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  2. Cross sectional study of primary care groups in London: association of measures of socioeconomic and health status with hospital admission rates
General Practice

Cross sectional study of primary care groups in London: association of measures of socioeconomic and health status with hospital admission rates

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7268.1057 (Published 28 October 2000) Cite this as: BMJ 2000;321:1057

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True but less valid

The results of the study by Majeed and colleagues are very important,
are compatible with the findings of others, fit into the current political
landscape and intuitively make sense. Many of the conclusions are based on
the secondary analysis of aggregate data, often generated using different
sampling frames. While I enjoyed reading the paper, I would be grateful
for an explanation why this is a cross sectional rather than an ecological
study. This distinction is more than just academic as the primary
objective of an ecological study is to generate new hypotheses. Results of
ecological studies cannot imply causality.

Competing interests: No competing interests

01 November 2000
Rudiger Pittrof
SpR GUM
St George's Hospital, London

The Inverse Care Law

Dear Dr Smith,

Majeed and his colleagues conclude that primary care groups have
variable patient and practice characteristics and that hospital admission
rates are higher in areas with greater deprivation.

This supports Tudor Hart's Inverse Care Law which argues that those
with the greatest need of health care are likely to live in areas with the
poorest provision of health and social services.

The current orthodoxy of primary care groups encourages them to take
a "big picture" view of their role and to include health improvement in
their planning and objectives. The problem with this, entirely laudable,
aim is that to achieve substantial changes in housing, employment and
education will require massive amounts of time, expertise and funding.

A focussed approach, with PCGs concentrating on clearly defined and
clinically led outcomes is more likely to deliver measurable improvements
in care within a realistic timetable.

Yours sincerely,

Dr John Hopkins

Competing interests: No competing interests

30 October 2000
John Hopkins
General Practitioner
Darlington
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