White, Jonathan, Gutacker, Nils orcid.org/0000-0002-2833-0621, Jacobs, Rowena orcid.org/0000-0001-5225-6321 et al. (1 more author) (2014) Hospital admissions for severe mental illness in England::Changes in equity of utilisation at the small area level between 2006 and 2010. Social Science & Medicine. pp. 243-251. ISSN 1873-5347
Abstract
Severe Mental Illness (SMI) encompasses a range of chronic conditions including schizophrenia, bipolar disorder and psychoses. Patients with SMI often require inpatient psychiatric care. Despite equity being a key objective in the English National Health Service (NHS) and in many other health care systems worldwide, little is known about the socio-economic equity of hospital care utilisation for patients with SMI and how it has changed over time. This analysis seeks to address that gap in the evidence base. We exploit a five-year (2006-2010) panel dataset of admission rates at small area level (n = 162,410). The choice of control variables was informed by a systematic literature search. To assess changes in socio-economic equity of utilisation, OLS-based standardisation was first used to conduct analysis of discrete deprivation groups. Geographical inequity was then illustrated by plotting standardised and crude admission rates at local purchaser level. Lastly, formal statistical tests for changes in socio-economic equity of utilisation were applied to a continuous measure of deprivation using pooled negative binomial regression analysis, adjusting for a range of risk factors. Our results suggest that one additional percentage point of area income deprivation is associated with a 1.5% (p < 0.001) increase in admissions for SMI after controlling for population size, age, sex, prevalence of SMI in the local population, as well as other need and supply factors. This finding is robust to sensitivity analyses, suggesting that a pro-poor inequality in utilisation exists for SMI-related inpatient services. One possible explanation is that the supply or quality of primary, community or social care for people with mental health problems is suboptimal in deprived areas. Although there is some evidence that inequity has reduced over time, the changes are small and not always robust to sensitivity analyses.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | Copyright © 2014. Published by Elsevier Ltd. |
Keywords: | England,Healthcare disparities/trends,Hospitals/utilization,Mental health services,Regression analysis,Small-area analysis,Socioeconomic factors,State Medicine/Organization & Administration |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Social Sciences (York) > Centre for Health Economics (York) The University of York > Faculty of Social Sciences (York) > Economics and Related Studies (York) |
Depositing User: | Pure (York) |
Date Deposited: | 25 Aug 2016 09:09 |
Last Modified: | 05 Jan 2025 00:09 |
Published Version: | https://doi.org/10.1016/j.socscimed.2014.09.036 |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.1016/j.socscimed.2014.09.036 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:104060 |
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Filename: JW_NG_RJ_AM_Hosp_admsns_sevre_mntl_ilnes_Englnd_SSM_120_243_51_2014.pdf
Description: JW NG RJ AM Hosp admsns sevre mntl ilnes Englnd SSM 120 243-51 2014
Licence: CC-BY 2.5