Inequalities In Need Research Articles

Geographic inequalities in need and provision of social prescribing link workers a retrospective study in primary care.

Long-term health conditions are major challenges for care systems. Social prescribing link workers have been introduced via primary care networks (PCNs) across England since 2019 to address the wider determinants of health by connecting individuals to activities, groups, or services within their local community. To assess whether the rollout of social prescribing link workers was in areas with the highest need. A retrospective study of social prescribing link workers in England from 2019 to 2023. Workforce, population, survey, and area-level data at the PCN-level from April 2020 to October 2023 were combined. Population need before the rollout of link workers was measured using reported lack of support from local services in the 2019 General Practice Patient Survey. To assess if rollout reflected need, linear regression was used to relate provision of link workers (measured by full-time equivalent [FTE] per 10 000 patients) in each quarter to population need for support. Populations in urban, more deprived areas and with higher proportions of people from minority ethnic groups had the highest reported lack of support. Geographically these were in the North West and London. Initially, there was no association between need and provision; then from July 2022, this became negative and significant. By October 2023, a 10-percentage point higher need for support was associated with a 0.035 (95% confidence interval = -0.634 to -0.066) lower FTE per 10 000 patients. Rollout of link workers has not been sufficiently targeted at areas with the highest need. Future deployments should be targeted at those areas.

Demographic and social inequalities in need for orthodontic treatment among schoolchildren in Lithuania

The present study, which focused on Lithuanian 11-15-year-old schoolchildren, was aimed to describe the frequency of orthodontic anomalies in terms of self-reported complaints about malposed teeth and malocclusion and self-reported use of orthodontic appliances (removable or braces) across different sociodemographic strata. The study population comprised 5632 schoolchildren surveyed in the 2005-2006 school year according to the WHO collaborative cross-national HBSC study in Lithuania. Almost half (47.5%) of schoolchildren reported orthodontic complaints. Therefore, only 15.8% of total population or 27.0% of schoolchildren who had orthodontic complaints reported wearing orthodontic appliances. Several municipalities of Lithuania with a high prevalence of orthodontic problems among schoolchildren were identified. Orthodontic problems were more prevalent among girls than boys. The prevalence of orthodontic complaints was not associated with social factors, while the use of orthodontic appliances was significantly related to social determinants. Children from rural areas were 2.44 times less likely of wearing orthodontic appliances than those living in cities, and children from families with low affluence were 2.33 times less likely of wearing orthodontic appliances than children from high-affluence families. There is a considerable variation and high social inequalities in need of orthodontic treatment among schoolchildren across different municipalities in Lithuania.

Modeling the need for hip and knee replacement surgery. Part 1. A two‐stage cross‐cohort approach

To explore inequalities in the need for hip/knee replacement surgery using a 2-stage cross-cohort approach. In the first stage, a small-area population-based survey, the Somerset and Avon Survey of Health, was used to provide a high-quality measure of need for hip/knee replacement using the New Zealand (NZ) score. Receiver operating characteristic curve analyses were used to validate a simplified NZ score, excluding information from clinical examination. In the second stage, a nationally representative population-based survey, the English Longitudinal Study of Ageing, was used to explore inequalities in need for hip/knee replacement using the simplified NZ score. Multilevel Poisson regression modeling was used to estimate rates of need for surgery. Exposures considered were age, sex, social class, ethnicity, obesity, Index of Multiple Deprivation 2004 deprivation quintiles, rurality, and ethnic mix of area. Rates of need for hip/knee replacement increase with age and are lower in men than in women (rate ratio [RR] 0.7, 95% confidence interval [95% CI] 0.6-0.9 for hips; RR 0.8, 95% CI 0.7-1.0 for knees). Those of lowest social class have greater need. Need was greatest for people living in more deprived areas. Individual ethnic group did not predict the need for surgery. For hip replacement, there was no rurality effect; for knee replacement, those in town and fringe areas had greater need. Obesity was a strong predictor of need for surgery (RR 2.3, 95% CI 1.9-2.8 for hips; RR 2.4, 95% CI 2.0-2.8 for knees). This study provides evidence of greater variations of inequalities in need for hip/knee replacement than previous studies. Further research should explore geographic variation and produce small-area estimates of need to inform local health planning. It is important to complement data on need with willingness to undergo surgery.

Socioeconomic inequalities in neonatal intensive care admission rates

Objective:To examine socioeconomic inequalities in neonatal intensive care (NIC) admissions relating to preterm birth, intrauterine growth restriction (IUGR), multiple births and other conditions.Methods:Retrospective review of all NIC admissions from 1996...

Geography and mental health: a review.

In our current health care context, characterized by fiscal restraint and decentralization of accountability for health to regional authorities, geographic inequities in need, access to care, utilization, and health outcomes will come under increasing scrutiny. Knowledge gained from ecological studies about geographic disparities in mental health are likely to have important implications for policy, program planning, and resource allocations. In light of the growing relevance of the geography of mental health, this paper will review (1) selected contributions of geographic studies to the field of mental health, (2) common ecologic study approaches used in most geographic studies, (3) key conceptual and methodological challenges related to the application and interpretation of ecologic models in mental health, and (4) the wider potential of this technique for resource equity. Given the importance of geography for needs assessment and service planning, it is surprising that geographic study designs, which use ecological data, have not received greater attention as an important and viable method of assessing population mental health.