Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: 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 socioeconomic disadvantage have higher rates of emergency admissions for ACSCs than their more affluent counterparts. Emergency admis...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/9/1/e002991.full |
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| author | Bernie Carter Enitan D Carrol David Taylor-Robinson Konstantinos Daras Tanith Rose Kate Mason Courtney Franklin Lateef Akanni |
| author_facet | Bernie Carter Enitan D Carrol David Taylor-Robinson Konstantinos Daras Tanith Rose Kate Mason Courtney Franklin Lateef Akanni |
| author_sort | Bernie Carter |
| collection | DOAJ |
| description | Background Ambulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socioeconomic 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 and 2017, paediatric emergency admissions for acute ACSCs increased, while admissions for chronic ACSCs decreased. At the neighbourhood level, each 1% 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 years old. 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. |
| format | Article |
| id | doaj-art-b2e74604bd83479e991fbb7290c3666e |
| institution | Kabale University |
| issn | 2399-9772 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj-art-b2e74604bd83479e991fbb7290c3666e2025-01-20T05:30:09ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722025-01-019110.1136/bmjpo-2024-002991Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017Bernie Carter0Enitan D Carrol1David Taylor-Robinson2Konstantinos Daras3Tanith Rose4Kate Mason5Courtney Franklin6Lateef Akanni71 Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UKInstitute of Infection and Global Health, University of Liverpool, Liverpool, UKprofessor of public health and policy, and NIHR research professorInstitute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK1 Health Protection Research Unit in Gastrointestinal Infections, National Institute for Health Research, Liverpool, UK2 Institute of Population Health Sciences, University of Liverpool, Liverpool, UK1Public Health, Policy and Systems, University of Liverpool, Liverpool, UKInstitute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UKBackground Ambulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socioeconomic 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 and 2017, paediatric emergency admissions for acute ACSCs increased, while admissions for chronic ACSCs decreased. At the neighbourhood level, each 1% 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 years old. 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.https://bmjpaedsopen.bmj.com/content/9/1/e002991.full |
| spellingShingle | Bernie Carter Enitan D Carrol David Taylor-Robinson Konstantinos Daras Tanith Rose Kate Mason Courtney Franklin Lateef Akanni Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017 BMJ Paediatrics Open |
| title | Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017 |
| title_full | Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017 |
| title_fullStr | Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017 |
| title_full_unstemmed | Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017 |
| title_short | Neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children: a longitudinal ecological analysis in England, 2012–2017 |
| title_sort | neighbourhood socioeconomic conditions and emergency admissions for ambulatory care sensitive conditions in children a longitudinal ecological analysis in england 2012 2017 |
| url | https://bmjpaedsopen.bmj.com/content/9/1/e002991.full |
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