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

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.