Income and regional disparities dictate how young people use healthcare services

There is a stark contrast in how young people access healthcare, depending on their income and where they live.

According to a new study from Imperial College Business School, people aged 14 to 17 living in more affluent areas have easier and faster access to outpatient care, including mental health and dental services.

By contrast, those in more deprived areas struggle to access preventative healthcare. They face longer waiting times and are more likely to cancel or not attend outpatient appointments (though the study does not explore the reasons for this). This means their health is more likely to worsen, making them more reliant on emergency care when they need urgent medical treatment, according to the study.

“Given that young people from poorer backgrounds face overall worse health, this means there is a risk they could get caught in a cycle of poor health and insufficient treatment.” Dr Mario Martínez-Jiménez Research Associate, Business School

The research, published in Social Science and Medicine, used data from Next Steps on people born in England in 1989-1990. Researchers interviewed over 13,000 participants at age 14-15 and over 11,000 at age 16-17. They then linked over 4,000 of the participants to their hospital records when they turned 25, providing data about their use of healthcare services since their teenage years.

“Our study uncovers a stark contrast in healthcare usage between adolescents from income-deprived areas and those from wealthier areas”, said Dr Mario Martínez-Jiménez, Research Associate at Imperial’s Centre for Health Economics & Policy Innovation, and lead author of the study.

Although the study focused on a cohort of millennials (adults who are now in their 30’s), the researchers say the findings are still relevant for today’s adolescents who were more likely to struggle with their mental health during the COVID-19 pandemic.

“The disparity we found indicates a troubling scenario where poorer adolescents rely more on emergency care, potentially due to a lack of access to regular, preventative healthcare services. For today’s teenagers, we believe this may have been exacerbated due to the COVID-19 pandemic and the effect of lockdowns on young people,” Dr Martínez-Jiménez explained.

Regional divide

The research shows how people’s economic circumstances play a big role in how they experience healthcare during their adolescence.

The researchers quantified the relative impact on health and healthcare inequalities of circumstances beyond young people’s control such as their parents’ socioeconomic status and where they live, and lifestyle habits within their control such as smoking, drinking and playing sports.

While lifestyle factors were found to influence the situation, the study found that regional differences and parents’ socioeconomic status were likely to have the biggest impact on young people’s access to hospital services.

This geographical context is important, given the findings show that young people living in more affluent areas tend to face shorter waiting times for outpatient appointments. According to the study, these early-intervention specialist appointments prevent health issues developing into medical emergencies, and difficulty accessing them leaves young people in more deprived areas more reliant on accident and emergency departments.

Emergency services

The researchers also identified an inequality of access to accident and emergency services. They found that emergency services in more deprived areas were more likely to be overwhelmed and under-resourced than in wealthier areas.

This leads to young people facing longer waiting times due to greater demand and lower resources in deprived areas, potentially exacerbating inequalities between more and less deprived areas. This is in line with more recent Census data showing that accident and emergency attendance increases with the level of deprivation people experience.

“Given that young people from poorer backgrounds face overall worse health, this means there is a risk they could get caught in a cycle of poor health and insufficient treatment”, Dr Martínez-Jiménez said.

“Without effective measures and policies to address this, the UK is at risk of failing to uphold the core principle of providing equal healthcare services to all citizens based on their level of need," he said.

The study, Socioeconomic deprivation, health and healthcare utilisation among millennials, is published in the journal Social Science and Medicine. The paper was authored by Dr Mario Martínez-Jiménez, Research Associate at the Centre for Health Economics & Policy Innovation at Imperial College Business School, and Dr Bruce Hollingsworth and Dr Eugenio Zucchelli from Lancaster University.