title: Social deprivation and hospital admission rates, length of stay and readmissions in emergency medical admissions.
abstract: BACKGROUND
  Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission. How deprivation relates to the admission or readmission incidence rates, episode length of stay (LOS) and ancillary resource utilization is less clear.
  
  
  METHODS
  All emergency medical admissions (66,861 episodes in 36,214 patients) between 2002 and 2013, categorized by quintile of Irish National Deprivation Index were assessed against admission or readmission incidence rates (/1000 local population by electoral division), LOS and utilization of five ancillary services. Univariate and multi-variable risk estimates (odds ratios (OR) or incidence rate ratios (IRR)) were calculated, using truncated Poisson regression.
  
  
  RESULTS
  The deprivation index quintile was strongly correlated with the emergency medical admission rate with IRR (as compared with quintile 1) as follows: Q2 1.99 (95% CI: 1.96, 2.01), Q3 3.45 (95% CI: 3.41, 3.49), Q4 3.27 (95% CI: 3.23, 3.31) and Q5 4.29 (95% CI: 4.23, 4.35). LOS was not influenced by deprivation status; although increasing deprivation resulted in increased utilization of social services (OR 1.04: 95% CI: 1.03, 1.06), with a lower requirement for occupational therapy (OR 0.94: 95% CI: 0.93, 0.96) and speech/language services (OR 0.83: 95% CI: 0.80, 0.86). There was a rather decreased use of ancillary services with increasing deprivation; however, the readmission rate was strongly predicted by deprivation status.
  
  
  CONCLUSIONS
  Deprivation status strongly influenced the admission and readmission rates for medical patients admitted as emergencies; however, ancillary resource utilization was not increased. Deprivation index will increase demand on hospital resources due to the aggregate effect on both admission and readmission incidence rates.
authors.affiliation: Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland.
authors.forename: Seán
authors.initials: S
authors.lastname: Cournane
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
authors.forename: Declan
authors.initials: D
authors.lastname: Byrne
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
authors.forename: Richard
authors.initials: R
authors.lastname: Conway
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
authors.forename: Deirdre
authors.initials: D
authors.lastname: O'Riordan
authors.affiliation: School of Geographical and Earth Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK.
authors.forename: Seamus
authors.initials: S
authors.lastname: Coveney
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland. Electronic address: bernardsilke@physicians.ie.
authors.forename: Bernard
authors.initials: B
authors.lastname: Silke
mesh_terms: D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D004630:Emergencies / Q000453:epidemiology / Q000523:psychology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012934:Social Isolation / Q000523:psychology*; D013223:Statistics as Topic
keywords: Admission incidence rates; Deprivation index; Emergency medical patients; Resource utilization