Centre for Population and Health Sciences, University of Glasgow, Glasgow, UK.
J Intellect Disabil Res. 2011 Mar;55(3):313-23. doi: 10.1111/j.1365-2788.2010.01361.x. Epub 2011 Jan 4.
Adults with intellectual disabilities (IDs) experience health inequalities and are more likely to live in deprived areas. The aim of this study was to determine whether the extent of deprivation of the area a person lives in affects their access to services, hence contributing to health inequalities.
A cross-sectional study design was used. Interviews were conducted with all adults with IDs within a defined location (n = 1023), and their medical records were reviewed. The extent of area deprivation was defined by postcode, using Carstairs scores.
Area deprivation did not influence access to social supports, daytime primary health-care services or hospital admissions, but people in more deprived areas made less use of secondary outpatient health care [first contacts (P = 0.0007); follow-ups (P = 0.0002)], and more use of accident and emergency care (P = 0.02). Women in more deprived areas were more likely to have had a cervical smear; there was little association with other health promotion uptake. Area deprivation was not associated with access to paid employment, daytime occupation, nor respite care. These results were essentially unchanged after adjusting for type of accommodation and level of ability.
Deprivation may not contribute to health inequality in the population with IDs in the same way as in the general population. Focusing health promotion initiatives within areas of greatest deprivation would be predicted to introduce a further access inequality.
智障成年人（ID）存在健康不平等现象，且更可能生活在贫困地区。本研究旨在确定一个人所居住地区的贫困程度是否会影响他们获得服务的机会，从而导致健康不平等。
采用横断面研究设计。对指定区域内的所有成年 ID 进行访谈（n = 1023），并查阅他们的医疗记录。使用 Carstairs 评分，根据邮政编码来定义地区贫困程度。
地区贫困程度并不影响社会支持、日间初级保健服务或住院治疗的可及性，但生活在较贫困地区的人对二级门诊医疗保健的利用率较低（首次就诊：P = 0.0007；随访：P = 0.0002），对急症护理的利用率较高（P = 0.02）。生活在贫困地区的女性更有可能进行宫颈癌筛查；与其他健康促进措施的接受情况相关性较小。地区贫困程度与获得有偿就业、日间职业和临时护理的机会无关。在调整住宿类型和能力水平后，这些结果基本保持不变。
贫困程度可能不会像在一般人群中那样导致 ID 人群的健康不平等。预计在贫困程度最高的地区开展健康促进活动将进一步导致获得服务的不平等。
