An epidemiological study of varying emergency medical admission rates in Glasgow

[摘要] Background: Emergency medical admissions in the United Kmgdom havebeen rising for many years. This rise has resulted in increasing pressureson hospitals' resources, with consequent difficulties in coping with peaks ofadmissions. This rise has not been intended or planned. The epidemiologyof emergency medical admissions is poorly understood.Aims: To investigate the epidemiology of emergency medical admissions inGlasgow in terms of time, person and place. To explore variations inGlasgow's general practices' and hospitals' emergency medical admissionrates.Literature review: Articles relating to variations in emergency medicaladmission rates were identified by searching bibliographic databases, crossreferencing from known articles, consulting other researchers and handsearching of journal indexes. Relevant articles were included in asystematic review of the epidemiology of varying rates of hospitals'emergency admissions. Articles that postulated causes of the rise ofemergency admissions or factors associated with varying admission rateswere also reviewed. A summary of mechanisms whereby hospitals mightcope with pressures of emergency admissions concluded the literaturereview.Published evidence of variations of rates of hospital emergency admissionwas limited. Most articles were found to contain postulated associationswith variations in hospitals' emergency admissions. While many publishedmechanisms for hospitals to adapt to pressures from emergency admissionswere identified, only a minority of these had been formally evaluated.3Setting: Greater Glasgow Health Board residents (813,029 adults at June1997). Data obtained from the Health Board's Community Health Index(CHI).Subjects: 537,798 Greater Glasgow Health Board residents admitted toGlasgow hospitals7 medical beds between 1980 and 1997 (43,236 patientsin 1997). Data obtained from Scottish Morbidity Record database one(SMRl).Methods: Anonymised CHI and SMRl datasets linked by patients' generalpractitioners' codes, using a computer database package. Standardisedemergency medical admission rates were calculated by the database.Computerised maps of standardised emergency medical admission ratioswere plotted for Glasgow7s postcode sectors to show geographicalvariations. Correlation and logistic regression were used to explorevariations in standardised emergency medical admission ratios.Outcome measures: Crude emergency medical admission rates.Standardised emergency medical admission ratios adjusted for patients7age, sex and Carstairs7 deprivation categories.Results: The numbers of emergency medical admissions doubled between1980 and 1997. Emergency medical admission rates increased steeply withincreasing age of patients, more than doubling for every two decades. Menabove 40 years had approximately 20% higher age specific emergencymedical admission rates than women. Emergency medical admission rateswere more than twice as high amongst patients from Glasgow's mostdeprived areas, compared with the most affluent.Cardiovascular disease (ICD10 chapter IX) discharge diagnoses werecommonest (27.2% in 1997)' followed by the non-specific diagnoses inICDlO chapter XVII (21.0%). The non-specific diagnoses mainly comprisedchest pain (9.6%) which was the commonest reason for admission. Between1980 and 1997, non-specific diagnoses (ICD10 chapter XVII) increased attwice the rate of all other ICDlO chapters of diagnoses.There were two areas of Glasgow that had raised standardised emergencymedical admission ratios (adjusted for patients' ages, sex and deprivation).These corresponded to the catchment areas of two acute hospitals, whichhad substantially higher adjusted emergency medical admission ratiosthan had the other three.There was a 2.51 fold variation between the top and bottom deciles ofGlasgow's general Practices' crude emergency medical admission rates.After adjustment for their patients' age, sex and deprivationcharacteristics, this reduced to a 1.87 fold variation. Additional adjustmentfor general practices' admitting hospitals (along with their patients' age,sex and deprivation) accounted for a total of 84% of the inter-practicevariation in crude emergency medical admission rates.Fundholding general practices had modestly raised emergency medicaladmission rates (odds ratio 1.06.) There were no associations betweenpractices' rates of emergency medical admissions and any other measuredpractices' characteristics (including numbers of partners, practices' sizes ordispersions, immunisation and cytology rates).Conclusions: This large study discovered epidemiological associationsbetween emergency medical admission rates and patients' sex and socioeconomicdeprivation that had not previously been shown. It showed thatemergency admission rate variations between general practices were onlypartly accounted for by patient characteristics. Apart from fundholdingstatus, difference between practices were not related to variations in theirrates of emergency medical admissions. However, a substantial part of thevariation between general practices could be attributed to differencesbetween their admitting hospitals.

[发布机构] University:University of Glasgow;Department:Institute of Health and Wellbeing

[关键词] RA0421 Public health. Hygiene. Preventive Medicine