Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-08T13:20:38.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Deprivation linked to malnutrition risk and mortality in hospital

Published online by Cambridge University Press:  08 March 2007

Rebecca J. Stratton  and
Marinos Elia
Rebecca J. Stratton*
Affiliation:
Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton, UK
Marinos Elia
Affiliation:
Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton, UK
*
*Corresponding author: Dr R. J. Stratton, fax +44 (0) 23 80794945, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This study aimed to investigate the link between deprivation and in-hospital malnutrition and to assess any independent and interrelated effects of deprivation and malnutrition on clinical outcome in hospital. One thousand patients (mean age 71 (sd 19) years, mean BMI 25·6 (sd 5·4) kg/m2) were screened for malnutrition (using the Malnutrition Universal Screening Tool (‘MUST’)) and their clinical outcome assessed prospectively. The deprivation of patients' locality of residence prior to admission was recorded using the Index of Multiple Deprivation 2000 (IMD). Patients with medium and high malnutrition risk (42 %, n 420) were admitted from areas with significantly greater deprivation (lower ranks) than low-risk patients (IMD 3731 v. 3946; P<0·02). The prevalence of malnutrition increased by multiples of 1·14 (95 % CI 1·02, 1·28) for each increment in quartile of IMD rank. The odds of malnutrition of the most deprived quartile were greater than those of the least deprived quartile by a factor of 1·59 (95 % CI 1·11, 2·28). They were also greater for five of the six components of IMD deprivation (and by a factor of 1·73 (95 % CI 1·20, 2·49) for income and 1·69 (95 % CI 1·18, 2·42) for employment). Greater in-hospital mortality was associated with malnutrition, independently of IMD (or its individual components; odds ratio 2·04 (95 % CI 1·22, 3·44)). Length of stay was associated only with malnutrition risk (P<0·0005). This study highlights that in-hospital malnutrition and deprivation are interrelated, yet have independent, adverse associations with patient outcome. Effective strategies are required to tackle these common health inequalities in both clinical and public health settings.

Keywords

MalnutritionScreeningDeprivationOutcome Assessment
Type
Research Article
Information
British Journal of Nutrition , Volume 96 , Issue 5 , November 2006 , pp. 870 - 876
Copyright
Copyright © The Nutrition Society 2006

References

Acheson, D (1998) Independent Enquiry into Inequalities in Health. London: The Stationery Office.Google Scholar
Armstrong, J, Dorosty, AR & Reilly, JJChild Health Information Team & Emmett, PM (2005) Coexistence of social inequalities in undernutrition and obesity in preschool children: population based cross sectional study. Arch Dis Child 88, 671–675.CrossRefGoogle Scholar
Bukhari, HM, Margetts, BM & Jackson, A (2004) Food insecurity in the UK; determinants and consequences. Asia Pac J Clin Nutr 13, S167.Google Scholar
Carlisle, R, Avery, AJ & Marsh, P (2002) Primary care teams work harder in deprived areas. J Publ Health Med 24, 43–48.CrossRefGoogle ScholarPubMed
Department of Environment, Transport and the Regions (2000) Indices of Deprivation 2000. London: DETR.Google Scholar
Department of Health (2001) Tackling Health Inequalities. A Programme for Action. London: Department of Health.Google Scholar
Department of Health (2004) Choosing Health? Choosing a Better Diet. A Consultation on Priorities for a Food and Health Action Plan. London: NHS Estates, Department of Health.Google Scholar
Department of Health and Social Security (1980) Inequalities in Health: Report of a Research Working Group (Black Report). London: DHSS.Google Scholar
Elia, M (ed.) (2000) Guidelines for Detection and Management of Malnutrition. Maidenhead: British Association for Parenteral and Enteral Nutrition, Malnutrition Advisory Group.Google Scholar
Elia, M (2003) Screening for Malnutrition: A Multidisciplinary Responsibility. Development and Use of the Malnutrition Universal Screening Tool (‘MUST’) for Adults. Redditch: British Association for Parenteral and Enteral Nutrition.Google Scholar
Elia, M & Stratton, RJ (2005) Geographical inequalities in nutrient status and risk of malnutrition among English people aged 65 years and over. Nutrition 21, 1100–1106.CrossRefGoogle Scholar
Hawker, JIOlowokure, BSufi, F, Weinberg, J, Gill, N & Wilson, RC (2003) Social deprivation and hospital admission for respiratory infection: an ecological study. Respir Med 97, 1219–1224.CrossRefGoogle ScholarPubMed
Hutchings, A, Raine, R, Brady, A, Wildman, M & Rowan, K (2004) Socioeconomic status and outcome from intensive care in England and Wales. Med Care 42, 943–951.CrossRefGoogle ScholarPubMed
Johnson, R, Horne, B, Feltblower, RG, Butler, GE & Glaser, AW (2004) Hospital attendance patterns in long term survivors of cancer. Arch Dis Child 89, 374–377.CrossRefGoogle ScholarPubMed
Jordan, H, Roderick, P & Martin, D (2004) The Index of Multiple Deprivation 2000 and accessibility effects on health. J Epidemiol Commun Health 58, 250–257.CrossRefGoogle ScholarPubMed
Kirkwood, BR & Sterne, JAV (2005) Regression modelling. In Essential Medical Statistics, 2nd ed., pp. 315–342Oxford: Blackwell Science.Google Scholar
Lyratzopoulos, G, Havely, D, Gemmell, I & Cook, GA (2005) Factors influencing emergency medical readmission risk in a UK district general hospital: a prospective study. BMC Emerg Med 21, 1.CrossRefGoogle Scholar
NHS Executive (2000) Deprivation in the South East Regional Office. An Analysis of the Department of the Environment, Transport and Regions Indices of Deprivation 2000. London: Department of Public Health Medicine.Google Scholar
Niggebrugge, A, Haynes, R, Jones, A, Lovett, A & Harvey, I (2005) The index of multiple deprivation 2000 access domain: a useful indicator for public health?. Soc Sci Med 60, 2743–2753.CrossRefGoogle Scholar
Office of the Deputy Prime Minister (2004) The English Indices of Deprivation 2004. London: Office of the Deputy Prime Minister.Google Scholar
Shaw, M, Davey Smith, G & Dorling, D (2005) Health inequalities and New Labour: how the promises compare with real progress. BMJ 330, 1016–1021.CrossRefGoogle ScholarPubMed
Stratton, RJ (2005) Elucidating effective ways to identify and treat malnutrition. Proc Nutr Soc 64, 305–311.CrossRefGoogle ScholarPubMed
Stratton, RJ, Dixon, R, Longmore, D, Stroud, M & Elia, M (2003 a) Effect of recalled weight and height on malnutrition risk. Clin Nutr 22, S9–S10.CrossRefGoogle Scholar
Stratton, RJ, Green, CJ & Elia, M (2003 b) Disease-related Malnutrition: An Evidence Based Approach to Treatment. Oxford: CABI Publishing.CrossRefGoogle Scholar
Stratton, RJ, Hackston, A, Longmore, D, Dixon, R, Price, S, Stroud, M, King, C & Elia, M (2004) Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults. Br J Nutr 92, 799–808.CrossRefGoogle ScholarPubMed
Stratton, RJ, King, CL, Stroud, MA, Jackson, AA & Elia, M (2006) Malnutrition Universal Screening Tool (‘MUST’) predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr 95, 325–330.CrossRefGoogle ScholarPubMed
Townsend, P, Phillimore, P & Beattie, A (1988) Health and Deprivation: Inequality and the Nort. London. Croom Helm.Google Scholar
Whynes, DK, Frew, EJ, Manghan, CM, Scholefield, JH & Hardcastle, JD (2003) Colorectal cancer, screening and survival: the influences of socio-economic deprivation. Publ Health 117, 289–295.CrossRefGoogle ScholarPubMed
Woods, LM, Rachet, B, Riga, M, Stone, N, Shah, A & Coleman, MP (2005) Geographical variation in life expectancy at birth in England and Wales is largely explained by deprivation. J Epidemiol Commun Health 59, 115–120.CrossRefGoogle ScholarPubMed