The effect of socioeconomic status on outcomes for people with cystic fibrosis: A longitudinal study
Lead Research Organisation:
University of Liverpool
Department Name: Population Community and Behavioural Sci
Abstract
People from disadvantaged backgrounds experience worse health than those more well off in society. In the UK and internationally policies are being implemented to try to reduce these differences in health. This is proving difficult, however, and it is important to develop a better understanding of how these health differences are generated and maintained.
In this project cystic fibrosis will be used as an example, to investigate these processes. Cystic fibrosis is an important chronic disease of childhood and young adulthood. It is a genetic disease requiring intensive medical and social support. I will analyse the national cystic fibrosis registers from the UK and Denmark from a health inequalities point of view. I will investigate the health and social outcomes experienced by people with cystic fibrosis from different socio-economic backgrounds. For example, are there differences in lung function, access to healthcare, survival, educational attainment and employment, for people living in different socio-economic circumstances?
In addition to improving our understanding of health inequalities, this project will generate an in-depth description of the outcomes experienced by people with cystic fibrosis. These insights will inform the development of policies to improve public health and patient care.
In this project cystic fibrosis will be used as an example, to investigate these processes. Cystic fibrosis is an important chronic disease of childhood and young adulthood. It is a genetic disease requiring intensive medical and social support. I will analyse the national cystic fibrosis registers from the UK and Denmark from a health inequalities point of view. I will investigate the health and social outcomes experienced by people with cystic fibrosis from different socio-economic backgrounds. For example, are there differences in lung function, access to healthcare, survival, educational attainment and employment, for people living in different socio-economic circumstances?
In addition to improving our understanding of health inequalities, this project will generate an in-depth description of the outcomes experienced by people with cystic fibrosis. These insights will inform the development of policies to improve public health and patient care.
Technical Summary
Aim
To investigate the effect of socioeconomic status on clinical outcomes, healthcare use and employment opportunities in people with cystic fibrosis.
Objectives
In people with cystic fibrosis:
1. To investigate the relationships between socioeconomic status and clinical outcomes.
2. To investigate the impact of socioeconomic status on educational attainment and employment.
3. To assess the policy implications of the above.
Design
Longitudinal analysis of the UK and Danish cystic fibrosis registers.
Methodology
Extensive data are available from cystic fibrosis registers in the UK and Denmark. In the first analysis, data from the UK CF register will be analysed. The UK Cystic Fibrosis Patient Register (CFPTR) captures data on all people with CF in the UK at patient registration (11,359 records to end of 2007), annual review (42,267 records) and ad hoc clinic visits (86,182 records). The database contains clinical (e.g.% predicted FEV1; Body mass index centile; survival; frequency of respiratory exacerbations); social (e.g. employment status; educational achievement) and healthcare use data (e.g. time in hospital, intravenous therapy days, CF related therapy use). Full postcode data allows estimation of an area-based measure of socioeconomic status. To analyse these data, we will use recently developed methodology and associated open-source software that allow examination of association between important CF outcomes and socio-economic status whilst allowing for correlation between repeated measurements within patients, trends over time and potentially informative missing values. For the Danish CF register, the analysis will exploit the richer, individual-level socioeconomic data that they contain, including employment, income, healthcare expenditure and receipt of welfare benefits.
Scientific and medical opportunities
This project will inform policy and practice around inequalities in health. This is a priority at national and international levels. A better understanding of the mechanisms that generate and maintain health differentials is required in order to design effective policy interventions. In addition this project will generate an in-depth longitudinal description of the health, healthcare and social outcomes of people with cystic fibrosis in the UK. This will be an important contribution to our understanding of the clinical and social epidemiology of cystic fibrosis.
To investigate the effect of socioeconomic status on clinical outcomes, healthcare use and employment opportunities in people with cystic fibrosis.
Objectives
In people with cystic fibrosis:
1. To investigate the relationships between socioeconomic status and clinical outcomes.
2. To investigate the impact of socioeconomic status on educational attainment and employment.
3. To assess the policy implications of the above.
Design
Longitudinal analysis of the UK and Danish cystic fibrosis registers.
Methodology
Extensive data are available from cystic fibrosis registers in the UK and Denmark. In the first analysis, data from the UK CF register will be analysed. The UK Cystic Fibrosis Patient Register (CFPTR) captures data on all people with CF in the UK at patient registration (11,359 records to end of 2007), annual review (42,267 records) and ad hoc clinic visits (86,182 records). The database contains clinical (e.g.% predicted FEV1; Body mass index centile; survival; frequency of respiratory exacerbations); social (e.g. employment status; educational achievement) and healthcare use data (e.g. time in hospital, intravenous therapy days, CF related therapy use). Full postcode data allows estimation of an area-based measure of socioeconomic status. To analyse these data, we will use recently developed methodology and associated open-source software that allow examination of association between important CF outcomes and socio-economic status whilst allowing for correlation between repeated measurements within patients, trends over time and potentially informative missing values. For the Danish CF register, the analysis will exploit the richer, individual-level socioeconomic data that they contain, including employment, income, healthcare expenditure and receipt of welfare benefits.
Scientific and medical opportunities
This project will inform policy and practice around inequalities in health. This is a priority at national and international levels. A better understanding of the mechanisms that generate and maintain health differentials is required in order to design effective policy interventions. In addition this project will generate an in-depth longitudinal description of the health, healthcare and social outcomes of people with cystic fibrosis in the UK. This will be an important contribution to our understanding of the clinical and social epidemiology of cystic fibrosis.
