“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Can neighbourhood type explain variations in uptake of bowel cancer screening? Dr. Kelechi E. Nnoaham Specialist Registrar in Public Health South Central Strategic Health Authority

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Broad headings  Background  Objectives  Methods  Results  Conclusions  What next?

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Background

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” GenderAgeDeprivationEthnicity Uptake of bowel cancer screening

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Geodemographic segmentation systems  Small geographic areasPeople  Originated from research commissioned by OPCS and DE in late 70s  Adopted and used commercially for targeting marketing resource  Neighbourhood effects and conditioned behaviours – the “birds and feathers” question.  Better predictor of some behaviours than income, social class, age (Webber, 2005)

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Multivariate data profiles Composite indicator variables Census variables Enumeration Dist.

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Objectives

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”  Examine relationship of age, gender and deprivation to screening uptake in the South Central population  Investigate whether geodemographic types explain variation in uptake over and above amount explained by above variables

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Methods

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”  Data on uptake for Southern hub populations - >89,000 records  Linked to LSOAs and geodemographic segmentation types (OAC and p2)  Linked to deprivation data from IMD 2004  Imported into Stata 10 and new categories for age and deprivation quintiles created  Imported into MLwiN software for multilevel analysis and into Microsoft MapPoint for mapping

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Multilevel logit model:  For each LSOA, what is the probability that a person invited for bowel cancer screening would decline invitation (non-response), given their age, gender and deprivation category and those of other invited persons living in the same LSOA?  How much does the probability of non-response vary between LSOAs belonging to the same cluster?

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Sample model output

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Results Uptake of screening by geography

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

South West/South Central

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” South East Coast

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” South West

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” South West

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

52% 75% 72%

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” So what geodemographic types discriminate regarding non-uptake?

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” GD typesCharacteristics OAC classifications 5C3 Rent (public)All flats Public transportUnemployed 7A2 Rent (public)All flats BME ethnicity 5C2 Rent (public)All flats Public transportUnemployed 2A1All flats No central heating 5A1 Age 65+ Single pensioner household Rent (public)All flatsUnemployed/R P2 Branches L37 Rent (public)All flats Public transportUnemployed No central heating Shop at ASDA M38 Age 75+ Single pensioner household Rent (public)All flats Public transportUnemployed/R No central heating BME ethnicity Shop at ASDA K36 Age Single pensioner household Rent (public)Flats Public transportUnemployed/R No central heating Shop at ASDA

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Profile of a person declining invitation to bowel cancer screening A retired pensioner living alone in a publicly rented flat without central heating, and commutes by public transport to ASDA for shopping.

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” What next?  Extend method to other screening programmes  Targeted health promotion  Collaborative working

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Acknowledgements  Julietta Patnick, Claire Nickerson, Steven Halloran - BCSP  Alison Frater - NHS South Central  Paul Roderick, Graham Moon - Southampton University