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Inequalities in Accident and Emergency Department Attendance by Socio-Economic Characteristics: Population Based Study

22 Pages Posted: 19 Oct 2023

See all articles by Owen Gethings

Owen Gethings

Government of the United Kingdom - Office for National Statistics

Perrine Machuel

Government of the United Kingdom - Office for National Statistics

Vahe Nafilyan

Government of the United Kingdom - Health Analysis and Life Events Division

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Abstract

Background: Demand for Emergency services has been soaring within England. Socio-economically disadvantaged people are more frequent users of healthcare services in general, particularly emergency services, however the underlying reason for this remains unclear.   

Methods: We estimated the odds of A&E attendance by socioeconomic status using data from the 2021 Census linked with Emergency Care data that included 51,776,958 individuals aged 0 to 95 resident in England. Logistic regression models were used to estimate odds of attendance, and to test whether health explained these differences.  

Findings: The odds of A&E attendance increased with level of deprivation, with the odds for those in the most deprived decile being 1.69 (95% CI – 1.68 to 1.69) times greater than the least deprived decile. Adjusting for underlying health attenuated but did not fully explain the association, with the odds reducing to 1.41 (95% CI – 1.40 to 1.41). This pattern was similar across age groups but most pronounced for people aged between 30 and 65. Those living in the most deprived decile had 2.26 times (95% CI = 2.23 to 2.28) higher odds of attending A&E for a condition classified as low acuity compared with those in the least deprived decile. This reduced to 2.02 (95% CI = 1.99 to 2.02) after adjusting for health.  

Interpretation: People living in more deprived areas were more likely to access A&E and these differences are not fully explained by differences in underlying health, and other factors, such as access to primary care services, may explain the remaining differences.

Funding: The Office for National Statistics.

Declaration of Interest: I confirm that authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported.

Ethical Approval: This study was ethically self-assessed against the ethical principles of the National Statistician's Data Ethics Advisory Committee (NSDEC) using NSDEC's ethics self- assessment tool. We engaged with the UK Statistics Authority Data Ethics team, who were satisfied that no further ethical approval was required.

Keywords: Accident and Emergency, Inequalities, Deprivation, Socioeconomic Status, health, Emergency Department

Suggested Citation

Gethings, Owen and Machuel, Perrine and Nafilyan, Vahe, Inequalities in Accident and Emergency Department Attendance by Socio-Economic Characteristics: Population Based Study. Available at SSRN: https://ssrn.com/abstract=4600146 or http://dx.doi.org/10.2139/ssrn.4600146

Owen Gethings (Contact Author)

Government of the United Kingdom - Office for National Statistics ( email )

London, SW1A 2AA
United Kingdom

Perrine Machuel

Government of the United Kingdom - Office for National Statistics ( email )

London, SW1A 2AA
United Kingdom

Vahe Nafilyan

Government of the United Kingdom - Health Analysis and Life Events Division ( email )

United Kingdom