title: Spatial proximity and childhood hospital admissions in a densely populated conurbation: evidence from Hong Kong's 'Children of 1997' birth cohort.
abstract: OBJECTIVE
  Physical distance affects hospital use. In a densely populated city in China, we examined if child public hospital use was associated with individual-level proximity, and any differences by admission type or geo-spatially.
  
  
  METHODS
  We used negative binomial regression in a large, population-representative birth cohort to examine the adjusted associations of proximity to emergency facilities (A&E) with hospital admissions, bed-days and length of stay from 8 days to 8 years of age. We used geographically weighted regression to assess geo-spatial variation.
  
  
  RESULTS
  Proximity was positively associated with emergency admissions (incidence rate ratio (IRR) 1.21, 95% confidence interval (CI) 1.10 to 1.34 for <1km compared to ≥2km) and bed-days but not with length of stay, adjusted for parental education and mother's birthplace. There was no such association for other admissions (IRR 1.03, 95% CI 0.84 to 1.26). There was little geo-spatial variation.
  
  
  CONCLUSIONS
  Proximity was associated with emergency admissions. Given the societal costs of such use and the risks of iatrogenesis, attention should focus on achieving a more effective use of scarce resources.
authors.affiliation: Life course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Unit 624-627, Level 6, Core F, Cyberport 3, 100 Cyberport Road, Hong Kong SAR, China.
authors.forename: C Mary
authors.initials: CM
authors.lastname: Schooling
authors.forename: Man Ki
authors.initials: MK
authors.lastname: Kwok
authors.forename: Cynthia
authors.initials: C
authors.lastname: Yau
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Cowling
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006723:Hong Kong; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011156:Population Density; D012044:Regression Analysis