cause-specific hospital utilisation and mortality patterns in new zealand by area deprivation,...
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Cause-specific hospital utilisation and mortality patterns in New Zealand by area deprivation, 1974-2006
Ngaire Coombs
Zoë Matthews, Sabu Padmadas
Division of Social Statistics, School of Social Sciences, University of Southampton
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
New Zealand Population, 2002
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
Deprivation Decile 1 Deprivation Decile 10
• Aims
• Data
• Results
• Discussion
• Further Work?
Outline
Aims
1. To determine if areas with high deprivation scores have higher mortality rates than areas with low deprivation scores.
2. To determine if areas with high deprivation scores have higher hospital bed day rates than areas with low deprivation scores.
3. To determine if the cause of death varies by deprivation score.
4. To determine if the cause of hospital use varies by deprivation score.
Mortality• 1974-2006* (800,000 events)
Hospital Discharges• 1974-2007 (20 million events)
NZDep• Area deprivation score• 1991, 1996, 2001, 2006
National analyses 1974-2006Sub-national analyses (by deprivation) 1991-2006
Data
*Excluding 2001
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Unfiltered
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Unfiltered
Hospital Discharges, 1974-2007 Hospital Bed Days, 1974-2007
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Unfiltered Day Patients Long stay
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Unfiltered Day Patients Long Stay
Hospital Discharges, 1974-2007 Hospital Bed Days, 1974-2007
Filtering of Hospital Data
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Unfiltered Day Patients Long stay
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Unfiltered Day Patients Long Stay
Hospital Discharges, 1974-2007 Hospital Bed Days, 1974-2007
Hospital Discharges, 1974-2007 Hospital Bed Days, 1974-2007
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Sub-National National Unfiltered
Day Patients Long Stay
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Sub-National National Unfiltered
Day Patients Long stay
Results
Standardised* Hospital Bed Day and Mortality Rates
Hospital Bed Day rate Mortality rate (per 1000)
*Standardised to 1991 New Zealand Population
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
19
74
19
76
19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
Male Female
0.00
2.00
4.00
6.00
8.00
10.00
12.00
19
74
19
76
19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
Male Female
1. To determine if areas with high deprivation scores have higher mortality rates than areas with low deprivation scores.
2. To determine if areas with high deprivation scores have higher hospital bed day rates than areas with low deprivation scores.
Aims
Hospital Bed Day and Mortality rates by Deprivation, Age 60-64, 2002
Mortality rate (per 1000)Hospital Bed Day rate
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
1 2 3 4 5 6 7 8 9 10
Deprivation Decile
Male Female
0.0
5.0
10.0
15.0
20.0
25.0
1 2 3 4 5 6 7 8 9 10
Deprivation Decile
Male Female
Hospital Bed Day and Mortality rates by Deprivation, Age 80-84, 2002
Mortality rate (per 1000)
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
1 2 3 4 5 6 7 8 9 10
Deprivation Decile
Male Female
0.0
20.0
40.0
60.0
80.0
100.0
120.0
1 2 3 4 5 6 7 8 9 10
Deprivation Decile
Male Female
Hospital Bed Day rate
3. To determine if the cause of death varies by deprivation score.
Aims
Deprivation Decile 1 Deprivation Decile 10
Standardised* Mortality rate (per 1000) 2002, by Cause, 95% C.I.
*Standardised to 1991 New Zealand Population
0.00.51.01.52.02.53.03.54.0
A0
0-B
99
C0
0-D
48
D5
0-D
89
E0
0-E
90
F0
0-F
99
G0
0-H
99
I00
-I9
9J0
0-J
99
K0
0-K
93
L0
0-M
99
N0
0-N
99
O0
0-Q
99
R0
0-R
99
E0
0-E
99
ICD10 Code
Male
Female
0.00.5
1.01.52.0
2.53.0
3.54.0
A0
0-B
99
C0
0-D
48
D5
0-D
89
E0
0-E
90
F0
0-F
99
G0
0-H
99
I00
-I9
9
J00
-J9
9
K0
0-K
93
L0
0-M
99
N0
0-N
99
O0
0-Q
99
R0
0-R
99
E0
0-E
99
ICD10 Code
Male
Female
4. To determine if the cause of hospital use varies by deprivation score.
Aims
Deprivation Decile 1 Deprivation Decile 10
Standardised* Hospital Bed Day rate (per 1000) 2002, by Cause, 95% C.I.
*Standardised to 1991 New Zealand Population
0.000.020.040.060.080.100.120.140.160.18
A0
0-B
99
C0
0-D
48
D5
0-D
89
E0
0-E
90
F0
0-F
99
G0
0-H
99
I00
-I9
9J0
0-J
99
K0
0-K
93
L0
0-M
99
N0
0-N
99
O0
0-Q
99
R0
0-R
99
E0
0-E
99
Z0
0-Z
99
ICD10 Code
Male
Female
0.000.020.040.060.080.100.120.140.160.18
A0
0-B
99
C0
0-D
48
D5
0-D
89
E0
0-E
90
F0
0-F
99
G0
0-H
99
I00
-I9
9J0
0-J
99
K0
0-K
93
L0
0-M
99
N0
0-N
99
O0
0-Q
99
R0
0-R
99
E0
0-E
99
Z0
0-Z
99
ICD10 Code
Male
Female
Results
1 & 2. Mortality and hospital bed day rates amongst the oldest ages (80+) do not vary substantially by deprivation decile, the overall differential is driven by younger ages (50 to 75).
3. The cause of mortality does not vary substantially by deprivation score.
4. The cause of hospital use does vary slightly by deprivation score
Discussion
New Zealand Population, 2002
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
Deprivation Decile 1 Deprivation Decile 10
New Zealand Population, 2002
Deprivation Decile 1 Deprivation Decile 10
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
New Zealand Population, 2002
Deprivation Decile 1 Deprivation Decile 10
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
New Zealand Population, 2002
Deprivation Decile 1 Deprivation Decile 10
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
.07 .06 .05 .04 .03 .02 .01 .00 .01 .02 .03 .04 .05 .06 .07
0-45-9
10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84
85+
Male Female
Standardised* Mortality Rates by Age, 2006
0.00
0.02
0.04
0.06
0.08
0.10
0.12
0.14
0-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
485
+
Age
Decile 1
Decile 10
0.00
0.02
0.04
0.06
0.08
0.10
0.12
0.14
0-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
485
+
Age
Decile 1
Decile 10
Male Female
*Standardised to 1991 New Zealand Population
Standardised* Hospital Bed Day Rates by Age, 2006
Male Female
*Standardised to 1991 New Zealand Population
0.00
1.00
2.00
3.00
4.00
5.00
6.00
0-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
485
+
Age
Decile 1
Decile 10
0.00
1.00
2.00
3.00
4.00
5.00
6.00
0-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
485
+
Age
Decile 1
Decile 10
Further Work?
• Log-linear analysis
• Avoidable/non-Avoidable
• Private health sector
• Ethnicity
• Compression of morbidity