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       #Post#: 226--------------------------------------------------
       Who is at risk of emergency admission?
       By: admini5 Date: May 13, 2015, 7:54 am
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       A number of factors are associated with increased rates of
       admission, and are therefore important to consider when
       targeting interventions to reduce avoidable admissions.
       Age
       Age is a risk factor for emergency hospital admission, with
       babies or very young children and older people being at higher
       risk. However, it is important to recognise that only those aged
       5 to 14 years have low risk. Figure 1 overleaf shows emergency
       admissions for one PCT in England, and illustrates the large
       number of admissions occurring in those under 65 years of age.
       Social deprivation
       There is evidence from the UK, North America and Europe that
       people who live in areas of socio-economic deprivation have
       higher rates of emergency admissions, after adjusting for other
       risk factors. In the UK, admission rates are significantly
       correlated with measures of social deprivation (Majeed et al
       2000). Socio-demographic variables explain around 45 per cent of
       the variation in emergency admissions between GP practices, with
       deprivation more strongly linked to emergency than to elective
       admission (Reid et al 1999; Duffy et al 2002). Practices serving
       the most deprived populations have emergency admission rates
       that are around 60–90 per cent higher than those serving the
       least deprived populations (Blatchford et al 1999; Purdy et al
       2010a).
       Deprivation is also a risk factor for admission in Europe.
       Socio-economic risk factors for cardiovascular admission were
       evaluated in two large Scandinavian studies; both show that
       increasing socio-economic status – whether measured by
       employment status,
       census variables, education, housing tenure or social capital –
       is associated with decreased emergency admission rates for
       coronary heart disease (Sundquist et al 2007; Tüchsen and Endahl
       1999).
       Morbidity levels
       Higher levels of morbidity in a population are associated with
       higher levels of emergency admission. Admission rates are also
       correlated with chronic illness (Majeed et al 2000).
       Higher levels of recorded morbidity and chronic disease in
       patients registered with GP practices have also been shown to be
       associated with higher rates of emergency admission from those
       practices (Bottle et al 2008; Donald and Ambery 2000).
       Area of residence
       Those who live in urban areas have higher rates of emergency
       hospital admission than those in rural areas; for example, we
       found a 16 per cent higher rate of asthma admissions for urban
       patients compared with rural patients (Purdy et al 2010a). What
       is uncertain
       is whether these rates are lower due to better management in the
       community or because patients who live further from secondary
       care have more difficulty accessing services (O’Donnell 2000).
       We also found that those who live closer to A&E departments have
       higher rates of admission (for instance, a 12 per cent higher
       rate of admission for asthma), even after taking into account
       other risk factors, including living in an urban area (Purdy et
       al 2010a).
       Ethnicity
       Data on the impact of ethnicity on risk of emergency admission
       are fairly limited. Being from a minority ethnic group is
       associated with a higher risk of emergency admission (Bottle et
       al 2006). For example, in the UK, asthma admission rates for
       South Asian patients have been double those of white patients,
       and are also high for black patients (Gilthorpe et al 1998).
       Different ways of coping with asthma exacerbations and accessing
       care may partly explain the increased risk of hospital admission
       among South Asian patients (Griffiths et al 2001).
       
       Environmental factors
       The evidence for environmental risk factors is variable across
       diseases. For example, air pollution and meteorological factors
       in the UK are probably less important in relation to
       cardiovascular admissions than they are in respiratory
       conditions such as COPD, where cold weather is associated with
       increased rates of admission (Maheswaran et al 2005; Moran et al
       2000; Marno 2006).
       Recommendation:
       
       socio-economic deprivation and other socio-demographic factors
       when designing policy around admission rates.
       For further information, please visit:
  HTML http://www.kingsfund.org.uk/sites/files/kf/Avoiding-Hospital-Admissions-Sarah-Purdy-December2010.pdf
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