Deprivation linked to malnutrition risk and mortality in hospital

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/m(2)) 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.