Background Around one fifth of emergency admissions to hospital are for conditions regarded as “ambulatory care sensitive”, that is the need for admission could have potentially been avoided through timely access to primary care. Previous studies have found that age and deprivation have strong influence on the likelihood of hospital admission. The present study examines whether rates of emergency admission for ACS conditions are disproportionately higher for deprived older people.
Methods An observational study based on routinely collected hospital admission data from April 2011 to March 2012 from NHS hospitals in England. Age-specific emergency admission rates were calculated at the national level using population and deprivation estimates for small area of residence. An admission was categorised as “ambulatory care sensitive” if any of 27 specific ACS conditions were noted in the ICD-10 diagnostic codes associated with the admission.
Results Rates of ACS admission increase with deprivation in every age band. The inequality is least evident for people aged between 15 and 19, when the least deprived group have 64 ACS admissions per 100,000 while the most deprived group have 104 admission per 100,000 (a rate 1.6 times higher). As rates of admission increase with age, so does the disparity between deprivation groups, reaching a maximum of 3.8-fold difference in the 45-49 age group (49 vs 184 admissions per 100,000). From that point the inequality narrows as age continues to increase, with people aged 85 and over having just a 1.6-fold difference between the least and most deprived groups (993 vs 1,610 admissions per 100,000). Emergency admissions for ACS conditions are more strongly influenced by deprivation than those for non-ACS conditions, and patterns of admission vary by individual ACS condition.
Conclusion Rates of admission for conditions potentially amenable to primary care increase with both increasing patient age and local levels of deprivation. The degree of increase due to deprivation does not vary linearly with age. This suggests that efforts to prevent hospital admission, which traditionally focus on patients aged 65 and over, may benefit from including adults up to twenty years younger in the most deprived areas.
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