Analysing geographic variations in mortality using Poisson regression: the example of ischaemic heart disease in England and Wales 1969-1973.

This paper describes how Poisson regression techniques can be used to examine the relationship between mortality and possible explanatory variables over a series of areas in cases where the number of deaths involved is relatively low. As an example an analysis is carried out on deaths from ischaemic heart disease among young adults in the county boroughs of England and Wales during 1969-1973. The results of the study indicate that the number of deaths was higher for males than females and was positively related to age, the size of the 'at risk' population and crowding, but negatively associated with water hardness and the size of the New Commonwealth population. A comparison of the Poisson and log-normal regression models clearly shows that the latter provides an inferior goodness of fit and unreliable results. It is therefore concluded that when the number of deaths is small there are both theoretical and practical advantages in using Poisson regression to analyse mortality data.

Role of branch surgeries in a rural area.

Surveys of general practitioners and rural residents were conducted in Norfolk to establish the characteristics of branch surgeries in the district and the patients who use them. The branch surgeries tend to serve an unrepresentative section of patients, predominantly those disadvantaged both in health and personal mobility-those from manual social classes, the elderly and those without cars. While doctors and patients were agreed that lower standards of care are provided in most branch surgeries compared with main surgeries, the evidence suggests that branch surgeries nevertheless meet a social need.

The effects of accessibility on general practitioner consultations, out-patient attendances and in-patient admissions in Norfolk, England.

A social survey was conducted to investigate the effects of accessibility on contacts with general practitioners and hospitals under the National Health Service in the predominantly rural county of Norfolk. Random samples of adults were taken close to hospital and general practitioner services in the city of Norwich, in villages close to Norwich with and without a general practitioner surgery and in villages relatively remote from the city with and without a surgery. General practitioner consultation rates, out-patient attendance rates and in-patient admissions were all found to decline with decreasing accessibility. For people with a long-standing illness, the main difference in rates was between urban and rural areas. The groups most affected in the rural areas were those with the highest relative need of health care. Their counterparts in the city used the health services much more. For the larger section of the sample, those with no long-standing illness, the most significant differences were between the various rural locations. Here, both distance to a surgery and distance to the city hospitals were associated with decreasing consultation, out-patient and in-patient rates. The main trend was of young mobile people with high expectations in places with readily accessible health services using those services more than would be expected from their usage rates elsewhere. There was also evidence among the people with no long-standing illness of less prosperous sub-groups being affected by remoteness at the out-patient stage.