterial disease and chronic kidney disease at presentation (Table). The etiology (thrombotic vs embolic) was not associated with SES. No significant differences were seen between SES and the severity of ALI at presentation (P = .96) or the treatment modality (P = .80). We found no association between SES and either 30-day or 1-year limb loss or mortality (Table). Lower SES (higher NDI) was associated with increased 30-day readmissions (P = .021). This association persisted on multivariate analysis (P = .023). SES was not associated with the severity of ALI at presentation. Although SES was associated with the presence of peripheral arterial disease and chronic kidney disease at presentation and higher readmission rates for patients with ALI, SES was not a predictor of short-term or 1-year limb loss or mortality. In the present study, ALI presentation and treatment outcome were independent of SES.TableDifference in mean NDI stratified by comorbidity, disease severity at presentation, and outcomeVariableNDIP valueBaseline characteristic Diabetes.19 No0.19 ± 0.91 Yes0.36 ± 1.00 HTN.06 No0.033 ± 0.92 Yes0.32 ± 0.95 CAD.36 No0.21 ± 0.91 Yes0.33 ± 1.00 PAD.01 No0.074 ± 0.85 Yes0.39 ± 0.99 HLD.06 No0.36 ± 1.01 Yes0.14 ± 0.86 CHF.40 No0.22 ± 0.96 Yes0.34 ± 0.91 CKD.04 No0.17 ± 0.91 Yes0.49 ± 1.01 Cancer.70 No0.27 ± 0.94 Yes0.19 ± 1.03Smoker.72 Never0.17 ± 0.93 Previous0.31 ± 0.99 Current0.22 ± 0.91Rutherford class.96 10.37 ± 0.75 2a0.23 ± 0.96 2b0.27 ± 0.99 30.30 ± 0.94Etiology.43 Embolic0.32 ± 0.98 Thrombotic0.19 ± 0.95Intervention.80 Endovascular0.23 ± 0.78 Open0.19 ± 0.91 Primary amputation0.31 ± 1.01 Medical treatment0.42 ± 0.93Outcome 30-Day readmission.02 No0.15 ± 0.90 Yes0.49 ± 1.06 30-Day limb loss.18 No0.30 ± 0.96 Yes0.06 ± 0.97 1-Year limb loss.17 No0.32 ± 0.98 Yes0.10 ± 0.97 30-Day mortality.58 No0.26 ± 0.96 Yes0.15 ± 0.88 1-Year mortality.71 No0.26 ± 0.96 Yes0.20 ± 0.94CAD, Coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; HLD, hyperlipidemia; HTN, hypertension; NDI, neighborhood deprivation index.Data presented as mean ± standard deviation. Open table in a new tab

Construction of an area deprivation index for 2869 counties in China: a census-based approach

BackgroundA paucity of data has made it challenging to construct a deprivation index at the lowest administrative, or county, level in China. An index is required to guide health equity...

A Measure of Child Exposure to Household Material Deprivation: Empirical Evidence from the Portuguese Eu-Silc

Although monitoring and evaluating child poverty has been recognized as important, there is little statistical information focused on children. Because the annual EU-Statistics on Income and Living Conditions (EU-SILC) survey does not include child-specific information on an annual basis, this study proposes a measure of child exposure to household material deprivation based on this dataset. The study considers four domains of deprivation that have a direct impact on child development: housing conditions, household financial capacity, household durable goods, and environmental living conditions. Although developing a child-centered measurement of child deprivation is important, the EU-SILC considers the household as the unit of measurement. Therefore, our proposal is household-based, allowing annual monitoring of children’s exposure to deprivation—an important insight for social policy purposes to tackle the problem of child poverty. Using the 2017 Portuguese sample, we applied graded response models to assess the psychometric properties of the EU-SILC items and fit separate indexes per domain and the composite index. Item selection was based on their characteristic curves and information functions. The results allow for the selection of more informative items for every domain to obtain the composite index. In general, the empirical analysis confirmed the theoretical approach for item selection. The methodology may be directly applied to the full EU dataset or to each country individually.

Neighbourhood deprivation and child behaviour across childhood and adolescence

Children living in deprived areas tend to show greater problem behaviour relative to children in more advantaged areas. We explored the effect of different forms of area deprivation (such as income, education and health) on the development of child problem behaviour (emotional and behavioural problems) from early childhood to middle adolescence. Using data from the Millennium Cohort Study, we modelled trajectories of child problem behaviour depending on the level of deprivation in the neighbourhood, across ages 3 to 14 years, in England (n = 6,127). We explored seven types of social, economic and environmental deprivation in small standard areas, using the Index of Multiple Deprivation. Child problem behaviour was measured with the Strengths and Difficulties Questionnaire. Most types of deprivation were moderately predictive of child problem behaviour at around age eight (where we set the intercept), when explored in separate models, even after adjustments to reduce area selection bias. However, they were not related to longitudinal changes in problem behaviour. Socio-economic aspects of area deprivation – education, income and employment – were most consistently related to child problem behaviour – and were robust to adjustments for other domains of area deprivation including crime and living environment.

Using hierarchical clustering to explore patterns of deprivation among English local authorities.

The English Indices of Multiple Deprivation (IMD) is widely used as a measure of deprivation. However, similarly ranked areas can differ substantially in the underlying domains of deprivation. These domains contain a richer set of data that might be useful for classifying local authorities. Clustering methods offer a set of techniques to identify groups of areas with similar patterns of deprivation. Hierarchical agglomerative (i.e. bottom-up) clustering methods were applied to domain scores for 152 upper tier local authorities. Advances in statistical testing allow clusters to be identified that are unlikely to have arisen from random partitioning of a homogeneous group. The resulting clusters are described in terms of their subdomain scores and basic geographic and demographic characteristics. Five statistically significant clusters of local authorities were identified. These clusters only partially reflect different levels of overall deprivation. In particular, two clusters share similar overall IMD scores but have contrasting patterns of deprivation. Hierarchical clustering methods identify five distinct clusters that do not correspond closely to quintiles of deprivation. This approach may help to distinguish between places that face similar underlying challenges, and places that appear similar in terms of overall deprivation scores, but that face different challenges.

P6134Understanding non-attendance to an inner city tertiary centre heart failure clinic: a pilot project

Abstract Background Tackling health inequalities is a priority in heart failure (HF). We do not fully understand why some patients do not attend their hospital HF clinic appointments. Currently when a patient DNAs (does not attend) they are offered a repeat appointment often months later or are discharged from the service with a request to the primary care physician to re-refer. Non-attendance represents a missed opportunity to improve patients' health. Purpose The purpose of this pilot was to look at the demographics and patient factors that contribute to non-attendance. The aim is to understand and personalise our DNA policy to reduce health inequality, improve outcomes, and reduce inefficiencies in our service. Methods The last consecutive 45 patients who DNAd HF clinic were identified and for each, a patient who did attend the same clinic date (Attender), was chosen at random (random.org). The demographics were obtained (age, ethnicity, contact details) and medical notes reviewed (LVEF%, co-morbidities). The patient address was scored for its Index of Multiple Deprivation (IMD) – a UK government dataset measuring relative deprivation by ranking 32,844 neighbourhoods nationally using 37 indicators across 7 domains of deprivation where neighbourhood 1 is the most deprived nationally. Patients were phoned up to three times to establish the patient's mode, duration and cost of their last journey to clinic and, for those patients who DNAd, to ascertain the reason for non-attendance. Results Demographic and medical history was obtained for all patients. It was not possible to contact 2/45 of the Attenders, and 13/45 of the DNA patients. There was no significant difference in age, gender, number of comorbidities, LVEF%, travel time, or travel cost between DNAs and attenders. The mean one-way journey time was 53.4 mins (range 15–210 mins) and the mean return journey cost was GBP ≤10.95 (range ≤0–≤80). Common reasons for non-attendance were not receiving appointment details, forgetting appointments, being unwell on the day and difficulties with travel. The IMD score for the patients who DNAd was significantly lower confirming these patients lived in more deprived areas (9436±5863 vs. 15414±7801, p&lt;0.001) with 71% of DNA patient's addresses in the bottom third most deprived neighbourhoods nationally. Figure 1 Conclusions There was a significant difference in deprivation score between patients who attended and DNAd their clinics. In addition, we found that all patients were travelling up to an hour each way to attend clinic, and that the cost of travel may be a barrier to attendance, even in a healthcare system that is free at the point of delivery. Despite calling three times, we were unable to speak to 29% of patients who DNAd and 4% of the patients who attended their appointments. Work is ongoing to reduce our DNA rates and personalise our response in this deprived population, with the aim of improving engagement and health inequality.

Adverse impact of neighbourhood socioeconomic deprivation on psychological treatment outcomes: the role of area-level income and crime

Aim: Socioeconomic deprivation is known to be associated with depression and anxiety symptoms. This study aimed to investigate the influence of several domains of neighbourhood deprivation on psychological treatment outcomes. Method: Healthcare records from 44805 patients who accessed psychological treatment were analyzed. Patient-level depression (PHQ-9) and anxiety (GAD-7) outcome measures were linked to their neighbourhood statistics, including area-level indices of income, unemployment, education, health and disability, crime, housing quality, and quality of the local environment. Linear regressions were applied to examine associations between these domains and post-treatment symptom severity after controlling for patient-level and service-level variables. Results: Neighbourhood income and crime rates were associated with depression and anxiety symptoms after controlling for covariates, explaining 4% to 5% of variability in treatment outcomes. Patients living in low-income areas required a higher number of treatment sessions to benefit from therapy. Conclusions: Patients living in economically deprived neighbourhoods tend to have poorer depression and anxiety treatment outcomes and require lengthier interventions.

Different domains of deprivation and their relationship with obesity in New Zealand 4-year-old children.

There is a relationship between childhood obesity and area-level deprivation. While the New Zealand Index of Deprivation (NZDep) has been used widely in research for the past 20years, the Index of Multiple Deprivation (IMD) was released in 2017. This study aims to investigate the association between deprivation and childhood obesity in New Zealand and compare measures of deprivation. Data from 316794 4-year-olds in New Zealand undertaking the B4 School Check in 2010 to 2016, a national health and development screen, were analysed. Multilevel logistic regression models assessed the relationship between area-level deprivation and individual-level child obesity. Models were adjusted for age, sex, immigration status, ethnicity, and year. Deprivation was measured using the census-based NZDep2013 (deciles) and the administrative data-based IMD (deciles). The seven domains of the IMD were also considered. The relationship between deprivation and obesity was very similar for the IMD and NZDep2013, point estimates were near identical, and confidence intervals overlapped substantially. Higher levels of deprivation were associated with a higher prevalence of child obesity. The relationship between deprivation and child obesity varied considerably across IMD domains. The education domain had the strongest association with child obesity and had an association with child obesity independent of the other domains of deprivation. Overall, there was little difference between the NZDep and IMD. However, the IMD's domains and IMD-1 approach reveal more nuanced understandings of the deprivation-obesity gradient, including the importance of area-level education deprivation for predicting child obesity rates.

Corrigendum to: Whānau Māori explain how the Harti Hauora Tool assists with better access to health services.

In this paper, whānau Māori highlight how a Kaupapa Māori-centred intervention (the Harti Hauora Tamariki tool, hereafter Harti tool) has improved interactions with health services. The Harti tool is undergoing a randomised control trial (RCT) at Waikato Hospital in New Zealand. As part of the RCT, the authors engaged in a series of qualitative interviews with whānau members of tamariki Māori (children aged 0-5 years) admitted to Waikato Hospital's paediatric ward. Whānau who met at least one criteria for New Zealand's domains of deprivation were included. Using a Kaupapa Māori approach to the study, participants shared their views on barriers and facilitators to accessing health resources and primary care services. The interviews conducted highlight how the Harti tool, when administered in a culturally appropriate and respectful manner that prioritised relationship-building, enabled better connection to healthcare services. Prevalent in our analysis were connections to wider determinants of health and ways to reduce existing health inequities. To conclude the paper, how the Harti tool has enhanced feelings of being in control of health, with the potential to reduce the likelihood of a hospital readmission, is highlighted.