Research Associate, Department of Primary Care and Public Health Sciences, King's College London, London, UK.
J Health Serv Res Policy. 2013 Oct;18(4):215-23. doi: 10.1177/1355819613493772. Epub 2013 Aug 14.
This study aimed to estimate the impact of deprivation on the occurrence, health outcomes and health care costs of people with multiple morbidity in England.
Cohort study in the UK Clinical Practice Research Datalink, using deprivation quintile (IMD2010) at individual postcode level. Incidence and mortality from diabetes mellitus, coronary heart disease, stroke and colorectal cancer, and prevalence of depression, were used to define multidisease states. Costs of health care use were estimated for each state from a two-part model.
Data were analysed for 141,535 men and 141,352 women aged ≥30 years, with 33,862 disease incidence events, and 13,933 deaths. Among incidences of single conditions, 22% were in the most deprived quintile and 19% in the least deprived; dual conditions, most deprived 26%, least deprived 16% and triple conditions, most deprived 29%, least deprived 14%. Deaths in participants without disease were distributed most deprived 22%, least deprived 19%; in participants with single conditions, most deprived 24%, least deprived 18%; dual conditions, most deprived 27%, least deprived 15%, and triple conditions, most deprived 33%, least deprived 17%. The relative rate of depression in most deprived participants with triple conditions, compared with least deprived and no disease, was 2.48 (1.74 to 3.54). Costs of health care use were associated with increasing deprivation and level of morbidity.
The higher incidence of disease, associated with deprivation, channels deprived populations into categories of multiple morbidity with a greater prevalence of depression, higher mortality and higher costs. This has implications for the way that resources are allocated in England's National Health Service.
本研究旨在评估贫困对英国多重疾病患者发病、健康结局和医疗保健费用的影响。
本研究采用英国临床实践研究数据链接中的队列研究，使用个体邮政编码水平的剥夺五分位数（IMD2010）。糖尿病、冠心病、中风和结直肠癌的发病率和死亡率以及抑郁症的患病率用于定义多疾病状态。使用两部分模型从医疗保健使用成本估计每种状态的成本。
对 141535 名年龄≥30 岁的男性和 141352 名女性进行了数据分析，共发生 33862 例疾病发病事件和 13933 例死亡。在单病种发病中，22%发生在最贫困五分位，19%发生在最不贫困五分位；双病种，最贫困五分位 26%，最不贫困五分位 16%；三病种，最贫困五分位 29%，最不贫困五分位 14%。无疾病参与者中死亡的分布情况为最贫困五分位 22%，最不贫困五分位 19%；单病种参与者中最贫困五分位 24%，最不贫困五分位 18%；双病种参与者中最贫困五分位 27%，最不贫困五分位 15%；三病种参与者中最贫困五分位 33%，最不贫困五分位 17%。与最不贫困和无疾病相比，三重条件下最贫困参与者中抑郁的相对发生率为 2.48（1.74 至 3.54）。医疗保健使用成本与贫困程度和疾病严重程度呈正相关。
与贫困相关的更高疾病发病率会导致贫困人群进入多重疾病类别，其中抑郁的患病率更高、死亡率更高、成本更高。这对英格兰国民保健制度中资源分配的方式产生了影响。
