Influence of social deprivation, overcrowding and family structure on emergency medical admission rates.
BACKGROUND
Patients from deprived backgrounds have a higher in-patient mortality following emergency medical admission.


OBJECTIVE
To evaluate the influence of Deprivation Index, overcrowding and family structure on hospital admission rates.


METHODS
Retrospective cohort study.


METHODS
All emergency medical admissions from 2002 to 2013 were evaluated. Based on address, each patient was allocated to an electoral division, whose small area population statistics were available from census data. Patients were categorized by quintile of Deprivation Index, overcrowding and family structure, and these were evaluated against hospital admission rate, calculated as rate/1000 population. Univariate and multivariable risk estimates (Odds Ratios or Incidence Rate Ratios) were calculated, using logistic or zero truncated Poisson regression as appropriate.


RESULTS
There were 66 861 admissions in 36 214 patients over the 12-year study period. Deprivation Index quintile independently predicted the admission rate, with rates of Q1 12.0 (95% CI 11.8-12.2), Q2 19.5 (95% CI 19.3-19.6), Q3 33.7 (95% CI 33.3-34.0), Q4 31.4 (95% CI 31.2-31.6) and Q5 38.1 (95% CI 37.7-38.5). Similarly the proportions of families with children <15 years old, was an independent predictor of the admission rate with rates of Q1 20.8 (95% CI 20.4-21.1), Q2 23.0 (95% CI 22.7-23.3), Q3 32.2 (95% CI 31.9-32.5), Q4 32.4 (95% CI 32.2-32.7) and Q5 37.2 (95% CI 36.6-37.8). The proportion of families with children ≥15-years old was also predictive but quintile of overcrowding was only predictive in the univarate model.


CONCLUSIONS
Deprivation Index and family structure strongly predict emergency medical hospital admission rates.
From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland.|CARD Newman Research Fellow, University College Dublin, Belfield, Ireland.
R
R
Conway
From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland.
D
D
Byrne
From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland.
D
D
O'Riordan
From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland.
S
S
Cournane
School of Geographical and Earth Sciences, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
S
S
Coveney
From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland bernardsilke@physicians.ie.
B
B
Silke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011204:Poverty Areas; D012189:Retrospective Studies; D012959:Socioeconomic Factors