Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study

Jones, Charlotte EL and Shabuz, Zillur Rahman and Bachmann, Max Oscar and Burke, Amanda and Brainard, Julii and Cullum, Rachel and Saunders, Mike and Dalton, Alice M. and Enwo, Oby Otu and Steel, Nick (2024) Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study. PLoS One, 19 (5): e0303270. ISSN 1932-6203

Abstract

Introduction<jats:p/>Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated associations between individuals’ characteristics (including socioeconomic deprivation and long-term health conditions (LTC)) and the frequency of emergency department (ED) attendances in the Norfolk and Waveney subregions of the East of England.Methods<jats:p/>The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year, from April 1, 2022, to March 31, 2023. Linked primary and secondary care and geographical data included each individual’s sociodemographic characteristics, number of ED attendances during the same year, and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendance were estimated using Poisson regression models.Results<jats:p/>1,027,422 individuals were included, of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population, ED attendances were more frequent in individuals aged under five years (adjusted incidence rate ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15–35 years; living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63) for the least deprived compared to the most deprived; and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)).Conclusions<jats:p/>In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance.