title: Deprivation influences the emergency admission rate of ambulatory care sensitive conditions.
abstract: Ambulatory care sensitive conditions (ACSCs) are a group of conditions judged to be suitable for healthcare efficiency initiatives to reduce the rate of hospital admissions. All emergency medical admissions to an Irish hospital between 2002 and 2013 were assessed for ACSCs. They were categorised by quintile of deprivation index and evaluated against hospital admission rate. Univariable and multivariable risk estimates were calculated, using logistic regression or zero-truncated Poisson regression. There were 66,861 admissions in 36,214 patients. ACSCs represented 66.4% of admissions. The rate of ACSC admissions increased with deprivation index, Q1 10.4 (95% confidence interval (CI) 10.2-10.5), Q2 17.3 (95% CI 17.2-17.5), Q3 34.0 (95% CI 33.7-34.2), Q4 30.2 (95% CI 30.0-30.4) and Q5 44.5 (95% CI 43.8- 45.1) (p<0.001), corresponding incidence rate ratios compared with Q1 were: Q2 1.67 (95% CI 1.64-1.70), Q3 3.28 (95% CI 3.22-3.33), Q4 2.92 (95% CI 2.87-2.97) and Q5 4.29 (95% CI 4.20-4.39) (p<0.001). ACSCs are common in acute medical admissions and are strongly influenced by the underlying social demographics of the population.
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin, Ireland, and CARD Newman Research Fellow, University College Dublin, Dublin, Ireland.
authors.forename: Richard
authors.initials: R
authors.lastname: Conway
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin, Ireland.
authors.forename: Deirdre
authors.initials: D
authors.lastname: O'Riordan
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin, Ireland.
authors.forename: Declan
authors.initials: D
authors.lastname: Byrne
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin, Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Cournane
authors.affiliation: School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Seamus
authors.initials: S
authors.lastname: Coveney
authors.affiliation: Department of Internal Medicine, St James's Hospital, Dublin, Ireland bernardsilke@physicians.ie.
authors.forename: Bernard
authors.initials: B
authors.lastname: Silke
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: Deprivation index; admission rate; ambulatory care sensitive condition; emergency medical admission