title: The effect of deprivation, age and sex on NHS Direct call rates.
abstract: BACKGROUND
  The use of primary care services in the UK is traditionally high in deprived areas. There has been little research into the effect of deprivation on the uptake of NHS Direct, a national nurse-led health helpline.
  
  
  OBJECTIVE
  To explore the impact of deprivation, age and sex on call rates to two NHS Direct sites.
  
  
  METHODS
  Ecological study.
  
  
  METHODS
  West Yorkshire and West Midlands NHS Direct sites.
  
  
  METHODS
  Details of NHS Direct calls between July 2001 and January 2002 were linked to electoral wards and the Indices of Multiple Deprivation for 2000. Age-standardised call rates were calculated for five deprivation levels. Using a negative binomial regression model, West Yorkshire call rates were analysed by age group, sex, deprivation level and geographical location. Rates were mapped by ward for West Yorkshire NHS Direct.
  
  
  RESULTS
  Six-monthly call rates were highest for children under 5 years of age (130 per 1000 population). The ratio of female to male calls (all ages) was 1.30 (95% confidence interval [CI] = 1.27 to 1.33), this ratio being highest for the 15-44 year age group (P < 0.001). For both West Yorkshire and West Midlands NHS Direct, call rates (all ages combined) were highest in areas within the middle of the range of deprivation. West Yorkshire call rates about those under 5 years of age were lower in the most deprived areas than in the least deprived areas (< 1 year, P = 0.06; 1-4 years, P = 0.03). For adults aged 15-64 years, call rates were significantly higher in the most deprived areas (P < 0.001).
  
  
  CONCLUSIONS
  This work supports previous research and shows that overall demand for NHS Direct is highest in areas where deprivation is at or just above the national average. Additionally, this study suggests that the effect of extreme deprivation appears to raise adult call rates but reduce rates of calls about children.
authors.affiliation: Regional Serveillance Unit, Centre for Infections, Health Protection Agency West Midlands, Birmingham. duncan.cooper@hpa.org.uk
authors.forename: Duncan
authors.initials: D
authors.lastname: Cooper
authors.forename: Eve
authors.initials: E
authors.lastname: Arnold
authors.forename: Gillian
authors.initials: G
authors.lastname: Smith
authors.forename: Vivien
authors.initials: V
authors.lastname: Hollyoak
authors.forename: Frances
authors.initials: F
authors.lastname: Chinemana
authors.forename: Maureen
authors.initials: M
authors.lastname: Baker
authors.forename: Sarah
authors.initials: S
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D015277:Hotlines / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D012044:Regression Analysis; D017678:Sex Distribution; D013222:State Medicine / Q000706:statistics & numerical data*