Social Factors Determine the Emergency Medical Admission Workload

Abstract

We related social factors with the annual rate of emergency medical admissions using census small area statistics. All emergency medical admissions (70,543 episodes in 33,343 patients) within the catchment area of St. James's Hospital, Dublin, were examined between 2002 and 2016. Deprivation Index, Single-Parent status, Educational level and Unemployment rates were regressed against admission rates. High deprivation areas had an approximately fourfold (Incidence Rate Ratio (IRR) 4.0 (3.96, 4.12)) increase in annual admission rate incidence/1000 population from Quintile 1(Q1), from 9.2/1000 (95% Confidence Interval (CI): 9.0, 9.4) to Q5 37.3 (37.0, 37.5)). Single-Parent families comprised 40.6% of households (95% CI: 32.4, 49.7); small areas with more Single Parents had a higher admission rate-IRR (Q1 vs. for Q5) of 2.92 (95% CI: 2.83, 3.01). The admission incidence rate was higher for Single-Parent status (IRR 1.50 (95% CI: 1.46, 1.52)) where the educational completion level was limited to primary level (Incidence Rate Ratio 1.45 (95% CI: 1.43, 1.47)). Small areas with higher educational quintiles predicted lower Admission Rates (IRR 0.85 (95% CI: 0.84, 0.86)). Social factors strongly predict the annual incidence rate of emergency medical admissions.

Keywords: deprivation; education; emergency medical admissions; single-parent status.

Figure 1

Relationship between Deprivation status and Hospital Admission Incidence rates for emergency medical conditions. The predicted probabilities for each were derived from the zero-truncated Poisson model. We used margins to estimate the average marginal effect. Graphed is Admission Rates/1000 local area population between 2002–2016 for the first or any subsequent admission.

Figure 2

Spatial variation in Emergency Hospital Admission Incidence rates for medical conditions. There was a total of 74 EDs in the catchment area with a median population per ED of 2845 (IQR 2020, 3399). These areas have a high element of Deprivation, being ranked nationally as Deprivation Quintile I (n = 13), Quintile III (n = 5), Quintile IV (n = 4) and Quintile V (n = 49). ED = Electoral Division.

Figure 3

Relationship between Single-Parent status and Admission Incidence Rate of an emergency medical admission. The predicted probabilities were derived from the multi-variable truncated Poisson model. We used margins to estimate and interpret adjusted predictions for sub-groups, while controlling for other variables, using computations of average marginal effects. Single-Parent small area frequency predicted an increased admission rate, adjusted for Deprivation status.

Figure 4

Interaction between small area Single Parent and unemployment rates and the Admission Incidence Rate of an emergency medical admission. The predicted probabilities were derived from the multi-variable truncated Poisson model. We used margins to estimate and interpret adjusted predictions for sub-groups, while controlling for other variables, using computations of average marginal effects. As the Quintiles (Q1, Q3, Q3) of unemployment increased, the strength of the association of Single-Parent status with the admission rate increased.