168

RESOURCE ALLOCATION REVIEW

SIR,-The Resource Allocation Working Party (RAWP)formula is being revised, and it has been suggested that somemeasure of social deprivation should be included, besidesstandardised mortality ratios. Several currently used indices ofdeprivation-for example, the ACORN index/ the Department ofEnvironment social index,3 and the Jarman index’-are based oncensus data. These are, obviously, out of date, but it is not alwaysrealised that they may be badly distorted if used for comparisonbetween regions. A particular problem arises when using the"ethnic group" data. The Office of Population Censuses andSurveys foresaw resistance to such a question and census

respondents were asked about country of birth. As patterns ofsettlement have varied, there can be substantial differences betweenthe numbers belonging to an ethnic minority group and thenumbers bom in the corresponding country.s

ETHNIC MINORITY PERCENTAGES ESTIMATED FROM CENSUS

AND LABOUR FORCE SURVEYS

*Proportion of population resident in private households with head bom m NewCommonwealth and Pakistan

tProportion of population resident in private households who are of Afro-Caribbean,Indian, or Pakistani origin, according to respondents

MC = metropolitan county

The table compares the percentages of ethnic minoritiesestimated from the 1981 census question with data from the LabourForce Survey for 1981 and 1984.6 There are large differences evenin 1981. These are probably due to some reporting of UK bornchildren of ethnic minority parents as of UK origin in the LabourForce Survey; the General Household Survey gives a value of 4-5%coloured for Great Britain’ which is very similar to the nationalcensus value.What is of interest here is the relative values for the regions.

According to the census, Greater London had about 50% moreethnic minority people than West Midlands Metropolitan County,according to the Labour Force Survey, West Midlands had more.Thus, the census overestimated some regions and underestimatedothers substantially. When one compares Labour Force Surveydata for 1981 and 1984, the percentage in Greater London is seen tohave increased by the national average, while the percentages inother regions do not move in step. For example, the Yorkshire andHumberside percentage has increased by 40% and the percentagesin East Midlands and East Anglia have fallen against the trend.

Census-based data on ethnic groups is used in the Department ofEnvironment index and in the Jarman index with substantialweights in both. When ethnic minorities are taken as one of thecomponents of a measure of deprivation, some regions (eg, London)will benefit and others (eg, West Midlands) will lose becauseinformation is not only out-of-date but also wrong.

Centre for Health Economics;University of York,York YO1 5DD

ROY CARR-HILLALISON EASTWOODPIP STEPHENSON

1. National Health Service Management Board. Review of the RAWP formula LondonHM Stationery Office, 1986.

2 Morgan M, Chin S. ACORN group, social class and child health J Epidemiol CommunHealth 1983; 37: 196-203

3. Department of the Environment Information note no 2 Urban deprivation. London.Department of the Environment, Inner Cities Directorate, 1983.

4. Jarman B. Identification of under-privileged areas. Br Med J 1983; 286: 205-095. OPCS Labour Force Survey 1979 Ser LFS no 2. London HM Stationery Office,

1982.

6. OPCS Labour Force Surveys 1981, 1984. London:HM Stationery Office, 1983, 19867 Office of Population Census and Surveys. General Household Survey 1981. London

HM Stationery Office, 1983.

NEONATAL INTENSIVE CARE: TRENDS INMORBIDITY

SiR,—Your editorial of June 4, discussing Lantos and colleagues’paper in the New England Journal of Medicine1 contains a

misleading statement in the opening paragraph. The belief thatamong low-birthweight infants the "decrease in mortality has beenmirrored by an equally important reduction in morbidity" is widelyheld, but it is unsubstantiated by the evidence available.

In your editorial, this view was based on a comparison of thereported morbidity among two groups of infants. One of theseconsisted of babies born between 1973 and 1976 and admitted to aneonatal intensive-care unit (ICU) in the United States. The groupincluded babies born in the same hospital and others bornelsewhere. The second was a group of infants born between 1977and 1984 in a hospital in Melbourne, Australia. The earlier studydescribes infants with birthweights under 1250 g who wereventilated whereas the Australian study included all babies bom at23-28 weeks of gestation. Furthermore, the two studies measuredmorbidity differently. In the US study "neurodevelopmentaloutcome" was described and in the Australian study the outcomewas defmed by "incidence of impairment and major disability".The two studies are patently non-comparable.

Individual neonatal ICUs may wish to, and indeed have a

responsibility to, provide follow-up of their own patients as part ofthe continuing care and low birthweight babies and as an audit fortheir own patterns of care. There are, however, other importantquestions that such hospital-based follow-up studies cannot

answer. It is not possible to assess trends in morbidity throughstudies confined to babies born in or cared for in specific units. Thiscan only be done by following up all babies born to residents of adefined geographical area.2

Hundreds of "follow-up studies" have been published since theearly days of neonatal intensive care, and each represents a

considerable cost in terms of time and resources. It is, unfortunatethat only a mere handful of these are based on geographicallydefined populations since the sort of comparisons attempted in youreditorial can only be made through such studies. To date, theseshow that there has been no real change in the level of morbidityamong low birthweight survivors.34 The "important reduction inmorbidity", which we would all welcome, is yet to be demonstrated.

Oxford Region Child Development Project,Maternity Department,John Radcliffe Hospital,Oxford OX3 9DU M. A. JOHNSON

National Perinatal Epidemiology Unit,Radcliffe Infirmary, Oxford ALISON J. MACFARLANE

1 Lantos JD, Miles SH, Silvestein MD, Stocking CB Survival after cardiopulmonaryresuscitation in babies of very low birth weight Is CPR futile therapy? N Engl JMed 1988, 318: 910-15.

2 Sinclair JC, Torrance GW, Boyle MH, Horwood SP, Saigal S, Sackett DLEvaluation of neonatal intensive care programs. N Engl J Med 1981, 305: 489-93

3 Powell TG, Pharaoh POD, Cooke RWI. Survival and morbidity in a geographicallydefined population of low birth weight infants. Lancet 1986; i: 539-43.

4. Saigal S, Rosenbaum P, Stoskopf B, Sinclair JC Outcome in infants 501 to 1000 gm,birth weight delivered to residents in McMaster health region. J Pediatr 1984; 105:969-76.