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Influence of socio-demographic factors on distances travelled to access HIV services: enhanced surveillance of HIV patients in north west England.

Cook PA, Downing J, Wheater CP, Bellis MA, Tocque K, Syed Q, Phillips-Howard PA - BMC Public Health (2009)

Bottom Line: Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05).Of those bypassing local facilities, poorer people were more likely to access a specialist centre but did not have as far to travel to do so (3.6 km) compared to those from less deprived areas (8.6 km).Distance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Public Health, Liverpool John Moores University, Liverpool, UK. p.a.cook@ljmu.ac.uk

ABSTRACT

Background: Patient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV) can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services.

Methods: We extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983) accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling) and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14). Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1).

Results: HIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI) 4.6-4.9) per trip and had on average 6 visits (95% CI 5.9-6.2) annually for care. Longer trips were made by males (4.8 km vs 4.5 km), white people (6.2 km), the young (>15 years, 6.8 km) and elderly (60+ years, 6.3 km), those on multiple therapy (5.3 km vs 4.0 km), and the more affluent living in rural areas (16.1 km, P < 0.05). Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05). Of those bypassing local facilities, poorer people were more likely to access a specialist centre but did not have as far to travel to do so (3.6 km) compared to those from less deprived areas (8.6 km).

Conclusion: Distance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age. Thus despite offering an 'equitable' service, travel costs may advantage those with higher income.

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Related in: MedlinePlus

Detrended correspondence analysis (DCA) bi-plot to visualise the relationships between demographic and infection variables (listed in table 1). Axes 1 and 2 are the major axes of variation between individuals based on the inclusion of all measured variables (such that those at opposite ends of an axis are the most different, hence those that are most similar can form identifiable groupings). Arrows along the axes illustrate the significant correlation between distance travelled and the axis score (Axis 1: Spearman's rs = -0.135, P < 0.001; Axis 2: Spearman's rs = 0.274, P < 0.001). The individuals are labelled by infection route (Blood = contaminated blood/blood products, Het = heterosexual, IDU = injecting drug use, MSM = men who have sex with men, MTC = mother to child).
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Figure 1: Detrended correspondence analysis (DCA) bi-plot to visualise the relationships between demographic and infection variables (listed in table 1). Axes 1 and 2 are the major axes of variation between individuals based on the inclusion of all measured variables (such that those at opposite ends of an axis are the most different, hence those that are most similar can form identifiable groupings). Arrows along the axes illustrate the significant correlation between distance travelled and the axis score (Axis 1: Spearman's rs = -0.135, P < 0.001; Axis 2: Spearman's rs = 0.274, P < 0.001). The individuals are labelled by infection route (Blood = contaminated blood/blood products, Het = heterosexual, IDU = injecting drug use, MSM = men who have sex with men, MTC = mother to child).

Mentions: Simultaneous expression of all variables (age, sex, ethnicity, residential status, urbanisation category, deprivation and infection route) in two dimensions (using DCA), distinguishes four main groups in the scatter plot (Figure 1). Although all variables were included in the analysis, individuals have been labelled by infection route since this variable demonstrates a clear separation between the data points. Children infected through vertical transmission lie in the top right of the graph, while those nearer the bottom left are those infected through injecting drug use and sex between men. Those to the bottom right tend to be heterosexual. Many of the variables are interrelated, for example men who have sex with men (MSM) tend to be white and older, while non-white adults tend to be heterosexual and younger (groupings not illustrated here). Distance travelled is related along both axes of Figure 1, showing that children travel further, despite being largely non-white: a category that generally travels less.


Influence of socio-demographic factors on distances travelled to access HIV services: enhanced surveillance of HIV patients in north west England.

Cook PA, Downing J, Wheater CP, Bellis MA, Tocque K, Syed Q, Phillips-Howard PA - BMC Public Health (2009)

Detrended correspondence analysis (DCA) bi-plot to visualise the relationships between demographic and infection variables (listed in table 1). Axes 1 and 2 are the major axes of variation between individuals based on the inclusion of all measured variables (such that those at opposite ends of an axis are the most different, hence those that are most similar can form identifiable groupings). Arrows along the axes illustrate the significant correlation between distance travelled and the axis score (Axis 1: Spearman's rs = -0.135, P < 0.001; Axis 2: Spearman's rs = 0.274, P < 0.001). The individuals are labelled by infection route (Blood = contaminated blood/blood products, Het = heterosexual, IDU = injecting drug use, MSM = men who have sex with men, MTC = mother to child).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2662835&req=5

Figure 1: Detrended correspondence analysis (DCA) bi-plot to visualise the relationships between demographic and infection variables (listed in table 1). Axes 1 and 2 are the major axes of variation between individuals based on the inclusion of all measured variables (such that those at opposite ends of an axis are the most different, hence those that are most similar can form identifiable groupings). Arrows along the axes illustrate the significant correlation between distance travelled and the axis score (Axis 1: Spearman's rs = -0.135, P < 0.001; Axis 2: Spearman's rs = 0.274, P < 0.001). The individuals are labelled by infection route (Blood = contaminated blood/blood products, Het = heterosexual, IDU = injecting drug use, MSM = men who have sex with men, MTC = mother to child).
Mentions: Simultaneous expression of all variables (age, sex, ethnicity, residential status, urbanisation category, deprivation and infection route) in two dimensions (using DCA), distinguishes four main groups in the scatter plot (Figure 1). Although all variables were included in the analysis, individuals have been labelled by infection route since this variable demonstrates a clear separation between the data points. Children infected through vertical transmission lie in the top right of the graph, while those nearer the bottom left are those infected through injecting drug use and sex between men. Those to the bottom right tend to be heterosexual. Many of the variables are interrelated, for example men who have sex with men (MSM) tend to be white and older, while non-white adults tend to be heterosexual and younger (groupings not illustrated here). Distance travelled is related along both axes of Figure 1, showing that children travel further, despite being largely non-white: a category that generally travels less.

Bottom Line: Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05).Of those bypassing local facilities, poorer people were more likely to access a specialist centre but did not have as far to travel to do so (3.6 km) compared to those from less deprived areas (8.6 km).Distance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Public Health, Liverpool John Moores University, Liverpool, UK. p.a.cook@ljmu.ac.uk

ABSTRACT

Background: Patient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV) can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services.

Methods: We extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983) accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling) and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14). Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1).

Results: HIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI) 4.6-4.9) per trip and had on average 6 visits (95% CI 5.9-6.2) annually for care. Longer trips were made by males (4.8 km vs 4.5 km), white people (6.2 km), the young (>15 years, 6.8 km) and elderly (60+ years, 6.3 km), those on multiple therapy (5.3 km vs 4.0 km), and the more affluent living in rural areas (16.1 km, P < 0.05). Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05). Of those bypassing local facilities, poorer people were more likely to access a specialist centre but did not have as far to travel to do so (3.6 km) compared to those from less deprived areas (8.6 km).

Conclusion: Distance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age. Thus despite offering an 'equitable' service, travel costs may advantage those with higher income.

Show MeSH
Related in: MedlinePlus