Mays N, Chinn S
Department of Community Medicine, United Medical School, Guy's Hospital, London.
J Epidemiol Community Health. 1989 Jun;43(2):191-9. doi: 10.1136/jech.43.2.191.
The use of mortality data in the form of standardised mortality ratios (SMRs) to measure the need for health care resources in the Resource Allocation Working Party (RAWP) formula in England has been criticised for underestimating the wider effects of adverse socioeconomic conditions on need, particularly in inner city areas. To assess this criticism, we explored the relationships at NHS Regional and District levels in England between two indicators of illness from the 1981 Census, two contrasting indices of deprivation based on the 1981 Census (the Jarman 8 Underprivileged Area (UPA) score and Townsend's Index of Material Deprivation) and their constituent variables, and all cause SMRs for 1982-3. All cause SMRs were highly correlated at Regional and District level with permanent and temporary sickness rates. At Regional level, three of the Thames Regions showed relatively high deprivation scores in relation to their SMRs, in comparison to the remaining Regions where the relative level of deprivation closely matched the Region's mortality ranking. District level analyses of the relations between SMRs and the deprivation indices and their constituent variables showed that the Thames/non-Thames dichotomy was accounted for by the 14 Districts in inner London. These findings suggest that although there may be a prima facie case for including an allowance for deprivation in RAWP, it is still not clear how the deprivation variables available in the Census relate empirically to the need for additional health service resources. The analysis raises questions about the appropriate definition of need in this context and whether the Census is a suitable source for the construction of a deprivation weighting for use in national RAWP.
在英国资源分配工作小组（RAWP）公式中，使用标准化死亡比（SMR）形式的死亡率数据来衡量医疗保健资源需求，受到了批评，因为它低估了不利社会经济状况对需求的更广泛影响，尤其是在市中心地区。为了评估这一批评，我们在英格兰的国民保健服务（NHS）区域和地区层面，探讨了1981年人口普查中的两个疾病指标、基于1981年人口普查的两个不同的贫困指数（贾曼8贫困地区（UPA）得分和汤森物质剥夺指数）及其构成变量，与1982 - 1983年的全因SMR之间的关系。全因SMR在区域和地区层面与长期和短期疾病发生率高度相关。在区域层面，与其他地区相比，泰晤士河地区中的三个地区在SMR方面显示出相对较高的贫困得分，在其他地区，贫困的相对水平与该地区的死亡率排名紧密匹配。对SMR与贫困指数及其构成变量之间关系的地区层面分析表明，泰晤士河/非泰晤士河的二分法是由伦敦市中心的14个区造成的。这些发现表明，尽管在RAWP中可能有初步理由纳入贫困津贴，但仍然不清楚人口普查中可用的贫困变量在经验上如何与额外医疗服务资源的需求相关。该分析引发了关于在此背景下需求的适当定义以及人口普查是否是构建用于国家RAWP的贫困权重的合适数据来源的问题。
