The ecological relationship between deprivation, social isolation and rates of hospital admission for acute psychiatric care: a comparison of London and New York City
Section snippets
Introduction: background to the analysis
In the USA and the UK, mental health care for most patients is provided according to a model emphasising care in the community, rather than long-term care in residential institutions. Nevertheless, inpatient psychiatric care in acute hospitals continues to play an important role in community-based systems and consumes significant health care resources to meet the costs. Policy making and financial planning for mental health services therefore require information on the factors associated with
Method to compare geographical differences in hospitalization rates in New York City and London
We aimed to make a comparative empirical study to investigate the relationships discussed above in NYC and London. We analysed small area data, for both cities, on acute admissions of men and women aged 15–64, collated for selected psychiatric conditions, which we have defined as far as possible in similar terms for both cities. We have examined the relationship between local admission rates and a set of ‘predictor’ variables, which we also attempted to define in similar ways for both cities.
Results: local variation in hospitalization for psychiatric conditions in NYC and London
The patterns of admissions show some variation between New York and London. For example, crude rates of admission per 1000 men aged 15–64 are much higher in New York than in London (25/1000 compared with 11/1000). Admission rates for women are more similar between the two cities (11/1000 in NYC and 8/1000 in London). The large differential between male and female rates of admission in NYC is most evident for admissions due to conditions such as drug dependency. (Male admission rates for ICD-9
Discussion
There are other examples of international comparative studies of psychiatric care in urban settings (e.g., Goldberg and Thornicroft, 1998) and some have employed a standardized methodology to improve the potential for comparative measurement of variations in psychiatric care (e.g., Becker et al., 1999). However, we are not aware of other studies that have taken such a standardized approach to comparison of psychiatric hospitalization in NYC and London. This paper demonstrates that there are
Acknowledgement
We would like to thank, Prof Giles Glover, University of Durham, UK, and Dr. Fancis Boscoe, New York State Department of Health, for providing data on the location of pscyhiatric inpatient facilities in London and New York City; Lori Kohn for secretarial assistance. This research was funded by the Nuffield Foundation, UK.
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