title: Socio-economic deprivation and risk of emergency readmission and inpatient mortality in people with sickle cell disease in England: observational study.
abstract: BACKGROUND
  Sickle cell disease (SCD) is a cause of frequent emergency readmissions. We examined trends in SCD emergency readmissions and inpatient mortality in England in relation to socio-economic status.
  
  
  METHODS
  Data from Hospital Episode Statistics were extracted for all SCD patients admitted in 2005/06. The financial year 2005/06 was taken as the index year for analysis. We calculated readmission rates and inpatient mortality for patients admitted with a primary or secondary diagnosis of sickle cell anaemia with crisis and without crisis in the index year during the subsequent 5 years (2006/07-2010/11). Charlson Score was used to measure comorbidity. Using Cox proportional hazards models, we also examined the relationship between patient characteristics and both emergency readmissions and inpatient mortality.
  
  
  RESULTS
  In 2005/06, there were 7679 SCD index admissions. Over the subsequent 5-year period, patients living in the most socio-economically deprived areas were at highest risk of readmission (54.2% readmitted over the study period compared with 28% of the least deprived group). Inpatient mortality amongst readmissions was highest in patients living in the most deprived areas [hazard ratio (HR) 2.34, 95% CI 1.41-3.90].
  
  
  CONCLUSIONS
  SCD patients from the most socio-economically deprived areas and with comorbidities are at highest risk of both SCD readmissions and in-hospital mortality, suggesting that there are inequalities in healthcare access and health outcomes amongst people with SCD.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK.
authors.forename: Ghida
authors.initials: G
authors.lastname: Aljuburi
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Laverty
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Green
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Phekoo
authors.forename: Derek
authors.initials: D
authors.lastname: Bell
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: chronic disease; management and policy; socioeconomics factors