Seán Cournane1, Richard Conway2, Declan Byrne2, Deirdre O'Riordan2, Bernard Silke3. 1. Medical Physics and Clinical Engineering Department, St Vincent's Hospital, Dublin, Ireland. 2. Department of Internal Medicine, St James's Hospital, Dublin, Ireland. 3. Department of Internal Medicine, St James's Hospital, Dublin, Ireland. bernardsilke@physicians.ie.
Abstract
BACKGROUND: The community level of disability and social deprivation may result in an emergency hospitalisation; we have examined the annual admission incidence rate for emergency medical conditions in relation to the community prevalence of such factors. METHODS: All emergency medical admissions (96,305 episodes in 50,612 patients) within the institution's catchment area were examined between 2002 and 2016. The frequency of disability, level of full-time carers and unemployment for the 74 electoral divisions of the catchment area was regressed against admission rates; incidence rate ratios (IRR) were calculated using truncated Poisson regression. RESULTS: Disability was present in 12.1% of the catchment area population (95% CI = 9.7-15.0). The annual admission incidence rates/1000 population across disability quintiles for the more affluent areas increased from Q1 7.6 (95% CI = 7.4-7.8) to Q5 27.3 (95% CI = 27.0-27.5) and for the more deprived area from Q1 16.6 (95% CI = 16.4, 16.8) to and Q5 40.4 (95% CI = 40.1-40.7). Disability status influenced the overall admission IRR (compared with Q1/Q3) for Q4/Q5 1.11 (95% CI = 1.09-1.13) showing an increased rate of hospitalisation for the more deprived areas. Community disability levels interacted with local area unemployment and frequency of full-time carers; as they increased, a linear relationship between disability and the admission rate incidence was demonstrated. CONCLUSION: Local catchment area disability prevalence rates in addition to social deprivation factors are an important determinant of the annual incidence rate of emergency medical admissions.
BACKGROUND: The community level of disability and social deprivation may result in an emergency hospitalisation; we have examined the annual admission incidence rate for emergency medical conditions in relation to the community prevalence of such factors. METHODS: All emergency medical admissions (96,305 episodes in 50,612 patients) within the institution's catchment area were examined between 2002 and 2016. The frequency of disability, level of full-time carers and unemployment for the 74 electoral divisions of the catchment area was regressed against admission rates; incidence rate ratios (IRR) were calculated using truncated Poisson regression. RESULTS: Disability was present in 12.1% of the catchment area population (95% CI = 9.7-15.0). The annual admission incidence rates/1000 population across disability quintiles for the more affluent areas increased from Q1 7.6 (95% CI = 7.4-7.8) to Q5 27.3 (95% CI = 27.0-27.5) and for the more deprived area from Q1 16.6 (95% CI = 16.4, 16.8) to and Q5 40.4 (95% CI = 40.1-40.7). Disability status influenced the overall admission IRR (compared with Q1/Q3) for Q4/Q5 1.11 (95% CI = 1.09-1.13) showing an increased rate of hospitalisation for the more deprived areas. Community disability levels interacted with local area unemployment and frequency of full-time carers; as they increased, a linear relationship between disability and the admission rate incidence was demonstrated. CONCLUSION: Local catchment area disability prevalence rates in addition to social deprivation factors are an important determinant of the annual incidence rate of emergency medical admissions.
Entities:
Keywords:
Deprivation; Disability; Emergency medical admissions
Authors: Danielle Courtney; Richard Conway; John Kavanagh; Deirdre O'Riordan; Bernard Silke Journal: Postgrad Med J Date: 2014-04-02 Impact factor: 2.401