1. Surveillance Lab Meeting
December 17, 2009

2. Deprivation and Disease
Ecological Studies.
United Kingdom and Wales.
Studied the effects of social and material deprivation on hospital admission or mortality for:
Gastrointestinal infection.
Gynaecologic infection.
Neisseria meningitidis infection.
Respiratory infections:
Acute respiratory infection
Pneumonia
Influenza

3. Measuring Deprivation
Used Townsend Deprivation Score.
Based on 1991 Census data.
Proportion of households that are: owner-occupied, have no car, are overcrowded, and have unemployed residents.
The more deprived, the higher the score.
Divided into five deprivation categories.
Postal codes linked to Townsend Deprivation Score.
Cases without postal codes were normally excluded.

4. Results
For most infectious diseases; admission rates or mortality increased significantly with increasing deprivation.
Admission rates or mortality rates varied by age-group.

5. Infectious Intestinal Disease
Admission Rates (per 10,000 population)
Olowokure, B., et al. (1999).

6. Gynaecologic Infections
Olowokure, B., et al. (2004)

7. Gynaecologic Infections
Olowokure, B., et al. (2004)

8. Meningococcal Disease

9. Meningococcal Disease
Fone et al. (2003)

10. Respiratory Infections
Acute Respiratory Infection
Pneumonia
Hawker, J.I., et al. (2003)

11. Age and Deprivation Type of Infection Age Group
Incidence Rate Ratio (95% CI)
All Respiratory Infections
0-4
1.91 ( )
75+
1.18 ( )
Acute Respiratory Infections
1.89 ( )
5-24
1.26 ( )
Pneumonia
1.29 ( )
45-75
1.31 ( )
1.15 ( )

12. Respiratory Mortality
Jordan, R. et al. (2006).

13. Respiratory Mortality
Jordan, R. et al. (2006).

14. Possible Explanations
Increased exposure (Overcrowding or poor housing conditions).
Reduced resistance to disease (Malnutrition, poor hygiene).
Referral bias: Lower physician threshold for admission for those from deprived backgrounds.
Delay in seeking healthcare.
Less accessible healthcare services.

15. Summary
There is an association between social and material deprivation and hospital admission or mortality rates.
There is an association between age and hospital admission or mortality rates.
Depends on infectious disease.

16. References
Olowokure, B., et al. (1999). Deprivation and hospital admission for infectious intestinal diseases. Lancet. 353,
Olowokure, B., et al. (2004). Influence of material deprivation on hospital admissions for gynaecologic infections. European Journal of Clinical Microbiology and Infectious Diseases. 23,
Fone, D.L. et al. (2003). Meningococcal disease and social deprivation: a small area geographical study in Gwent, UK. Epidemiology and Infection. 130,
Hawker, J.I., et al. (2003). Social deprivation and hospital admission for respiratory infection: an ecological study. Respiratory Medicine. 97,
Jordan, R. et al. (2006). Age, sex, material deprivation and respiratory mortality. Respiratory Medicine. 100,