The Relationship Between Social Deprivation and a Weekend Emergency Medical Admission

The Relationship Between Social Deprivation and a Weekend Emergency Medical Admission

Abstract

Background: Deprivation increases admission rates; the specific effect of deprivation with regard to weekend admissions is unknown.

Methods: We calculated annual weekend admission rates for each small area population unit and related these to quintiles of Deprivation Index from 2002-2014. Univariate and multivariable risk estimates were calculated using truncated Poisson regression.

Results: There were 30,794 weekend admissions in 16,665 patients. The admission rate was substantially higher for more deprived areas, 12.7 per 1000 (95%CI 9.4, 14.7) vs 4.6 per 1000 (95%CI 3.3, 5.8). More deprived patients admitted at the weekend had a significantly lower 30-day in-hospital mortality (10.3% vs 14.5%, p<0.001).

Conclusion: Deprivation is a powerful determinant of weekend admissions, however these comprise a group of patients with better outcomes.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

  1. Aylin P, Yunus A, Bottle A, et al. Weekend mortality for emergency admissions. A large, multicentre study. Qual Saf Health Care 2010; 19: 213-7.
  2. Bell C, Redelmeier D. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 2001; 345: 663-8.
  3. Maggs F, Mallet M. Mortality in out-of-hours emergency medical admissions--more than just a weekend effect. J R Coll Physicians (Edinb) 2010; 40: 115-8.
  4. Becker D. Do Hospitals Provide Lower Quality Care on Weekends? Health Serv Res. Health Serv Res 2007; 42: 1589-612.
  5. Varnava A, Sedgwick J, Deaner A. Restricted weekend service inappropriately delays discharge after acute myocardial infarction. Heart 2002; 87: 216-9.
  6. Schmulewitz L, Proudfoot A, Bell D. The impact of weekends on outcome for emergency patients. Clin Med (Lond) 2005; 5: 621-5.
  7. Townsend P. Deprivation. Journal of Social Policy 1987; 16: 25-46.
  8. Kelly A, Teljeur C. SAHRU National Deprivation Index Trinity College, Dublin 2007. Available from: http://www.sahru.tcd.ie/services/deprivation/DeprivationFiles/WebReport07.pdf.
  9. Zhao Y, You J, Guthridge SL, et al. A multilevel analysis on the relationship between neighbourhood poverty and public hospital utilization: is the high Indigenous morbidity avoidable? BMC Public Health 2011; 11: 737.
  10. Epstein AM, Stern RS, Weissman JS. Do the poor cost more? A multihospital study of patients’ socioeconomic status and use of hospital resources. N Engl J Med 1990; 322: 1122-8.
  11. Cookson R, Laudicella M. Do the poor still cost more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001/2 to 2006/7 University of York: Health, Econometrics and Data Group; Available from: http://www.york.ac.uk/res/herc/research/hedg/
    wp.htm.
  12. Walsh JB, Coakley D, Murphy C, et al. Demographic profile of the elderly population in Dublin accident and emergency hospital catchment areas. Ir Med J 2004; 97: 84-6.
  13. Conway R, O’Riordan D, Silke B. Long-term Outcome of an AMAU – a Decade’s Experience. QJM. 2014 Jan;107(1):43-49.
  14. Conway R, Byrne D, O’Riordan D, Silke B. Patient risk profiling in acute medicine – the way forward? QJM. 2015 Sep;108(9):689-96.
  15. O’Loughlin R, Allwright S, Barry J, et al. Using HIPE data as a research and planning tool: limitations and opportunities. Ir J Med Sci 2005; 174: 40-5; discussion 52-7.
  16. O’Callaghan A, Colgan MP, McGuigan C, et al. A critical evaluation of HIPE data. Ir Med J 2012; 105: 21-3.
  17. Carstairs V, Morris R. Deprivation and mortality: an alternative to social class? Community Med 1989; 11: 210-9.
  18. Shimrat M. Algorithm 112: Position of point relative to polygon. Commun ACM 1962; 5: 434.
  19. Conway R, Galvin S, Coveney S, et al. Deprivation as an outcome determinant in emergency medical admissions. QJM 2013; 106: 245-51.
  20. Cameron A, Trivedi P. Microeconometrics Using Stata. College Station, TX: Stata Press; 2009.
  21. Silke B, Kellett J, Rooney T, et al. An improved medical admissions risk system using multivariable fractional polynomial logistic regression modelling. QJM 2010; 103: 23-32.
  22. O’Sullivan E, Callely E, O’Riordan D, et al. Predicting outcomes in emergency medical admissions – role of laboratory data and comorbidity. Acute Med 2012; 2: 59-65.
  23. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83.
  24. Chotirmall SH, Picardo S, Lyons J, et al. Disabling disease codes predict worse outcomes for acute medical admissions. Intern Med J 2014; 44: 546-53.
  25. Chotirmall SH, Callaly E, Lyons J, et al. Blood cultures in emergency medical admissions: a key patient cohort. Eur J Emerg Med 2016; 23: 38-43.
  26. Eames M, Ben-Shlomo Y, Marmot MG. Social deprivation and premature mortality: regional comparison across England. BMJ 1993; 307: 1097–102.
  27. Sloggett A, Joshi H. Higher mortality in deprived areas: community or personal disadvantage? BMJ 1994; 309: 1470–4.
  28. Major JM, Doubeni CA, Freedman ND, et al. Neighborhood socioeconomic deprivation and mortality: NIH-AARP diet and health study. PLoS ONE 2010; 5: e15538.

Request Permissions

To request copyright permission to republish or share portions of our works, please visit Copyright Clearance Center’s (CCC) Marketplace website by clicking the button below:

Get Permission

The Relationship Between Social Deprivation and a Weekend Emergency Medical Admission

21st October 2016
PMID: 27759746
Authors Affiliations
Richard Conway MED Directorate, St James’s Hospital, Dublin 8, Ireland.
Seán Cournane Medical Physics and Bioengineering Department, St. Vincent’s University Hospital, Dublin 4.
Declan Byrne BSc Human Nutrition, MB Bch BAO, MRCPI, Dist Pharmaceutical Medicine, MSc Pharmaceutical Science
Deirdre O’Riordan MED Directorate, St James’s Hospital, Dublin 8, Ireland.
Seamus Coveney PhD, School of Geographical and Earth Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
Bernard Silke MED Directorate, St James’s Hospital, Dublin 8, Ireland.

The Relationship Between Social Deprivation and a Weekend Emergency Medical Admission

Cite this article as:


The Relationship Between Social Deprivation and a Weekend Emergency Medical Admission

Share this article

Click the icon of the social media platform on which you would like to share this article.


Shopping Basket
Scroll to Top