The effect of deprivation, age and sex on NHS Direct call rates.

BACKGROUND The use of primary care services in the UK is traditionally high in deprived areas. There has been little research into the effect of deprivation on the uptake of NHS Direct, a national nurse-led health helpline. AIM To explore the impact of deprivation, age and sex on call rates to two NHS Direct sites. DESIGN OF STUDY Ecological study. SETTING West Yorkshire and West Midlands NHS Direct sites. METHOD Details of NHS Direct calls between July 2001 and January 2002 were linked to electoral wards and the Indices of Multiple Deprivation for 2000. Age-standardised call rates were calculated for five deprivation levels. Using a negative binomial regression model, West Yorkshire call rates were analysed by age group, sex, deprivation level and geographical location. Rates were mapped by ward for West Yorkshire NHS Direct. RESULTS Six-monthly call rates were highest for children under 5 years of age (130 per 1000 population). The ratio of female to male calls (all ages) was 1.30 (95% confidence interval [CI] = 1.27 to 1.33), this ratio being highest for the 15-44 year age group (P < 0.001). For both West Yorkshire and West Midlands NHS Direct, call rates (all ages combined) were highest in areas within the middle of the range of deprivation. West Yorkshire call rates about those under 5 years of age were lower in the most deprived areas than in the least deprived areas (< 1 year, P = 0.06; 1-4 years, P = 0.03). For adults aged 15-64 years, call rates were significantly higher in the most deprived areas (P < 0.001). CONCLUSION This work supports previous research and shows that overall demand for NHS Direct is highest in areas where deprivation is at or just above the national average. Additionally, this study suggests that the effect of extreme deprivation appears to raise adult call rates but reduce rates of calls about children.