inequitable access to public health and healthcare

School for Public Health Research 14/12/2015

Inequitable Access

to Public Health and Healthcare

Interventions for Older People: A Scoping

Review

This is an outline of independent research funded by the

National Institute for Health Research’s School for Public Health Research (NIHR SPHR).

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department

of Health.

Melanie Rimmer1, Nick Payne1, Sarah Salway1, Angie Rees1, Lynne Forrest2,

Stefanie Bucker3

1School for Health and Related Research (ScHARR), The University of Sheffield 2Newcastle University Institute of Health and Society and Fuse 3The University of Cambridge, Cambridge Institute of Public Health

Inequitable Access Project Leads: Yoav Ben-Shlomo, Martin White

School for Public Health Research

Aims of the Review

• To summarise evidence on the extent of age-

related inequity in healthcare access

• To describe and appraise the ‘state of the art’

in terms of research on age-related inequity in

healthcare access


• Healthcare equity can be defined as “equal healthcare

use for equal need”


Methods:

Inclusion Criteria

We searched for papers which:

– Compared older and younger people;

– Looked at any health intervention;

– Had data for use (receipt, access);

– Had data on need.


Methods:

Searching Approach

• Database searching (Medline etc)

• We used a “pearl” of several key papers

• Balance of sensitivity and specificity


Findings:

1. Issues Around Searching

• Sensitivity v Specificity

• Search Medline for “age inequity” in titles – 1 result

• Search for “age” AND “inequit*” in titles – 12 results

• Search for synonyms for age AND inequity - >53,000 results

• Journal indexing (e.g. MeSH), even in gerontology

journals, frequently fails to include a term related to

older people


Findings:

2. Range of Conditions Found

0

5

10

15

20

25

30

35

40

Num

ber

of

papers


Findings:

3. Measures of Need

Socio-

demographic data

Individuals with

diagnosed condition

Population health survey

Mortality data

Disease register


Findings:

4. Measures of Use

• Patient reported

• Routine data

• Survey

• Costing/billing data

• Prescribing data


Findings:

5. Analysis of Use-Need Relationship

• Use:need ratios

• Odds ratios

• Horizontal inequality indices e.g. Gini coefficient or

Concentration Index


Findings:

6. Equity or Inequity?

0

10

20

30

40

50

60

70

Pro-Young Pro-Old No Inequity N/A Other

Num

ber

of

papers


Next Steps

• Identify patterns of inequity e.g. which types of

intervention generate more or less inequities

and how

• Compare geographical locations, types of

service delivery etc

• Explore how research has been framed


Thank you

14

Gini coefficient

• Gini coefficient measures the extent to which something is inequitably distributed across a population.

• If income were distributed totally evenly across the population, the Cumulative Wealth line (Lorenz curve) would follow the diagonal Equality Line exactly.

• The further below the diagonal the Cumulative Wealth line (Lorenz curve) gets, the less equitable the distribution of income.

• Gini coefficient is = Area A/Area (A + B) Lorenz curve

A

B


11370

Documents retrieved

6867

456

178

Included in review

Fast title

sift

Abstract

sift

Full text

sift

4503

excluded

6411

excluded

256 excluded

22 duplicates or

bad file

inequitable access to public health and healthcare

Health & Medicine