Relationships between deprivation and duration of children's emergency admissions for breathing difficulty, feverish illness and diarrhoea in North West England: an analysis of hospital episode statistics

Richard G Kyle,Malcolm Campbell,Peter Powell,Peter Callery

doi:10.1186/1471-2431-12-22

Abstract

BackgroundIn the United Kingdom there has been a long term pattern of increases in children's emergency admissions and a substantial increase in short stay unplanned admissions. The emergency admission rate (EAR) per thousand population for breathing difficulty, feverish illness and diarrhoea varies substantially between children living in different Primary Care Trusts (PCTs). However, there has been no examination of whether disadvantage is associated with short stay unplanned admissions at PCT-level. The aim of this study was to determine whether differences between emergency hospital admission rates for breathing difficulty, feverish illness and diarrhoea are associated with population-level measures of multiple deprivation and child well-being, and whether there is variation by length of stay and age.MethodsAnalysis of hospital episode statistics and secondary analysis of Index of Multiple Deprivation (IMD) 2007 and Local Index of Child Well-being (CWI) 2009 in ten adjacent PCTs in North West England. The outcome measure for each PCT was the emergency admission rate to hospital for breathing difficulty, feverish illness and diarrhoea.Results23,496 children aged 0-14 were discharged following emergency admission for breathing difficulty, feverish illness and/or diarrhoea during 2006/07. The emergency admission rate ranged from 27.9 to 62.7 per thousand. There were no statistically significant relationships between shorter (0 to 3 day) hospitalisations and the IMD or domains of the CWI. The rate for hospitalisations of 4 or more days was associated with the IMD (Kendall's taub = 0.64) and domains of the CWI: Environment (taub = 0.60); Crime (taub = 0.56); Material (taub = 0.51); Education (taub = 0.51); and Children in Need (taub = 0.51). This pattern was also evident in children aged under 1 year, who had the highest emergency admission rates. There were wide variations between the proportions of children discharged on the day of admission at different hospitals.ConclusionsDifferences between rates of the more common shorter (0 to 3 day) hospitalisations were not explained by deprivation or well-being measured at PCT-level. Indices of multiple deprivation and child well-being were only associated with rates of children's emergency admission for breathing difficulty, feverish illness and diarrhoea for hospitalisations of 4 or more days.

Highlights

In the United Kingdom there has been a long term pattern of increases in children’s emergency admissions and a substantial increase in short stay unplanned admissions
In the remaining two Primary Care Trusts (PCTs) admissions of less than 50% to a single site can be explained by the existence of two within-area hospitals or the location of a within-area hospital at the edge of the PCT making a second site in a neighbouring PCT more accessible for some of the resident population (PCT j) (Table 1)
Only longer (4 or more day) lengths of stay were associated with population-level measures of multiple deprivation and child well-being, which suggests that deprivation adversely affects illness severity

Summary

Introduction

In the United Kingdom there has been a long term pattern of increases in children’s emergency admissions and a substantial increase in short stay unplanned admissions. In the United Kingdom there has been a long term pattern of increasing rates of children’s emergency admissions [1,2] and a substantial increase in short stay unplanned admissions [3] despite overall improvement in children’s well-being [4]. Children in need, overcrowding, houses in poor condition, homelessness and environmental factors, including air quality, were all associated with differences in EARs for acute respiratory conditions in children aged 1 or more living in Greater London [8]. There has been no examination of whether deprivation or child well-being is associated with short stay unplanned admissions for breathing difficulty, feverish illness and diarrhoea

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