P32 Pushing the Boundaries of Health Inequality Reporting with National Cancer Data

Background The National Disease Registration Service (NDRS, part of NHS England) collects, links and analyses all cancer diagnoses in England. These data are made widely available to support patient care, disease surveillance and research. Health inequalities in cancer are evident across the spectrum of patient characteristics that are well known, like gender and age. There is some evidence for worse health outcomes for other groups that are less easily studied, such as the homeless, or poorer coastal communities. Without data to support analyses in these groups, the full magnitude and characteristics of any inequities remain unknown, and whole groups of patients continue to suffer disproportionately. Aim The NDRS has recently committed to an ambitious goal: to ensure that all future regular data outputs are supplied with breakdowns by at least four health inequality dimensions (age group, gender, ethnic background and quintile of Index of Multiple Deprivation) as standard. Reporting that allows health inequality analyses will be the default, rather than an addition. Methods Alongside appraisal of all regular outputs, NDRS are also working to define and validate new variables that capture patient characteristics associated with those dimensions that are harder to ascertain, and will add breakdowns to regular reports according to these new variables in due course. Some report/breakdown combinations will be inappropriate to release, due to small counts, data slivers or other disclosure-related risks, for example. In these instances, the NDRS's approach is to provide a statement explaining why reporting is not possible, with transparent language. This reinforces the principle of health inequality-related breakdowns as the norm, not the exception. Results So far, more than 50 regular reports have been assessed against the Core20PLUS5 framework to understand the use of current inequality-related breakdowns, with recommendations for additional breakdowns or restructuring of those already included to ensure maximal internal and external consistency. Most (84%) of these reports already include at least one breakdown by a health inequality dimension. This work is challenging, as it requires careful consideration of the appropriateness of each breakdown for each report and stakeholder, in order to maximise data utility, transparency, trustworthiness and completeness while maintaining exemplary data security and safeguarding patient privacy. Conclusion Through this work, the NDRS hopes to lead the way towards reducing health inequalities in cancer, understanding our populations and supporting patients by maximising use of the data we are entrusted to keep.