DEPRIVATION AND EMERGENCY ADMISSIONS FOR CANCERS OF COLORECTUM, LUNG,AND BREAST IN SOUTH EAST ENGLAND - ECOLOGICAL STUDY

Objectives: To examine the relation between deprivation and acute emer gency admissions for cancers of the colon, rectum, lung, and breast in south east England. Design: Ecological analysis with data from hospit al episode statistics and 1991 census. Setting: North and South Thames Regional Health Authorities (population about 14 million), divided in to 10 aggregations of 31 470 census enumeration districts (median popu lation 462). Subjects: 146 639 admissions relating to 76 552 patients aged < 100 years on admission, resident in the Thames regions, admitte d between 1 April 1992 and 31 March 1995. Results: Residents living in deprived areas were more likely to be admitted as emergencies and has ordinary inpatient admissions and less likely to be admitted as day c ases. Adjusted odds of ordinary admissions from the most deprived tent h occurring as emergencies (relative to admissions from the most afflu ent tenth) were 2.29 (95% confidence interval 2.09 to 2.52) for colore ctal cancer, 2.20 (1.99 to 2.43) for lung cancer, and 2.41 (2.17 to 2. 67) for female breast cancer; adjusted odds of admissions as day cases were 0.70 (0.64 to 0.76), 0.50 (0.44 to 0.56), and 0.56 (0.50 to 0.62 ), respectively. Patients from deprived areas with lung or breast canc ers were less likely to be recorded as having surgical interventions. Adjusted odds of patients fi-om the most deprived tenth receiving surg ery were 0.88 (0.78 to 1.00), 0.58 (0.48 to 0.70), and 0.63 (0.56 to 0 .71), respectively. Admissions for colorectal cancer from the most dep rived areas were less likely to be to hospitals admitting 100 or more new patients a year; the opposite held true for breast cancer admissio ns. No association was found for lung cancer admissions. Conclusions: Earlier diagnostic and referral procedures in primary care in deprived areas are required if there are to be significant reductions in morta lity from these cancers. A national information strategy is required t o ensure the continued availability of population based data on NHS pa tients and to mandate standardised datasets from the private sector. R ationalisation of acute services, hospital mergers, and plans for bed closures must take into account the increased healthcare needs and ine quities in access to treatment and care of residents in areas with hig h levels of deprivation Health authorities and primary care groups sho uld re-examine their purchasing intentions, service reviews, and monit oring arrangements in the light of these findings.