Age, deprivation and rates of inguinal hernia surgery in men. Is there inequity of access to healthcare?

OBJECTIVES To study trends in hospital admissions for inguinal hernia surgery in men, examining relationships between age, deprivation and rate of surgery. DESIGN graphical analyses of hospital discharge data and demographic information, guided by three hypotheses on urgency of surgery, age and evidence of discordance between population prevalence of disease and rates of surgery. SETTING AND SUBJECTS Men undergoing inguinal hernia surgery in Scotland in 1982-4, 1987-9 and 1992-4. MAIN OUTCOME MEASURES Rate of operation per 100 000 population. RESULTS Over the study period, there has been (i) a marked increase in the rate of elective hernia operations in the over-65s, (ii) a stable rate of non-elective operations in all age groups, (iii) a lower rate of elective surgery in patients from deprived areas than in patients from affluent areas. CONCLUSIONS During the period studied there has been decreasing inequity on the grounds of age but persisting inequity on the grounds of deprivation. These techniques of analysis are potentially applicable to many conditions and may be useful in equity audit in patients of all ages.