TY - JOUR
T1 - Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children. A longitudinal ecological analysis in England
AU - Franklin, Courtney
AU - Mason, Kate
AU - Akanni, Lateef
AU - Daras, Konstantinos
AU - Rose, Tanith
AU - CARTER, BERNIE
AU - Carrol, Enitan
AU - Taylor-Robinson, David
PY - 2025/1/19
Y1 - 2025/1/19
N2 - BackgroundAmbulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socio-economic disadvantage have higher rates of emergency admissions for ACSCs than their more affluent counterparts. Emergency admissions for ACSCs have been increasing, but few studies have assessed how changing socioeconomic conditions (SECs) have impacted this. This study investigates the association between local SECs and emergency ACS hospital admissions in children in England.MethodsWe examined longitudinal trends in emergency admission rates for ACSCs, and investigate the association between local SECs and these admissions in children over time in England, using time-varying neighbourhood unemployment as a proxy for SECs. Fixed-effect regression models assessed the relationship between changes in neighbourhood unemployment and admission rates, controlling for unmeasured time-invariant confounding of each neighbourhood. We also explore the extent to which this relationship differs by acute and chronic ACSCs and is explained by access to primary and secondary care.ResultsBetween 2012- 2017, paediatric emergency admissions for acute ACSCs increased, whilst admissions for chronic ACSCs decreased. At the neighbourhood level, each one percentage point increase in unemployment was associated with a 3.9% and 2.7% increase in the rate of emergency admissions for acute ACSCs, for children aged 0-9 years and 10-19 years, respectively. A 2.6% increase in admission rates for chronic ACSCs was observed, driven by an association in 0–9-year-olds. Adjustment for primary and secondary care access did not meaningfully attenuate the magnitude of this association.ConclusionsIncreasing trends in neighbourhood unemployment were associated with increases in paediatric emergency admission rates for ACSCs in England. This was not explained by available measures of differential access to care, suggesting policy interventions should address the causes of unemployment and poverty in addition to health system factors to reduce emergency admissions for ACSCs.
AB - BackgroundAmbulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socio-economic disadvantage have higher rates of emergency admissions for ACSCs than their more affluent counterparts. Emergency admissions for ACSCs have been increasing, but few studies have assessed how changing socioeconomic conditions (SECs) have impacted this. This study investigates the association between local SECs and emergency ACS hospital admissions in children in England.MethodsWe examined longitudinal trends in emergency admission rates for ACSCs, and investigate the association between local SECs and these admissions in children over time in England, using time-varying neighbourhood unemployment as a proxy for SECs. Fixed-effect regression models assessed the relationship between changes in neighbourhood unemployment and admission rates, controlling for unmeasured time-invariant confounding of each neighbourhood. We also explore the extent to which this relationship differs by acute and chronic ACSCs and is explained by access to primary and secondary care.ResultsBetween 2012- 2017, paediatric emergency admissions for acute ACSCs increased, whilst admissions for chronic ACSCs decreased. At the neighbourhood level, each one percentage point increase in unemployment was associated with a 3.9% and 2.7% increase in the rate of emergency admissions for acute ACSCs, for children aged 0-9 years and 10-19 years, respectively. A 2.6% increase in admission rates for chronic ACSCs was observed, driven by an association in 0–9-year-olds. Adjustment for primary and secondary care access did not meaningfully attenuate the magnitude of this association.ConclusionsIncreasing trends in neighbourhood unemployment were associated with increases in paediatric emergency admission rates for ACSCs in England. This was not explained by available measures of differential access to care, suggesting policy interventions should address the causes of unemployment and poverty in addition to health system factors to reduce emergency admissions for ACSCs.
KW - emergency Care
KW - children
KW - ambulatory care
U2 - 10.1136/bmjpo-2024-002991
DO - 10.1136/bmjpo-2024-002991
M3 - Article (journal)
SN - 2399-9772
VL - 9
SP - 1
EP - 8
JO - BMJ Paediatrics Open
JF - BMJ Paediatrics Open
IS - e002991
M1 - e002991
ER -