Prevalence of 209 chronic conditions by area-level deprivation in England

Abstract Background Accounting for socioeconomic differences in disease prevalence is essential for designing and monitoring targeted prevention and for effective public health service planning. However, detailed condition-specific information is available for only a limited number of diseases. We aimed to quantify socioeconomic inequalities in prevalence for 209 chronic conditions in England, describing how prevalence varied by area-level deprivation, age, sex, and the care setting in which diagnoses were recorded. Methods We used Clinical Practice Research Datalink Aurum primary care records linked with Hospital Episode Statistics for 12.7 million patients registered with 1,406 general practices in England on 1 April 2018. We identified diagnoses recorded over the previous 12 years in primary and secondary care records. For each condition, we estimated prevalence by area-level deprivation quintile, age group, and sex, and calculated absolute prevalence gaps and relative prevalence ratios comparing the most and least deprived quintiles. We also compared estimates based on primary care records alone with estimates based on linked primary and secondary care records. Results Socioeconomic inequalities in prevalence were widespread, but patterns varied substantially by condition, age, sex, and care setting. Most conditions showed higher prevalence in the most deprived quintile, for example obesity, hypertension, depression, anxiety disorders, and alcohol or substance misuse. The proportion of conditions showing higher prevalence in more deprived quintiles was highest among patients aged 40–59 years, followed by those aged 60–79 years. However, a small number of conditions were more prevalent in less deprived groups, for example, raised total cholesterol in patients aged 60 years and over and all cancers combined, despite heterogeneous patterns across individual cancer conditions. Using linked primary and secondary care records generally produced larger absolute prevalence gaps than using primary care records alone, and increased the proportion of conditions showing higher prevalence in the most deprived quintile in every age-sex group. Conclusions This study provides the first national systematic assessment of prevalence by area-level deprivation of 209 chronic conditions recorded in primary or secondary care settings in England. These condition-specific descriptive estimates provide a basis for more tailored and adjusted analyses that account for socioeconomic differences in disease burden and case mix and may inform targeted prevention, public health planning, routine monitoring of inequalities, resource allocation, and evaluations.