title: Upper gastrointestinal haemorrhage and deprivation: a nationwide cohort study of health inequality in hospital admissions.
abstract: OBJECTIVE
  Inequalities in health are well recognized in cardiovascular disease and cancer, but in comparison, we have minimal understanding for upper gastrointestinal bleeding. Since furthering our understanding of such inequality signposts preventable disease, we investigated in detail the association between upper gastrointestinal bleeding and socioeconomic status.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  All English National Health Service hospitals.
  
  
  METHODS
  English adult population, 1 January 2001 to 31 December 2007.
  
  
  METHODS
  Deprivation scores defined according to quintiles of neighbourhood areas ranked by the Indices of Multiple Deprivation for England 2007.
  
  
  METHODS
  Rates of all adult admissions coded with a primary diagnosis of upper gastrointestinal bleed were analysed by deprivation quintile and adjusted for age, sex, region and year using Poisson regression.
  
  
  RESULTS
  The annual hospitalization rate for non-variceal haemorrhage was 84.6 per 100,000 population (95% CI 83.5 to 84.1; n=237,145), and for variceal haemorrhage, it was 2.83 per 100,000 population (95% CI 2.87 to 2.99; n=8291). There was a twofold increase in the hospitalization rate ratio for non-variceal haemorrhage from the most deprived areas compared to the least deprived (2.00, 95% CI 1.98 to 2.03). The ratio for variceal haemorrhage was even more pronounced (2.49, 95% CI 2.32 to 2.67). Inequality increased over the study period (non-variceal p<0.0001, variceal p=0.0068), and adjusting for age and sex increased the disparity between deprived and affluent areas. Case fatality did not have a similar socioeconomic gradient.
  
  
  CONCLUSIONS
  Both variceal and non-variceal haemorrhage hospitalization rates increased with deprivation, and there was a similar gradient in all areas of the country and in all age bands. The existence of such a steep gradient suggests that there are opportunities to reduce hospitalizations down to the low rates seen in the most affluent, and thus, there is the potential to prevent almost 10,000 admissions and over 1000 deaths a year.
authors.affiliation: Division of Epidemiology and Public Health, The University of Nottingham, Nottingham City Hospital, Nottingham, UK. colin.crooks@nottingham.ac.uk
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Crooks
authors.forename: Joe
authors.initials: J
authors.lastname: West
authors.forename: Tim R
authors.initials: TR
authors.lastname: Card
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D004381:Duodenal Ulcer / Q000150:complications / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D004932:Esophageal and Gastric Varices / Q000453:epidemiology*; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000453:epidemiology; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000453:epidemiology; D008875:Middle Aged; D011204:Poverty Areas; D012189:Retrospective Studies; D017678:Sex Distribution; D012923:Social Class; D012959:Socioeconomic Factors; D013276:Stomach Ulcer / Q000150:complications / Q000453:epidemiology; D055815:Young Adult