Is there an association between deprivation and pre-operative disease severity? A cross-sectional study of patient-reported health status

Objective. Differences in access to elective surgery may contribute to socioeconomic differences in health. We studied the associations between pre-operative health status (as an indicator of clinical need) and deprivation. Design. Cross-sectional study with risk-adjusted comparison of preoperative patient-reported health status and deprivation scores. Setting. Thirteen NHS hospitals, two independent sector treatment centres and one private hospital in England and Wales. Participants. A total of 1160 NHS-funded patients undergoing hip replacement, knee replacement or varicose vein surgery. Intervention(s) None. Main Outcome Measure(s). General health status (EQ-5D), disease-specific health status (Oxford hip score, Oxford knee score and Aberdeen varicose vein symptom severity score) and area deprivation score. Results. Patients from more deprived areas reported worse EQ-5D scores. Differences in crude mean disease-specific health status scores between the least and most deprived fifths were small: hip score 3.5; knee score 6.8; varicose vein score 4.8. When risk adjusted the strength of the association fell by about half for hip (0.176-0.083) and knee (0.214-0.117) and one-third for varicose vein surgery (0.215-0.140), although the coefficients remained statistically significant (P ≤ 0.01). Conclusions. Deprivation was associated with worse pre-operative general health status. However, given that the variation in pre-operative disease-specific health status by deprivation score was of small clinical significance and the limited power of the risk adjustment model, there is little evidence of socioeconomic inequity in access to three common elective surgical procedures.