title: Effect of social deprivation on the admission rate and outcomes of adult respiratory emergency admissions.
abstract: Patients with respiratory disorders constitute a major source of activity for Acute Medicine. We have examined the impact of Socio-Economic Status (SES) and weather factors on the outcomes (30-day in-hospital mortality) of emergency hospitalisations with a respiratory presentation.
  
  
  
  All emergency respiratory admissions to St. James Hospital, Dublin, from 2002 to 2014 were evaluated. Patients were categorized by quintile of Deprivation Index, and evaluated against hospital admission rate (/1000 population) and 30-day in-hospital mortality. Univariate and multivariable risk estimates (Odds Ratios (OR) or Incidence Rate Ratios (IRR)) were calculated, using logistic or zero truncated Poisson regression as appropriate.
  
  
  
  There were 32,538 episodes in 14,093 patients, representing 39.5% of medical emergency episodes over the 13-yr period. Deprivation Quintile independently predicted the admission rate, with incidence rate ratios (IRR) of Q3 2.02 (95% CI: 1.27, 3.23), Q4 2.55 (95% CI: 1.35, 4.83) and Q5 5.68 (95% CI: 3.56, 9.06). The 30-day in-hospital mortality for the highest quintile was increased (p < 0.01), Q5 1.31 (95% CI: 1.07, 1.61). Particulate matter (PM10) was predictive for the top two quintiles (>17.2 and 23.8 μg/m3respectively) with an OR for a worse outcome of Q4 1.22 (95% CI: 1.07, 1.40) and Q5 1.24 (95% CI: 1.08, 1.42). Weather (season) and the daily temperature did not affect the admission rate but were significantly associated with worse outcome.
  
  
  
  Socio-Economic Status influences the admission rate incidence and hospital mortality of respiratory emergency admissions; local environmental conditions (air pollution and temperature) appear only relevant to the mortality outcomes.
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: Envo-Geo Environmental Geoinformatics, Ireland.
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: D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000009:adverse effects*; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D011237:Predictive Value of Tests; D012129:Respiratory Function Tests / Q000379:methods; D012139:Respiratory Therapy Department, Hospital / Q000592:standards*; D012720:Severity of Illness Index; D012923:Social Class; D014887:Weather
keywords: Air pollution; Deprivation; Emergency respiratory admission; Weather