Inequalities in health measuring deprivation and its application in paediatric eye disease

This thesis describes an investigation of inequalities in health in paediatric ophthalmology from a health services research perspective and examines some associated methodological issues. I undertake an exploration of inequalities in the presentation of amblyopia, a common childhood eye disease. An area based deprivation measure is used to investigate the relationship between age at presentation of amblyopia and deprivation of children presenting to seven orthoptic clinics. I extend this work by evaluating the effect of a screening intervention on existing inequalities at one particular clinic. I then explore some methodological issues related to this work. The analyses of amblyopia data are based on an ecological measure of deprivation. Since there are problems in assuming that exposure effects at the area level apply at the individual level, I therefore investigate the relationship between individual and area level deprivation measures. I assess whether information about this relationship can be used to estimate of the effect of deprivation at the individual level in studies where only area level information is available.