Deprivation as an outcome determinant in emergency medical admissions

Conway, R., Galvin, S., Coveney, S., O'Riordan, D. and Silke, B. (2013) Deprivation as an outcome determinant in emergency medical admissions. QJM: An International Journal of Medicine, 106(3), pp. 245-251. (doi: 10.1093/qjmed/hcs233)

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Abstract

Background: Deprivation in the general population predicts mortality. We have investigated its relevance to an acute medical admission, using a database of all emergency admissions to St James’ Hospital, Dublin, over a ten year period (2002-2011). <p/>Methods: All emergency admissions, based on geocoding of residence, were allocated to a Small Area Health Research Unit (SAHRU) division, with a corresponding deprivation index. We then examined this index as a univariate (unadjusted) and independent (adjusted) predictor of 30-day in-hospital mortality. <p/>Results: The 30-day in-hospital mortality, over the 10 year period was higher, for those in the upper half of the deprivation distribution (9.6% vs 8.6%: p = 0.002). Indeed, there was a stepwise increase in 30-day mortality over the quintiles of deprivation from 7.3% (Quintile 1) to 8.8%, 10.0%, 10.0% and 9.3% respectively. Univariate logistic regression of the deprivation indices (quintiles) against outcome showed an increased risk (p = 0.002) of a 30-day death with OR’s respectively (compared with lowest deprivation quintile) of 1.23 (95% CI 1.07, 1.40), 1.41 (95% CI 1.24, 1.60), 1.41 (95% CI 1.24, 1.61) and 1.30 (95% CI 1.14, 1.48). The deprivation index was an independent predictor of outcome in a model when adjusted for illness severity and co-morbidity. The fully adjusted OR for a 30-day death was increased by 31% (p=0.001) for patients in the upper half of the deprivation index distribution (OR 1.31: 95% CI 1.20, 1.44). <p/>Conclusion: Deprivation independently of co-morbidity or acute illness severity is a powerful outcome predictor in acute medical admissions.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Coveney, Dr Seamus
Authors: Conway, R., Galvin, S., Coveney, S., O'Riordan, D., and Silke, B.
College/School:College of Science and Engineering > School of Geographical and Earth Sciences > Geography
Journal Name:QJM: An International Journal of Medicine
Publisher:Oxford University Press
ISSN:1460-2725
ISSN (Online):1460-2393
Published Online:18 December 2012
Copyright Holders:Copyright © 2012 Oxford University Press
First Published:First published in QJM - An International Journal of Medicine 106(3):245-251
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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