DEPRIVATION AND CAUSE-SPECIFIC MORBIDITY - EVIDENCE FROM THE SOMERSETAND AVON SURVEY OF HEALTH

Objective-To investigate the association between cause specific morbid ity and deprivation in order to inform the debates on inequalities in health and health services resource allocation. Design-Cross sectional postal questionnaire survey ascertaining self reported health status, with validation of a 20% sample through general practitioner and hosp ital records. Setting-Inner city, urban, and rural areas of Avon and S omerset. Subjects-Stratified random sample of 28 080 people aged 35 an d over from 40 general practices. Main outcome measures-Age and sex st andardised prevalence of various diseases; Townsend deprivation scores were assigned by linking postcodes to enumeration districts. Relative indices of inequality were calculated to estimate the magnitude of th e association between socioeconomic position and morbidity. Results-Th e response rate was 85.3%. The prevalence of most of the conditions ro se with increasing material deprivation. The relative index of inequal ity, for both sexes combined, was greater than 1 for all conditions ex cept diabetes. The conditions most strongly associated with deprivatio n were diabetic eye disease (relative index of inequality 3.21; 95% co nfidence interval 1.84 to 5.59), emphysema (2.72; 1.67 to 4.43) and br onchitis (2.27; 1.92 to 2.68). The relative index of inequality was si gnificantly higher in women for asthma (P<0.05) and in men for depress ion (P<0.01). The mean reporting of prevalent conditions was 1.07 for the most deprived fifth of respondents and 0.77 in the most affluent f ifth (P < 0.001). Conclusions-Material deprivation is strongly linked with many common diseases. NHS resource allocation should be modified to reflect such morbidity differentials.