The least educated are the most deprived and get hospitalised most, Cambridge study shows

People who live in areas of higher than average deprivation - those with “low educational attainment or in manual social class” - are more likely to be admitted to hospital and to spend longer in hospital, according to new research from the University of Cambridge.

In the research, published in BMJ Open, a team led by researchers at the Cambridge Institute of Public Health examined whether there was a link between living in an area of deprivation and subsequent hospital use. To do so, they examined data from almost 25,000 individuals (11,000 men and 14,000 women) from the EPIC-Norfolk cohort across almost two decades, between 1999 and 2018.

“Regardless of your age and gender, or even lifestyle factors such as smoking and obesity, living in an area of high deprivation is a significant risk factor for spending time in hospital,” said Dr Robert Luben, of the Department of Public Health and Primary Care and the study’s first author.

“People living in areas at or below the national average for deprivation were more likely to spend 20 or more days in hospital or be admitted to hospital on more than seven occasions during the two decades we examined.”

The researchers used the Townsend Index to measure the deprivation of individuals’ residential areas, levels of unemployment, number of households without a car, the percentage of households not owner-occupied and the percentage of households with more than one person per room. They found that people who lived in areas of highest deprivation spent the most time in hospital, but “the risk of a long hospital stay is seen disproportionately in people who also had low educational attainment or were in manual social class”. While the average amount of time spent in hospital over the two-decade period was “around 28 days for people with high educational attainment, for those with low educational attainment, the average was around 37 days, rising steeply to 43 days in the group living in areas of highest deprivation”.

The picture relating to social class was similar, though the differences between social classes was not as pronounced as those between educational attainments. Those individuals in non-manual social classes spent between 29 and 31.5 days in hospital; in manual social classes, people in areas of less deprivation spent around 32 days in hospital, rising to 39.5 days in areas of highest deprivation.

Senior author Professor Kay-Tee Khaw, also from the Department of Public Health and Primary Care, said: “People working in a manual occupation or with lower education level and living in more deprived areas had the greatest risk of hospitalisation. This suggests that hospitalisation is greatest when poorer individual socio-economic factors are combined with residential deprivation.

“It isn’t clear why this should be the case, though we can speculate that it could in part be down to better education improving an individual’s ability to live a healthier life.”

The hospitalisation data adds another layer of understanding about the conditions endured by the 14 million – one-fifth of its population – people in the UK who live in poverty, and 1.5 million of them experienced destitution in 2017, while close to 40 per cent of children are predicted to be living in poverty by 2021. And these factors are exaggerated in Cambridge, where extreme wealth and extreme poverty co-exist side-by-side.

Last year Public Health England revealed that the poorest children born in the UK will die more than 10 years before the richest - and the gap is getting wider. And, having condemned austerity as an “ideological project causing pain and misery”, the UN rapporteur on extreme poverty Philip Alston noted that nevertheless successive Conervative UK governments continued to inflict austerity “largely unabated, despite the tragic social consequences”, and it seems plausible that poverty so dire should push the individual’s wellbeing and overall health prospects into difficulties.

“It clearly is not enough just to focus on educating people and improving lifestyle factors at an individual level,” added Dr Luben. “A poor environment affects those least able to cope. Effective NHS and government policy also needs to address deprivation infrastructural levels – improving housing, transport, access to recreation and green space, for example.”

The research was funded by the Medical Research Council and Cancer Research UK.