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Clinical studies in cystic fibrosis
P99 Social deprivation and clinical outcomes in adult CF patients
  1. A Ashish,
  2. D Nazareth,
  3. A Tsoulkani,
  4. G Priona,
  5. M Harris,
  6. M Ledson,
  7. M Walshaw
  1. Liverpool Heart and Chest Hospital, Liverpool, UK

Abstract

Introduction Economic and social deprivation is associated with increased morbidity and mortality, and this may be particularly important in chronic disease states such as cystic fibrosis, where there is a high burden of care. Despite this, there have been no studies assessing its impact on adult patients with CF. Our large adult CF clinic takes patients from a wide catchment area, including some of the most deprived areas in the country: we wished to study the impact of this deprivation on the health of our CF patients.

Methods We used the postcode-based Index of Multiple Deprivation (IMD) which takes into account seven domains (including income, education, housing and health-related outcomes), to assign Lower Super Output Areas (LSOAs) in a range of 0–32 486 (where a lower LSOA indicates increased deprivation) to adult patients attending our centre. LSOAs were then correlated with spirometry, BMI, clinic attendances, number and length of inpatient spells, treatment burden, diabetes, and ultimate outcome between 2004 and 2009. Data were analysed using the χ2 test and bivariate correlations to calculate Pearson's coefficient, where appropriate.

Results Of 219 patients (mean age 27.8 years, range 17–65, 99 females), 113 (57%) lived in the lowest 20% of LSOAs (compared to only 20% nationally). We found no correlation between IMD score and FEV1, BMI, hospital admissions, diabetes and death, but there was an inverse relationship (r2=−0.153, p<0.05) with the mean length of inpatient stay.

Conclusion Although many of our adult CF patients live in very deprived areas, this seems to have little impact on their health over a 5-year period, but this is at the expense of more inpatient care, a surrogate marker for more intensive treatment. It is therefore likely that these patients will consume more healthcare resource, and this may need to be factored into any proposed national policy allotting funding towards this complex group of patients.

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