What is the relationship between age and deprivation in influencing emergency hospital admissions? A model using data from a defined, comprehensive, all-age cohort in East Devon, UK

• Published in: BMJ open Vol. 7; no. 2; p. e014045
• Main Authors: Pereira Gray, Denis, Henley, William, Chenore, Todd, Sidaway-Lee, Kate, Evans, Philip
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-02-2017; BMJ Publishing Group
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; Aged, 80 and over; Anaphylaxis; Child; Child, Preschool; Emergencies; Female; Health Care Rationing; Health Services Research; Health Status; Hospitalization; Humans; Infant; Infant, Newborn; Local government; Logistic Models; Male; Middle Aged; Morbidity; Older people; Patient Admission - statistics & numerical data; Patient admissions; Population; Probability; Public policy; Regional Health Planning; Residence Characteristics; Social Isolation; Socioeconomic Factors; Trends; United Kingdom; Young Adult; United Kingdom > UK; England; Scotland; ACCIDENT & EMERGENCY MEDICINE; GERIATRIC MEDICINE; SOCIAL MEDICINE
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-014045

ObjectivesTo clarify the relationship between social deprivation and age as two factors associated with emergency admissions to hospital.DesignEmergency admissions for 12 months were analysed for patients in the NHS NEW Devon CCG. Social deprivation was measured by the Index of Multiple Deprivation (IMD). Logistic regression models estimated the separate and combined effects of social deprivation and age on the risk of emergency admissions for people aged under and over 65.SettingEast Devon, UK—area of the NEW Devon CCG.Population765 861 patients in the CCG database.Main outcome measureEmergency admission to any English hospital.ResultsAge (p<0.001) and social deprivation (p<0.001) were significantly associated with emergency admission to hospital, but there was a significant interaction between age and social deprivation (p<0.001). From the third quintile of age upwards, age progressively overtakes deprivation and age has a dominant effect on emergency admissions over the age of 65. The effect of age was J-shaped in all deprivation groups, increasing exponentially after age 40. For patients under 65, age and social deprivation had similar risks for emergency admissions, the differences in risk between the top and bottom quintiles of IMD and age being ∼1.5 and 0.9 percentage points. In patients over 65, age had a much greater effect on the risk of admissions than social deprivation, the differences in risk between the top and bottom quintiles of IMD and age being ∼2.8 and 18.7 percentage points.ConclusionsRisk curves for all social groups have similar shapes, implying a common biological pattern for ageing in any social group. Over age 65, the biological effects of ageing outweigh the social effects of deprivation. Our model enables CCGs to anticipate and plan for emergency admissions to hospital. These findings provide a new logic for allocating resources to different populations.