Does deprivation affect access to Does deprivation affect access to Does deprivation affect access to Does deprivation affect access to health care services for hearing health care services for hearing health care services for hearing health care services for hearing impairment? impairment? impairment? impairment?
Hearing loss in UK adults Hearing loss in UK adults Hearing loss in UK adults Hearing loss in UK adults UK 16.1% Italy 17.1% Country Sweden 16.9% Finland 15.0% Denmark 14.3% 0.0% 5.0% 10.0% 15.0% 20.0% Prevalence of hearing loss Source: 1-5
Hearing health inequalities Hearing health inequalities Hearing health inequalities Hearing health inequalities Higher incidence of hearing loss among; Higher incidence of hearing loss among; Higher incidence of hearing loss among; Higher incidence of hearing loss among; Men 6 6 6 6- - - -9 9 9 9 • Men Men Men Persons with cardiovascular risk factors 10-14 • Persons with cardiovascular risk factors Persons with cardiovascular risk factors Persons with cardiovascular risk factors Ethnic minorities 15 • Ethnic minorities Ethnic minorities Ethnic minorities Persons of low socioeconomic status (SES) 6,7,13,15,16 • Persons of low socioeconomic status (SES) Persons of low socioeconomic status (SES) Persons of low socioeconomic status (SES)
Relationship between SES and hearing loss Relationship between SES and hearing loss Relationship between SES and hearing loss Relationship between SES and hearing loss Low SES is associated with; Low SES is associated with; Low SES is associated with; Low SES is associated with; Unhealthy behaviours 17,18 • Unhealthy behaviours Unhealthy behaviours Unhealthy behaviours Manual labour / industrial occupation 19,20 • Manual labour / industrial occupation Manual labour / industrial occupation Manual labour / industrial occupation
Pilot study Pilot study Pilot study Pilot study • First hearing aid fitting appointments First hearing aid fitting appointments First hearing aid fitting appointments First hearing aid fitting appointments • Retrospective analysis between 2015 Retrospective analysis between 2015 Retrospective analysis between 2015 Retrospective analysis between 2015- - - -18 18 18 18 • Compare by age and SES Compare by age and SES Compare by age and SES Compare by age and SES • Welsh Index of Multiple Deprivation as a surrogate Welsh Index of Multiple Deprivation as a surrogate Welsh Index of Multiple Deprivation as a surrogate Welsh Index of Multiple Deprivation as a surrogate for SES for SES for SES for SES
Welsh Index of Multiple Deprivation (WIMD) Welsh Index of Multiple Deprivation (WIMD) Welsh Index of Multiple Deprivation (WIMD) Welsh Index of Multiple Deprivation (WIMD) • Lower Super Output Areas Lower Super Output Areas Lower Super Output Areas Lower Super Output Areas (LSOAs) (LSOAs) (LSOAs) (LSOAs) • 1909 LSOAs in Wales 1909 LSOAs in Wales 1909 LSOAs in Wales 1909 LSOAs in Wales • Average population of 1600 Average population of 1600 Average population of 1600 Average population of 1600 people per LSOA people per LSOA people per LSOA people per LSOA Source: Stats Wales 21
WIMD rank WIMD rank WIMD rank WIMD rank 23.5% 23.5% 14% 14% 10% 5% 5% 5% Source: Welsh Government 22
WIMD by health board WIMD by health board WIMD by health board WIMD by health board • Seven health boards Seven health boards Seven health boards Seven health boards responsible for all of Wales responsible for all of Wales responsible for all of Wales responsible for all of Wales • Abertawe Abertawe Bro Bro Morgannwg Morgannwg Abertawe Abertawe Bro Bro Morgannwg Morgannwg University health board University health board University health board University health board (ABMU) (ABMU) (ABMU) (ABMU) Source: Welsh Government 21
LSOAs within ABMU boundary LSOAs within ABMU boundary LSOAs within ABMU boundary LSOAs within ABMU boundary • 327 LSOAs 327 LSOAs 327 LSOAs 327 LSOAs • Lowest = 6 Lowest = 6 Lowest = 6 Lowest = 6 • Highest = 1908 Highest = 1908 Highest = 1908 Highest = 1908 Most deprived Least deprived Source: Welsh Government 21
LSOAs within ABMU boundary LSOAs within ABMU boundary LSOAs within ABMU boundary LSOAs within ABMU boundary • 10 “decile” groups 10 “decile” groups 10 “decile” groups 10 “decile” groups • 9 Groups contained 33 LSOAs 9 Groups contained 33 LSOAs 9 Groups contained 33 LSOAs 9 Groups contained 33 LSOAs • 1 Group contained 30 LSOAs 1 Group contained 30 LSOAs 1 Group contained 30 LSOAs 1 Group contained 30 LSOAs Group 1, G2, G3, G4, G5, G6, G7, G8, G9, Group 10 Group 1, G2, G3, G4, G5, G6, G7, G8, G9, Group 10 Group 1, G2, G3, G4, G5, G6, G7, G8, G9, Group 10 Group 1, G2, G3, G4, G5, G6, G7, G8, G9, Group 10 Most deprived Least deprived
st fit appointments by year ABMU total 1 st st st ABMU total 1 ABMU total 1 ABMU total 1 fit appointments by year fit appointments by year fit appointments by year 3000 2844 2836 2664 2455 2500 Number of first fit appointments 2000 1500 1000 500 0 2015 2016 2017 2018 Year
st fit appointments by year & age ABMU 1 st st st ABMU 1 ABMU 1 ABMU 1 fit appointments by year & age fit appointments by year & age fit appointments by year & age 900 800 Number of first fit appointments 700 600 500 400 300 200 100 0 18-30 31-40 41-50 51-60 61-70 71-80 >80 Age group 2015 2016 2017 2018
st Fit appointments by deprivation group 1 st st st 1 1 1 Fit appointments by deprivation group Fit appointments by deprivation group Fit appointments by deprivation group • Age demographics vary between LSOAs Age demographics vary between LSOAs Age demographics vary between LSOAs Age demographics vary between LSOAs st fit appointments alone may give 1 st st st • Number of Number of 1 Number of Number of 1 1 fit appointments alone may give fit appointments alone may give fit appointments alone may give skewed results. skewed results. skewed results. skewed results. st Fit appointment rate as a proportion of; 1 st st st • 1 1 1 Fit appointment rate as a proportion of; Fit appointment rate as a proportion of; Fit appointment rate as a proportion of; - Population within ABMU - Population within ABMU - - Population within ABMU Population within ABMU - - - - Population within deprivation group Population within deprivation group Population within deprivation group Population within deprivation group
st Fit appointments all adults (>18) 1 st st st 1 1 1 Fit appointments all adults (>18) Fit appointments all adults (>18) Fit appointments all adults (>18) 1.4 1.4 1.2 1.2 Comparison of proportions Comparison of proportions 1 1 0.8 0.8 0.6 0.6 0.4 0.4 0.2 0.2 0 0 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 11 11 Deprivation group Deprivation group Linear (2015) 2015 Linear (2016) 2016 2017 Linear (2017) 2018 Linear (2018)
st Fit appointments by year (18 1 st st st 1 1 1 Fit appointments by year (18 Fit appointments by year (18 Fit appointments by year (18- -30) - - 30) 30) 30) 2.00 2.00 1.80 1.80 1.60 1.60 Comparison of proportions Comparison of proportions 1.40 1.40 1.20 1.20 1.00 1.00 0.80 0.80 0.60 0.60 0.40 0.40 0.20 0.20 0.00 0.00 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 11 11 Deprivation group Deprivation group Linear (2015) 2015 Linear (2016) 2016 2017 Linear (2017) 2018 Linear (2018)
st Fit appointments by year (31 1 st st st 1 1 1 Fit appointments by year (31 Fit appointments by year (31 Fit appointments by year (31- -40) - - 40) 40) 40) 3.00 3.00 2.50 2.50 Comparison of proportions Comparison of proportions 2.00 2.00 1.50 1.50 1.00 1.00 0.50 0.50 0.00 0.00 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 11 11 Deprivation group Deprivation group Linear (2015) 2015 Linear (2017) 2016 2017 Linear (2018) 2018 Linear (2016)
st Fit appointments by year (41 1 st st st 1 1 1 Fit appointments by year (41 Fit appointments by year (41 Fit appointments by year (41- -50) - - 50) 50) 50) 1.80 1.80 1.60 1.60 1.40 1.40 Comparison of proportions Comparison of proportions 1.20 1.20 1.00 1.00 0.80 0.80 0.60 0.60 0.40 0.40 0.20 0.20 0.00 0.00 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 11 11 Deprivation group Deprivation group Linear (2015) 2015 Linear (2016) 2016 2017 Linear (2017) 2018 Linear (2018)
st Fit appointments by year (51 1 st st st 1 1 1 Fit appointments by year (51 Fit appointments by year (51 Fit appointments by year (51- -60) - - 60) 60) 60) 1.60 1.60 1.40 1.40 Comparison of proportions Comparison of proportions 1.20 1.20 1.00 1.00 0.80 0.80 0.60 0.60 0.40 0.40 0.20 0.20 0.00 0.00 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 11 11 Deprivation group Deprivation group Linear (2015) 2015 Linear (2016) 2016 2017 Linear (2017) 2018 Linear (2018)
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