What are the social predictors of accident and emergency attendance in disadvantaged neighbourhoods? Results from a cross-sectional household health survey in the north west of England

• Published in: BMJ open 2019-01, Vol.9 (1), p.e022820-e022820
• Main Authors: Giebel, Clarissa, McIntyre, Jason Cameron, Daras, Konstantinos, Gabbay, Mark, Downing, Jennifer, Pirmohamed, Munir, Walker, Fran, Sawicki, Wojciech, Alfirevic, Ana, Barr, Ben
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Alcohol; Anxiety; Asthma; Cross-Sectional Studies; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; England; Female; General Practice - statistics & numerical data; Health services; Health Services Accessibility - statistics & numerical data; Health Surveys; Households; Humans; Inner city; Low income groups; Male; Mental depression; Mental health; Middle Aged; Morbidity; Neighborhoods; Patient Acceptance of Health Care - statistics & numerical data; Primary Health Care; Public Health; Regression Analysis; Residence Characteristics; Social support; Socioeconomic Factors; Vulnerable Populations; Young Adult
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-022820

ObjectivesThe aim of this study was to identify the most important determinants of accident and emergency (A&E) attendance in disadvantaged areas.Design, setting and participantsA total of 3510 residents from 20 disadvantaged neighbourhoods in the North West Coast area in England completed a comprehensive public health survey.Main outcome measuresParticipants were asked to complete general background information, as well as information about their physical health, mental health, lifestyle, social issues, housing and environment, work and finances, and healthcare service usage. Only one resident per household could take part in the survey. Poisson regression analysis was employed to assess the predictors of A&E attendance frequency in the previous 12 months.Results31.6% of the sample reported having attended A&E in the previous 12 months, ranging from 1 to 95 visits. Controlling for demographic and health factors, not being in employment and living in poor quality housing increased the likelihood of attending an A&E service. Service access was also found to be predictive of A&E attendance insofar as there were an additional 18 fewer A&E attendances per 100 population for each kilometre closer a person lived to a general practitioner (GP) practice, and 3 fewer attendances per 100 population for each kilometre further a person lived from an A&E department.ConclusionsThis is one of the first surveys to explore a comprehensive set of socio-economic factors as well as proximity to both GP and A&E services as predictors of A&E attendance in disadvantaged areas. Findings from this study suggest the need to address both socioeconomic issues, such as employment and housing quality, as well as structural issues, such as public transport and access to primary care, to reduce the current burden on A&E departments.