Geographic and socioeconomic variation in meningococcal disease: a rural/urban comparison

OBJECTIVES: To examine the incidence of meningococcal disease in a defined geographic area and relate this to rural/urban residence and material deprivation. METHODS: Retrospective review of statutory notifications, laboratory records and death registrations from 1 January 1996 through 31 December 2001 in an English health area. Incidence of disease was analysed in two populations residing within the area, one rural and one urban. Deprivation was measured using the Townsend material deprivation score. RESULTS: Altogether, 183 cases of meningococcal disease were identified. Average annual incidence was significantly higher (P=0.019) in the urban area (8.8/10(5)) compared to the rural area (6.2/10(5)). In 1996, the relative risk (RR) was greater in the urban area (RR 3.20 95% CI 1.40-7.32) compared to the rural area. During the study period a significant upward trend in disease incidence in the rural area (chi2 for trend P=0.018) was identified whereas a non-significant decrease was observed in the urban area. In the urban area, but not in the rural area, increasing deprivation was strongly associated with increasing disease incidence (chi2 for trend P=0.00010). CONCLUSIONS: Meningococcal disease places a disproportionate disease burden on certain populations. Further research is required to identify measures to address the inequalities identified.