Social Factors Determine the Emergency Medical Admission Workload.

Seán Cournane,Richard Conway,Deirdre O’Riordan,Seamus Coveney,Declan Byrne,Bernard Silke

doi:10.3390/jcm6060059

Seán Cournane, Richard Conway + Show 4 more

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https://doi.org/10.3390/jcm6060059

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Abstract

We related social factors with the annual rate of emergency medical admissions using census small area statistics. All emergency medical admissions (70,543 episodes in 33,343 patients) within the catchment area of St. James’s Hospital, Dublin, were examined between 2002 and 2016. Deprivation Index, Single-Parent status, Educational level and Unemployment rates were regressed against admission rates. High deprivation areas had an approximately fourfold (Incidence Rate Ratio (IRR) 4.0 (3.96, 4.12)) increase in annual admission rate incidence/1000 population from Quintile 1(Q1), from 9.2/1000 (95% Confidence Interval (CI): 9.0, 9.4) to Q5 37.3 (37.0, 37.5)). Single-Parent families comprised 40.6% of households (95% CI: 32.4, 49.7); small areas with more Single Parents had a higher admission rate-IRR (Q1 vs. for Q5) of 2.92 (95% CI: 2.83, 3.01). The admission incidence rate was higher for Single-Parent status (IRR 1.50 (95% CI: 1.46, 1.52)) where the educational completion level was limited to primary level (Incidence Rate Ratio 1.45 (95% CI: 1.43, 1.47)). Small areas with higher educational quintiles predicted lower Admission Rates (IRR 0.85 (95% CI: 0.84, 0.86)). Social factors strongly predict the annual incidence rate of emergency medical admissions.

Highlights

Deprivation [1] is associated with a marked increase in hospital admission rates [2], increased length of stay [3] and has been shown to influence mortality [4,5]
2002 and 2016, we investigate whether the emergency admission incidence rate is a sensitive indicator of healthcare outcomes as related to local area social factors
While our data relates to one hospital only and uses a different albeit related Deprivation Index methodology, the absolute admission incidence rate appears quite similar to those calculated for UK data [33]

Summary

Introduction

Deprivation [1] is associated with a marked increase in hospital admission rates [2], increased length of stay [3] and has been shown to influence mortality [4,5]. The emergency medical admission rate being a non-discretionary event can be proposed as a healthcare outcome measure to examine the impact of social or environmental factors on health in the broadest sense. All emergency medical admissions (70,543 episodes in 33,343 patients) within the catchment area of St. James’s Hospital, Dublin, were examined between. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) has been used for both diagnosis and procedure coding from 1990 to 2005, and ICD-10-CM since Data included parameters such as the unique hospital number, admitting consultant, date of birth, gender, area of residence, principal and up to nine additional secondary diagnoses, principal and up to nine additional secondary procedures, and admission and discharge dates. Additional information cross-linked and automatically uploaded to the database includes physiological, haematological and biochemical parameters

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