Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health

Abstract Objective : To investigate the association between cause specific morbidity and deprivation in order to inform the debates on inequalities in health and health services resource allocation. Design : Cross sectional postal questionnaire survey ascertaining self reported health status, with validation of a 20% sample through general practitioner and hospital records. Setting : Inner city, urban, and rural areas of Avon and Somerset. Subjects : Stratified random sample of 28080 people aged 35 and over from 40 general practices. Main outcome measures : Age and sex standardised prevalence of various diseases; Townsend deprivation scores were assigned by linking postcodes to enumeration districts. Relative indices of inequality were calculated to estimate the magnitude of the association between socioeconomic position and morbidity. Results : The response rate was 85.3%. The prevalence of most of the conditions rose with increasing material deprivation. The relative index of inequality, for both sexes combined, was greater than 1 for all conditions except diabetes. The conditions most strongly associated with deprivation were diabetic eye disease (relative index of inequality 3.21; 95% confidence interval 1.84 to 5.59), emphysema (2.72; 1.67 to 4.43) and bronchitis (2.27; 1.92 to 2.68). The relative index of inequality was significantly higher in women for asthma (P<0.05) and in men for depression (P<0.01). The mean reporting of prevalent conditions was 1.07 for the most deprived fifth of respondents and 0.77 in the most affluent fifth (P<0.001). Conclusions : Material deprivation is strongly linked with many common diseases. NHS resource allocation should be modified to reflect such morbidity differentials. Key messages Key messages The relative index of inequality is a useful tool for analysing self reported morbidity and informing debates on inequalities in health Diabetic eye disease, bronchitis, and emphysema are most closely associated with deprivation Broader socioenvironmental factors may also be implicated and merit increased attention The heavy burden of disease in the most deprived groups, particularly among elderly people, warrants attention in planning of the health service and resource allocation