title: Neighbourhood deprivation, health inequalities and service access by adults with intellectual disabilities: a cross-sectional study.
abstract: BACKGROUND
  Adults with intellectual disabilities (IDs) experience health inequalities and are more likely to live in deprived areas. The aim of this study was to determine whether the extent of deprivation of the area a person lives in affects their access to services, hence contributing to health inequalities.
  
  
  METHODS
  A cross-sectional study design was used. Interviews were conducted with all adults with IDs within a defined location (n = 1023), and their medical records were reviewed. The extent of area deprivation was defined by postcode, using Carstairs scores.
  
  
  RESULTS
  Area deprivation did not influence access to social supports, daytime primary health-care services or hospital admissions, but people in more deprived areas made less use of secondary outpatient health care [first contacts (P = 0.0007); follow-ups (P = 0.0002)], and more use of accident and emergency care (P = 0.02). Women in more deprived areas were more likely to have had a cervical smear; there was little association with other health promotion uptake. Area deprivation was not associated with access to paid employment, daytime occupation, nor respite care. These results were essentially unchanged after adjusting for type of accommodation and level of ability.
  
  
  CONCLUSIONS
  Deprivation may not contribute to health inequality in the population with IDs in the same way as in the general population. Focusing health promotion initiatives within areas of greatest deprivation would be predicted to introduce a further access inequality.
authors.affiliation: Centre for Population and Health Sciences, University of Glasgow, Glasgow, UK. sacooper@clinmed.gla.ac.uk
authors.forename: S-A
authors.initials: SA
authors.lastname: Cooper
authors.forename: A
authors.initials: A
authors.lastname: McConnachie
authors.forename: L M
authors.initials: LM
authors.lastname: Allan
authors.forename: C
authors.initials: C
authors.lastname: Melville
authors.forename: E
authors.initials: E
authors.lastname: Smiley
authors.forename: J
authors.initials: J
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000145:classification / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019989:Persons with Intellectual Disabilities / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012606:Scotland; D012959:Socioeconomic Factors