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Social and Spatial Inequalities in Healthcare Use and Health Outcomes Among People Living with Dementia in England.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Social and Spatial Inequalities in Healthcare Use and Health Outcomes Among People Living with Dementia in England./
Author:	Watson, James Robert.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2023,
Description:	217 p.
Notes:	Source: Dissertations Abstracts International, Volume: 85-05, Section: B.
Contained By:	Dissertations Abstracts International85-05B.
Subject:	Electronic health records. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=30721464
ISBN:	9798380729246

Social and Spatial Inequalities in Healthcare Use and Health Outcomes Among People Living with Dementia in England.
Watson, James Robert.

Social and Spatial Inequalities in Healthcare Use and Health Outcomes Among People Living with Dementia in England. - Ann Arbor : ProQuest Dissertations & Theses, 2023 - 217 p.

Source: Dissertations Abstracts International, Volume: 85-05, Section: B.

Thesis (Ph.D.)--The University of Liverpool (United Kingdom), 2023.

IntroductionThe number of people living with dementia (PLWD) continues to rise. PLWD from disadvantaged groups are more likely to experience delayed or incorrect diagnoses, suboptimal care, transitions into nursing care, lower quality of life and increased mortality risk. Big data can support understanding of inequalities in among PLWD and identify solutions for narrowing these inequalities. The aims of this PhD project were to: (i) synthesise evidence of inequalities from existing research using routine and cohort datasets, and identify gaps in the current literature. In identifying research gaps from this synthesis, the PhD thesis then aimed to: employ big data to identify variations among PLWD in (ii) their use of different types of primary and secondary healthcare services, (iii) risk of mortality, and (iv) experience of different temporal patterns in primary and secondary healthcare use in the five-years after dementia diagnoses, and the risk of subsequent mortality.MethodsTo address the aims of this PhD, three quantitative research studies and a systematic review were conducted. A systematic review synthesised evidence of dementia inequalities from research using routinely-collected data and identified gaps in the existing research. The gaps in the literature led to the development of three quantitative research papers utilising big data. Clinical Practice Research Datalink (CPRD) data included ~120 million healthcare contacts for over 142,300 people diagnosed with dementia in England between 2002-2016, examining geographic and socio-economic inequalities. Regression models evidenced the simultaneous impact of explanatory factors on mortality risk and healthcare use. Finally, clusters of PLWD were created based on healthcare use trajectories post-diagnosis. Cox proportional hazards regression evidenced variation in subsequent mortality across clusters.ResultsFindings highlight numerous inequalities for PLWD. The systematic review showed differences in care transitions, care quality, dementia progression and survival, associated with demographic, geographic and socio-economic factors. Quantitative studies demonstrated variations in mortality risk and healthcare use, associated with age, sex, ethnicity, deprivation and geography. Specifically, men, older PLWD and PLWD from more deprived areas experience greater risk of mortality, and men, people from White ethnicity groups and PLWD from more deprived and rural areas were more likely to encounter healthcare use associated with poor health outcomes. Additionally, four distinct trajectories in healthcare use were noted in early- and late-onset populations. Variation in mortality risk was associated with different patterns in healthcare use.DiscussionThis PhD sought to address gaps in the dementia care inequalities literature. By using big data this PhD identifies the simultaneous impact of multiple social and spatial factors in healthcare use and mortality risk among PLWD. Novel evidence also demonstrates temporal patterns in healthcare use among PLWD, and the impact of healthcare trajectories on subsequent mortality. This PhD demonstrates geographic and socio-economic inequalities in dementia, and the extent to which mortality risk varies based on healthcare pathways. Some subpopulations encounter suboptimal care and worse health outcomes, exacerbated by an underfunded and understaffed health and social care system. Our findings highlight the need for health and social care to view care among PLWD as heterogenous, and the benefits of involving PLWD and carers in their own care decisions. Promoting better and more accessible and consistent care for PLWD requires identification of initial, and changing needs. Identification of need, and person-centred care can illuminate the specific needs of the individual and make care more appropriate and accessible to the individual, which has the potential to narrow inequalities in how PLWD experience care and health outcomes. Future research should explore more factors of inequalities, comprehensive care trajectories, develop international collaborations and employ data science to support decision-making.

ISBN: 9798380729246Subjects--Topical Terms:

3433800
Electronic health records.

Social and Spatial Inequalities in Healthcare Use and Health Outcomes Among People Living with Dementia in England.
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