Evidence map›Paper›PMID 36187677›Full record

ArticleFrontiers in public health2022

Cost of health inequality to the NHS in Wales.

Rajendra Kadel, James Allen, Oliver Darlington, Rebecca Masters, Brendan Collins, Joanna M Charles, Miqdad Asaria, Mariana Dyakova, Mark Bellis, Richard Cookson

Open access · goldAbstract read
In one paragraph

Article in Frontiers in public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Rajendra KadelWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom.
James AllenWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom.
Oliver DarlingtonWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom.
Rebecca MastersWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom.
Brendan CollinsHealth and Social Services Group, Finance Directorate, Welsh Government, Cardiff, United Kingdom.
Joanna M CharlesHealth and Social Services Group, Finance Directorate, Welsh Government, Cardiff, United Kingdom.
Miqdad AsariaDepartment of Health Policy, London School of Economics and Political Science, London, United Kingdom.
Mariana DyakovaWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom.
Mark BellisWHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom.
Richard CooksonCentre for Health Economics, University of York, York, United Kingdom.
Public Health Wales · GBWelsh Government · GBLondon School of Economics and Political Science · GBUniversity of York · GB

Funding

Wellcome Trust 205427/Z/16/Z
6 · The paper itself

Abstract

Background: Forty years from the seminal work of Welsh GP Julian Tudor Hart on the Inverse Care Law, inequalities in health and healthcare remain deeply embedded in Wales. There is a wider gap (over 17 years) in healthy life expectancy between people living in the most and least deprived neighborhoods in Wales. This health inequality is reflected in additional healthcare use. In this study we estimate the cost of inequality associated with this additional healthcare use to the publicly funded National Health Service (NHS) in Wales. Methods: We retrieved administrative data on all NHS inpatient admissions, outpatient and accident and emergency attendances in Wales between April 2018 and March 2019 from Digital Health and Care Wales (DHCW). Hospital service use data were translated to costs using Healthcare Resource Group (HRG) and health service specific unit cost data and linked with area level mid-year population and deprivation indices in order to calculate the healthcare costs associated with socioeconomics deprivation. Results: Inequality in healthcare use between people from more and less deprived neighborhoods was associated with an additional cost of £322 million per year to the NHS in Wales, accounting for 8.7% of total NHS hospital expenditure in the country. Emergency inpatient admissions made up by far the largest component of this additional cost contributing £247.4 million, 77% of the total. There are also substantial costs of inequality for A&E attendances and outpatient visits, though not maternity services. Elective admissions overall have a negative cost of inequality, since among men aged 50-75 and women aged 60-70, elective utilization is actually negatively associated with deprivation. Conclusion: There are wide inequalities in health and healthcare use between people living in more deprived neighborhoods and those living in less deprived neighborhoods in Wales. Tackling health inequality through a combination of health promotion and early intervention policies targeted toward deprived communities could yield substantial improvement in health and wellbeing, as well as savings for the Welsh NHS through reduced use of emergency hospital care.

Indexed as

Health Status DisparitiesState MedicineFemaleHealth PromotionHumansMaleSocioeconomic FactorsWalescosthealth service useinequalityNHSWales

Identifiers

PMID36187677
PMCPMC9523137
OpenAlexW4296241793

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.