Intended for healthcare professionals

Rapid response to:


A/H1N1 influenza update

BMJ 2009; 339 doi: (Published 23 July 2009) Cite this as: BMJ 2009;339:b2977

Rapid Response:

Impact of Health Inequalities on Antiviral Access

As part of its response to the H1N1 pandemic, Walsall Primary Care
Trust, serving a population of one quarter million, collated data on
patients obtaining antiviral medication. Our preliminary information
suggests that access rates to the National Pandemic ‘Flu Service (NPFS)
are associated with deprivation in local communities. We highlight that
management of the virus must consider patterns of behaviour and
demography, as well as patterns of disease.

Anecdotal reports were received of higher levels of antiviral
medication usage in areas of highest deprivation, and we examined this
using locally gathered data, grouped by lower super output area (LSOA).

Significant variations in collection rates per population unit were
observed across the borough. The collection rate varied between 68 and 684
per 10,000 residents in the 169 LSOAs. The initial anecdotal reports were
supported by apparent clustering around the areas of highest deprivation.
We explored this relationship using linear regression of antiviral
collection rate by LSOA against population density (count per hectare),
Index of Multiple Deprivation (IMD) Score, and BME population

No evidence of association was identified with population density (R2
0.111), perhaps surprising given the perceived risk of spread amongst
populations in close living circumstances. However, some association was
observed between collection rate and IMD score (R2 0.422), and BME
population (R2 0.453).

The limited number of cases prevented standardisation of this
information, although we noted that areas of highest deprivation generally
had younger populations that were more likely to have been affected by the
H1N1 virus.

The rates of antiviral access provide some encouragement that
messages regarding the NPFS have penetrated into communities that can be
more difficult to access. However, we suggest several other factors may
contribute to this association, and merit further investigation.

We considered that this information implies inequalities may be
emerging in how residents understand, and apply, H1N1 prevention and
treatment information. Given public discussions on the necessity of
antiviral medication for all cases, the apparent disparity may highlight
trends in behaviour amongst deprived communities due to a lack of access
to this informed debate. It may also indicate failures in promotion of
self management advice. This data clearly does not support a hypothesis
that affluent communities abuse access to antiviral medications.

We commend to other health bodies to actively monitor the impact of
inequalities on residents during the current pandemic, and highlight the
need for further research using the more comprehensive national datasets
in this area.

Competing interests:
None declared

Competing interests: No competing interests

28 September 2009
Christopher J Chiswell
SpR Public Health
Dr Sam Ramaiah, Andrew Hood, Rehman Teagle
NHS Walsall, WS2 7JL