Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children. A longitudinal ecological analysis in England: A longitudinal ecological analysis in England, 2012-2017

Background
Ambulatory 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.
Methods
We 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.
Results
Between 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.
Conclusions
Increasing 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.