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

Abstract

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.

Predictors of emergency department and GP use among patients with mental health conditions: a public health survey

“…Most participants (89%, n = 3844) indicated that they were of white European ethnic background. Compared with census data for the north west of England, the sample was biased towards female (study sample: 57% versus census: 51%) and black and minority ethnic (study sample: 11% versus census: 8%) participants 37…”

Social prescribing for people with mental health needs living in disadvantaged communities: the Life Rooms model

“…The NWC is one of the most disadvantaged areas in the country, with consistently higher rates of premature mortality, illness, hospital admissions, mood and anxiety disorder [20]. Specifically, the NWC Household Health Survey (HHS) has shown how socio-economic issues are linked to variations in healthcare utilisation and suggests the need to address both socio-economic issues and structural issues, such as public transport and access to primary care [21,22]. This study explored the experiences of secondary mental health care service users use of the Life Rooms.…”

Do people living in disadvantaged circumstances receive different mental health treatments than those from less disadvantaged backgrounds?

“…The NWC Household Health Survey (HHS) has collected information on a number of demographic and neighbourhood level characteristics, health, mental health, lifestyle, social capital, and health care utilisation. Previous analysis of the HHS has shown that being unemployed and living in poor quality housing, as well as living further from a GP practice, were linked to increased rates of Accident and Emergency (A&E) attendance [9]. This may suggest sub-optimal health management by not approaching primary care services first, but instead attending A&E. Furthermore, comorbid mental health problems have also been linked to increased healthcare utilisation in general [10].…”