title: Inequalities in access to a tertiary children's chronic pain service: a cross-sectional study.
abstract: Poor health, including chronic pain, has been consistently shown to be associated with lower socioeconomic status (SES).
  
  
  
  To describe the SES of a clinical population of children with chronic pain referred to tertiary care in England, and to determine if access to, and utilisation of, the service is related to SES.
  
  
  
  Using a retrospective cross-sectional study design, all children referred to a tertiary chronic pain management service between 2000 and 2014 were included. SES was determined using the English Index of Multiple Deprivation for the area in which they lived. Distance from the study site, using Ordinance Survey National Grid coordinates, and service utilisation, from hospital records, were also calculated.
  
  
  
  737 children were included. The proportion of patients referred from the most socially deprived areas was substantially lower (14%) than from the least deprived (25%). In addition, the proportion of patients from the most deprived areas fell with increasing distance from the study site. Patients from the most deprived areas were more likely not to attend hospital appointments.
  
  
  
  Contrary to expectations, there were fewer patients from the most deprived areas. The proportion of children from more deprived areas fell with increasing distance from the study site, and those children who were referred were less likely to attend scheduled appointments. Our results imply that there is a social gradient in access to tertiary services for children's chronic pain management.
authors.affiliation: Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital, London, UK.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Jay
authors.affiliation: Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital, London, UK.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Howard
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D059350:Chronic Pain / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012923:Social Class; D062606:Tertiary Care Centers / Q000592:standards / Q000706:statistics & numerical data
keywords: Epidemiology; Health Service; Pain