Wheelchair user spatial clustering in Wales is associated with socioeconomic deprivation: a multi-domain analysis using the Welsh index of multiple deprivation

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Wheelchair users represent a population with significant and often permanent mobility impairment. Despite well-established links between disability and socioeconomic deprivation, the geographic relationship between wheelchair user concentration and area-level deprivation has not previously been examined at national scale. This study aimed to identify spatial clusters of wheelchair users across Wales and characterise their association with socioeconomic deprivation across domains of the Welsh Index of Multiple Deprivation (WIMD). This cross-sectional ecological study used 43,790 NHS-registered wheelchair users across all 1,917 Lower Layer Super Output Areas (LSOAs) in Wales. Local Moran’s I identified statistically significant High-High (HH) spatial clusters of wheelchair user counts. Chi-square goodness of fit tests, chi-square tests of association, and binary logistic regression quantified the association between WIMD deprivation quintile (Q1-5) and HH clustering across WIMD domain, with Benjamini-Hochberg false discovery rate correction applied throughout. One-hundred-and-ten HH clusters were identified, with 41% in the most deprived WIMD Overall quintile. Significant deprivation gradients were observed across six domains; Health and Employment showed the strongest associations, with Q1:Q5 wheelchair user ratios of 1.747 and 1.738 and up to 20-fold greater odds of HH cluster membership in the most deprived quintile. Housing and Access to Services showed divergent patterns, with clusters concentrated in areas of moderate rather than extreme deprivation. Wheelchair user spatial clustering in Wales is strongly associated with socioeconomic deprivation, but the association varies by WIMD domain. These findings provide actionable spatial evidence to support equitable NHS wheelchair service commissioning aligned with true geographic need. The geographic concentration of wheelchair users across South, Southwest, and North Wales, in communities characterised by convergent socioeconomic deprivation, indicates that commissioners may benefit from directing workforce capacity, equipment budgets, and service development towards areas of greatest need, rather than distributing resources uniformly across health board populations.Posture and mobility services that support the most health- and employment-deprived communities are likely to serve populations with greater clinical complexity. Ensuring adequate staffing, specialist assessment capacity, and timely review and follow-up in these areas may help to reduce secondary complications associated with delayed or inadequate wheelchair provision.High concentrations of wheelchair users are associated with income and education deprivation. Where deprivation compounds barriers to attending centralised services, flexible scheduling, accessible communication, and the community-based components of posture and mobility services, including home visits and community assessment, should be prioritised to ensure timely equipment review for those least able to travel. The geographic concentration of wheelchair users across South, Southwest, and North Wales, in communities characterised by convergent socioeconomic deprivation, indicates that commissioners may benefit from directing workforce capacity, equipment budgets, and service development towards areas of greatest need, rather than distributing resources uniformly across health board populations. Posture and mobility services that support the most health- and employment-deprived communities are likely to serve populations with greater clinical complexity. Ensuring adequate staffing, specialist assessment capacity, and timely review and follow-up in these areas may help to reduce secondary complications associated with delayed or inadequate wheelchair provision. High concentrations of wheelchair users are associated with income and education deprivation. Where deprivation compounds barriers to attending centralised services, flexible scheduling, accessible communication, and the community-based components of posture and mobility services, including home visits and community assessment, should be prioritised to ensure timely equipment review for those least able to travel.

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