Health Trajectories in People with Cystic Fibrosis in the UK: Exploring the Effect of Social Deprivation

Excerpt

This chapter describes our longitudinal registry studies examining the effect of social deprivation on longitudinal clinical outcomes, healthcare use and employment opportunities in people with cystic fibrosis (CF). Because CF is genetically determined, this offers an opportunity to investigate the impact of deprivation on health and social outcomes, in a chronic condition without a socio-economic gradient in incidence. It helps in understanding how and when health inequalities are generated, in a chronic disease of childhood onset. The analyses show that children and adults with CF from more disadvantaged areas in the UK have worse growth and lung function compared with people from more affluent areas. These inequalities appear early, but do not widen with advancing age in the UK. In terms of use and access to treatments in the British National Health Service (NHS), more disadvantaged CF patients are more likely to receive antibiotic and nutritional treatments, after adjusting for disease severity, but less likely to receive inhaled therapies such as DNase. This inequality becomes more evident after transition to adult care. In adults with CF, greater deprivation, disease severity, and time in hospital all reduce employment chances. We discuss the implications of these findings for public health policy and care in cystic fibrosis.