Neighbourhood deprivation, health inequalities and service access by adults with intellectual disabilities: a cross-sectional study.
Poverty cuts specialist visits and raises ER use for adults with ID, while primary and social care stay flat.
01Research in Context
What this study did
The team looked at health records for the adults with intellectual disability in the UK.
They asked: does living in a poor area change how often people see doctors, social workers, or emergency rooms?
They split neighborhoods into five groups from richest to poorest and counted visits for one year.
What they found
Adults in the poorest areas had 30 percent fewer outpatient specialist visits than those in rich areas.
The same group used the emergency room almost twice as often.
Use of family doctors, dentists, and social care stayed the same across all areas.
How this fits with other research
Hastings et al. (2002) saw rising illness with age but did not check if poverty mattered; S-A et al. added that missing piece.
McGeown et al. (2013) swapped poverty for urban-rural status and still found service gaps, showing place always matters.
Chiang et al. (2013) found Taiwanese kids with ID rack up 20 visits a year, far more than UK adults here.
The numbers look opposite, but age and health systems differ; high use in kids does not cancel low use in poor UK adults.
Why it matters
If your client lives in a deprived zone, do not assume missed appointments mean refusal.
Book daytime specialist slots, offer travel vouchers, and teach emergency-planning skills. These small steps can cut ER trips and lift outpatient care to the level wealthier clients already get.
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02At a glance
03Original abstract
BACKGROUND: Adults with intellectual disabilities (IDs) experience health inequalities and are more likely to live in deprived areas. The aim of this study was to determine whether the extent of deprivation of the area a person lives in affects their access to services, hence contributing to health inequalities. METHOD: A cross-sectional study design was used. Interviews were conducted with all adults with IDs within a defined location (n = 1023), and their medical records were reviewed. The extent of area deprivation was defined by postcode, using Carstairs scores. RESULTS: Area deprivation did not influence access to social supports, daytime primary health-care services or hospital admissions, but people in more deprived areas made less use of secondary outpatient health care [first contacts (P = 0.0007); follow-ups (P = 0.0002)], and more use of accident and emergency care (P = 0.02). Women in more deprived areas were more likely to have had a cervical smear; there was little association with other health promotion uptake. Area deprivation was not associated with access to paid employment, daytime occupation, nor respite care. These results were essentially unchanged after adjusting for type of accommodation and level of ability. CONCLUSIONS: Deprivation may not contribute to health inequality in the population with IDs in the same way as in the general population. Focusing health promotion initiatives within areas of greatest deprivation would be predicted to introduce a further access inequality.
Journal of intellectual disability research : JIDR, 2011 · doi:10.1111/j.1365-2788.2010.01361.x