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Rural/urban differences in the association between deprivation and healthcare utilisation

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  • Gilthorpe, Mark S.
  • Wilson, Richard C.

Abstract

Whilst associations between inequalities in healthcare utilisation and socio-economic deprivation are well established in the UK it is argued that deprivation indices, such as the Townsend index, remain insensitive to rural/urban differences. This study examines how Townsend and its components differ in their association with healthcare utilisation across the rural/urban spectrum of a large health region. Our research was carried out in the West Midlands National Health Service region (population 5.3 million), comprising of a similar geographical population diversity to that of the United Kingdom (UK) using Hospital Episode Statistics (1994/5-1998/9) and 1991 census socio-demographic data. Retrospective multilevel multivariate models compare three ward-level healthcare utilisation measures (standardised episode-, admission-, and bed-rates) in relation to the Townsend index of material deprivation, its components, and four rural/urban characteristics (population density, population potential, electoral ward area and perimeter size). The associations between outcomes and Townsend were generally not attenuated by the rural/urban characteristics. The constituent component of car-ownership was similarly unperturbed, whereas population potential significantly perturbed the home-ownership model and overcrowding was significantly perturbed by all four rural/urban characteristics considered. A deprivation index may encapsulate different meanings to that of its components when used to assess variations in healthcare utilisation. Constituent components may yield considerable perturbation in relation to healthcare utilisation across the rural/urban spectrum, whilst the composite measure does not. In particular, and contrary to anecdotal opinion, car-ownership and unemployment (as recorded in the 1991 UK census) exhibited a stable relationship across different rural/urban areas with respect to healthcare utilisation.

Suggested Citation

  • Gilthorpe, Mark S. & Wilson, Richard C., 2003. "Rural/urban differences in the association between deprivation and healthcare utilisation," Social Science & Medicine, Elsevier, vol. 57(11), pages 2055-2063, December.
    • Handle: RePEc:eee:socmed:v:57:y:2003:i:11:p:2055-2063
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    Cited by:

    1. Burke, Amanda & Jones, Andy, 2019. "The development of an index of rural deprivation: A case study of Norfolk, England," Social Science & Medicine, Elsevier, vol. 227(C), pages 93-103.
    2. Havard, Sabrina & Deguen, Séverine & Bodin, Julie & Louis, Karine & Laurent, Olivier & Bard, Denis, 2008. "A small-area index of socioeconomic deprivation to capture health inequalities in France," Social Science & Medicine, Elsevier, vol. 67(12), pages 2007-2016, December.
    3. Enrico Ivaldi & Paolo Parra Saiani & Juan José Primosich & Carolina Bruzzi, 2020. "Health and Deprivation: A New Approach Applied to 32 Argentinian Urban Areas," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 151(1), pages 155-179, August.
    4. Philibert, M.D. & Pampalon, R. & Hamel, D. & Thouez, J.-P. & Loiselle, C.G., 2007. "KW - Quebec: A local-scale evaluation system," Social Science & Medicine, Elsevier, vol. 64(8), pages 1651-1664, April.
    5. Stefano Landi & Enrico Ivaldi & Angela Testi, 2018. "Measuring Change Over Time in Socio-economic Deprivation and Health in an Urban Context: The Case Study of Genoa," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 139(2), pages 745-785, September.

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