'ALSPAC' infant morbidity and Council Tax Band: doctor consultations are higher in lower bands.

BACKGROUND: The discrepancy between the occurrence of disease and the risk of consulting a doctor is well known, but whether or not it is socially governed is uncertain and could have important implications for primary care manpower and resource allocation. The aim of the study was to investigate whether (i) reported occurrence of common symptoms in infancy and (ii) consulting rates for those symptoms, are associated with socio-economic status as marked by Council Tax Valuation Band (CTVB). METHODS: Compound cross-sectional analysis of data was obtained from sequential parental questionnaires. Data were taken from Avon Longitudinal Study of Parents and Children of over 14,000 responders from Avon county since 1991. Comparative analyses by CTVB and other covariables were carried out. RESULTS: Final study group of nearly 10 000: diarrhoea, wheeze and accidental injuries moderately associated with CTVB but consulting behaviour for all morbidity bar earache strongly associated with CTVB, the lower the band the higher the clinical burden. CONCLUSION: The children from more modest homes are more likely to be taken to a doctor for everyday symptoms: for infant morbidity, the lower the CTVB of home address, the higher the clinical burden for UK general practices.

Council tax valuation bands and contacts with a GP out-of-hours service.

UK GPs are no longer responsible for the organisation of out-of-hours care for their patients, but resources remains capitation-based. This cross-sectional study tests whether council tax valuation bands can predict the demand for such services. All out-of-hours contacts made by patients in North Wiltshire over 4 months were classified by council tax band; frequencies compared with official population statistics. Council tax band predicts out-of-hours GP workload irrespective of age and sex: the more modest the home, the higher the GP contact rate. It may prove more difficult to sustain out-of-hours services in deprived parts of the UK.

Council tax valuation band predicts breast feeding and socio-economic status in the ALSPAC study population.

BACKGROUND: Breast-feeding rates in the UK are known to vary by maternal socio-economic status but the latter function is imperfectly defined. We test if CTVB (Council Tax Valuation Band - a categorical assessment of UK property values and amenities governing local tax levies) of maternal address predicts, in a large UK regional sample of births, (a) breast-feeding (b) personal and socio-economic attributes of the mothers. METHODS: Retrospective study of a subset (n.1390 selected at random) of the ALSPAC sample (Avon Longitudinal Study of Parents and Children), a large, geographically defined cohort of mothers followed from early pregnancy to 8 weeks post-delivery. Outcome measures are attitudes to breast-feeding prior to delivery, breast-feeding intention and uptake, demographic and socio-economic attributes of the mothers, CTVB of maternal home address at the time of each birth. Logistic regression analysis, categorical tests. STUDY SAMPLE: 1360 women divided across the CTVBs--at least 155 in any band or band aggregation. CTVB predicted only one belief or attitude--that bottle-feeding was more convenient for the mother. However only 31% of 'CTVB A infants' are fully breast fed at 4 weeks of life whereas for 'CTVB E+ infants' the rate is 57%. CTVB is also strongly associated with maternal social class, home conditions, parental educational attainment, family income and smoking habit. CONCLUSION: CTVB predicts breast-feeding rates and links them with social circumstances. CTVB could be used as the basis for accurate resource allocation for community paediatric services: UK breast-feeding rates are low and merit targeted promotion.

The costs of care in general practice: patients compared by the council tax valuation band of their home address.

BACKGROUND: It is difficult to measure and compare workload in UK general practice. A GP/health economist team recently proposed a means of calculating the unit cost of a GP consulting. It is therefore now possible to extrapolate to the costs of other clinical tasks in a practice and then to compare the workloads of caring for different patients and compare between practices. OBJECTIVES: The study aims were: (i) to estimate the relative costs of daily clinical activities within a practice (implying workload); and (ii) to compare the costs of caring for different types of patients categorized by gender, by age, and by socio-economic status as marked by the Council Tax Valuation Band (CTVB) of home address. METHODS: The study design was a cross-sectional cost comparison of all clinical activity aggregated, by patient, over one year in an English semi-rural general practice. The subjects were 3339 practice patients, randomly selected. The main outcome measures were costs per clinical domain and overall costs per patient per year; both then compared by gender, age group and by CTVB. RESULTS: CTVB is as significant a predictor of patient care cost (workload) as is patient gender and age (both already known). CONCLUSIONS: It is now possible to estimate the cost of care of different patients in such a way that NHS planning and especially resource allocation to practices could be improved.

The life of Dr Jan Ingen Housz (1730-99), private counsellor and personal physician to Emperor Joseph II of Austria.

A brief biography is presented of Dr Jan Ingen Housz, as written, originally in Dutch, by M J Godefroi, a mid-nineteenth-century Dutch physician who was a friend of a near descendant of Dr Ingen Housz. From being a general practitioner at Breda, his home town, he moved to England to learn smallpox inoculation, was sent to inoculate members of the Habsburg family at Vienna and dedicated his later life to scientific experimentation, notably revealing the fundamentals of photosynthesis.

Council tax valuation band of patient residence and clinical contacts in a general practice.

BACKGROUND: There is a dearth of data relating UK general practice workload to personal and social markers of individual patients. AIM: To test whether there is a significant association between general practice patient contact rates and the council tax valuation band of their residential address. DESIGN OF STUDY: Cross-sectional analyses using data recorded, over 1 year, for over 3300 general practice patients. SETTING: One medium-sized group practice in an industrialised English market town. METHOD: Face-to-face contacts between the patients and the doctors and nurses in the practice were compared by patient age, sex, registration period, distance from surgery, Underprivileged Area 8 (UPA8) score, and council tax valuation band. RESULTS: Patient sex, age, recent registration, distance from surgery, and council tax valuation band were each significantly associated with face-to-face contact rate in univariate analyses. UPA8 score was not significantly associated with contact rates. On multivariate testing, sex, age, recent registration, and council tax valuation band remained significantly associated with contact rates. The last is a new finding. CONCLUSION: Council tax valuation bands predict contact rate in general practice; the lower the band, the higher the contact rate. Council tax valuation band could be a useful marker of workload that is linked to socioeconomic status. This is a pilot study and multipractice research is advocated.

Is council tax valuation band a predictor of mortality?

BACKGROUND: All current UK indices of socio-economic status have inherent problems, especially those used to govern resource allocation to the health sphere. The search for improved markers continues: this study proposes and tests the possibility that Council Tax Valuation Band (CTVB) might match requirements. PRESENTATION OF THE HYPOTHESIS: To determine if there is an association between CTVB of final residence and mortality risk using the death registers of a UK general practice. TESTING THE HYPOTHESIS: Standardised death rates and odds ratios (ORs) for groups defined by CTVB of dwelling (A - H) were calculated using one in four denominator samples from the practice lists. Analyses were repeated three times - between number of deaths and CTVB of residence of deceased 1992 - 1994 inclusive, 1995 - 1997 inc., 1998 - 2000 inc. In 856 deaths there were consistent and significant differences in death rates between CTVBs: above average for bands A and B residents; below average for other band residents. There were significantly higher ORs for A, B residents who were female and who died prematurely (before average group life expectancy). IMPLICATIONS OF THE HYPOTHESIS: CTVB of final residence appears to be a proxy marker of mortality risk and could be a valuable indicator of health needs resource at household level. It is worthy of further exploration.