Top

Published in:

01-04-2018 | Original Article

Is the use of emergency departments socially patterned?

Authors: Hélène Colineaux, Fanny Le Querrec, Laure Pourcel, Jean-Christophe Gallart, Olivier Azéma, Thierry Lang, Michelle Kelly-Irving, Sandrine Charpentier, Sébastien Lamy

Published in: International Journal of Public Health | Issue 3/2018

Abstract

Objectives

To analyse the association between patients’ socioeconomic position (SEP) and the use of emergency departments (EDs).

Methods

This population-based study included all visits to ED in 2012 by inhabitants of the French Midi-Pyrénées region, recorded by the Regional Emergency Departments Observatory. We compared ED visit rates and the proportion of non-severe visits according to the patients’ SEP as assessed by the European Deprivation Index.

Results

We analysed 496,388 visits. The annual ED visit rate increased with deprivation level: 165.9 [95% CI (164.8–166.9)] visits per 1000 inhabitants among the most advantaged group, compared to 321.9 [95% CI (320.3–323.5)] per 1000 among the most disadvantaged. However, the proportion of non-severe visits was about 14% of the visits, and this proportion did not differ according to SEP.

Conclusions

Although the study shows a difference of ED visit rates, the probability of a visit being non-severe is not meaningfully different according to SEP. This supports the assumption that ED visit rate variations according to SEP are mainly explained by SEP-related differences in health states rather than SEP-related differences in health behaviours.

Available only for authorised users

Ahmad O, Boshi-Pinto C, Lopez A et al (2001) Age standardization of rates: a new WHO standard. GPE discussion paper series 31. EIP/GPE/EBD World Health Organisation, Geneva

Berchet C (2015) Emergency care services: trends, drivers and interventions to manage the demand, OECD Health Working Papers, No. 83. OECD Publishing, Paris

Carret ML, Fassa AG, Kawachi I (2007) Demand for emergency health service: factors associated with inappropriate use. BMC Health Serv Res 7(1):131. https://doi.org/10.1186/1472-6963-7-131 CrossRefPubMedPubMedCentral

Cour des Comptes (2007) Annual public report—medical emergencies: findings and recent developments rapport public annuel. Première partie—les observations des juridictions financières. Les urgences médicales: constats et évolution récente

Delpierre C, Fantin R, Chehoud H et al (2016) Social inequalities in access to care and prevention in Midi-Pyrenees, France, 2012. Inégalités sociales d’accès aux soins et à la prévention en Midi-Pyrénées, France, 2012. Bull Epidémiol Hebd 1:2–8

Department for Communities and Local Government (2011) The English indices of deprivation 2010. Department for Communities and Local Government, London

Devaux M, De Looper M (2012) Income-related inequalities in health service utilisation in 19 OECD countries, 2008–2009. OECD health working papers. Organisation for Economic Co-operation and Development, Paris. http://www.oecd-ilibrary.org/content/workingpaper/5k95xd6stnxt-en. Accessed 10 May 2016

Durand A-C, Gentile S, Devictor B et al (2011) ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. Am J Emerg Med 29(3):333–345. https://doi.org/10.1016/j.ajem.2010.01.003 CrossRefPubMed

Fourestié V, Roussignol E, Delkharrat D et al (1994) Clinical classification of emergency patients (CCMU). Definition and reproducibility. Classification clinique des malades des urgences. définition et reproductibilité. Réanim Urgences 3:573–578CrossRef

Gentile S, Vignally P, Durand A-C et al (2010) Nonurgent patients in the emergency department? A French formula to prevent misuse. BMC Health Serv Res 10(March):66. https://doi.org/10.1186/1472-6963-10-66 CrossRefPubMedPubMedCentral

Guillaume E, Pornet C, Dejardin O et al (2015) Development of a cross-cultural deprivation index in five European countries. J Epidemiol Community Health. https://doi.org/10.1136/jech-2015-205729 PubMedPubMedCentral

Harris MJ, Patel B, Bowen S (2011) Primary care access and its relationship with emergency department utilisation: an observational, cross-sectional ecological study. Br J Gen Pract 61(593):e787–e793. https://doi.org/10.3399/bjgp11X613124 CrossRefPubMedPubMedCentral

Honigman LS, Wiler JL, Rooks S, Ginde AA (2013) National study of non-urgent emergency department visits and associated resource utilization. West J Emerg Med 14(6):609–616. https://doi.org/10.5811/westjem.2013.5.16112 CrossRefPubMedPubMedCentral

Jayaprakash N, O’Sullivan R, Bey T et al (2009) Crowding and delivery of healthcare in emergency departments: the European perspective. West J Emerg Med 10(4):233–239PubMedPubMedCentral

Lang T, Davido A, Diakité B et al (1996) Non-urgent care in the hospital medical emergency department in France: how much and which health needs does it reflect? J Epidemiol Community Health 50(4):456–462CrossRefPubMedPubMedCentral

Lee A, Lau FL, Hazlett CB et al (1999) Measuring the inappropriate utilization of accident and emergency services? Int J Health Care Qual Assur 12(6–7):287–292CrossRef

Little RJ, D’Agostino R, Cohen ML et al (2012) The prevention and treatment of missing data in clinical trials. N Engl J Med 367(14):1355–1360. https://doi.org/10.1056/NEJMsr1203730 CrossRefPubMedPubMedCentral

Mackenbach JP, Stirbu I, Roskam A-JR et al (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358(23):2468–2481. https://doi.org/10.1056/NEJMsa0707519 CrossRefPubMed

Marchenko Y (2011) Chained equations and more in multiple imputation in stata 12. United Kingdom Stata Users’ Group Meetings 2011. Stata Users Group. http://econpapers.repec.org/paper/bocusug11/14.htm. Accessed 3 June 2016

McHale P, Wood S, Hughes K et al (2013) Who uses emergency departments inappropriately and when—a national cross-sectional study using a monitoring data system. BMC Med 11:258. https://doi.org/10.1186/1741-7015-11-258 CrossRefPubMedPubMedCentral

Padgett DK, Brodsky B (1992) Psychosocial factors influencing non-urgent use of the emergency room: a review of the literature and recommendations for research and improved service delivery. Soc Sci Med 35(9):1189–1197CrossRefPubMed

Pines JM, Hilton JA, Weber EJ et al (2011) International perspectives on emergency department crowding. Acad Emerg Med 18(12):1358–1370. https://doi.org/10.1111/j.1553-2712.2011.01235.x CrossRefPubMed

Pornet C, Delpierre C, Dejardin O et al (2012) Construction of an adaptable European transnational ecological deprivation index: the French version. J Epidemiol Community Health 66(11):982–989. https://doi.org/10.1136/jech-2011-200311 CrossRefPubMedPubMedCentral

Rey G, Rican S, Joula E (2013) Measuring social inequalities in mortality by cause of death. Ecological approach based on social a deprivation index. Bull Epidémiol Hebd 8–9:87–90

Rudge GM, Mohammed MA, Fillingham SC et al (2013) The combined influence of distance and neighbourhood deprivation on emergency department attendance in a large English population: a retrospective database study. PLoS One 8(7):e67943. https://doi.org/10.1371/journal.pone.0067943 CrossRefPubMedPubMedCentral

Scantlebury R, Rowlands G, Durbaba S et al (2015) Socioeconomic deprivation and accident and emergency attendances: cross-sectional analysis of general practices in England. Br J Gen Pract 65(639):e649–e654. https://doi.org/10.3399/bjgp15X686893 CrossRefPubMedPubMedCentral

Townsend P (1987) Deprivation. J Soc Policy 16(2):125–146. https://doi.org/10.1017/S0047279400020341 CrossRef

Tozer AP, Belanger P, Moore K, Caudle J (2014) Socioeconomic status of emergency department users in Ontario, 2003–2009. CJEM 16(3):220–225CrossRefPubMed

VanStone NA, Belanger P, Moore K, Caudle JM (2014) Socioeconomic composition of low-acuity emergency department users in Ontario. Can Fam Physician 60(4):355–362PubMedPubMedCentral

Title: Is the use of emergency departments socially patterned?
Authors: Hélène Colineaux
Fanny Le Querrec
Laure Pourcel
Jean-Christophe Gallart
Olivier Azéma
Thierry Lang
Michelle Kelly-Irving
Sandrine Charpentier
Sébastien Lamy
Publication date: 01-04-2018
Publisher: Springer International Publishing
Published in: International Journal of Public Health / Issue 3/2018
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI: https://doi.org/10.1007/s00038-017-1073-3

At a glance: The STEP trials

Springer Medicine

Is the use of emergency departments socially patterned?

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Lifestyle differences between older migrants and non-migrants in 14 European countries using propensity score matching method

The use of critical incident technique in population health intervention research: lessons learned

Blended learning is an effective strategy for acquiring competence in public health biostatistics

Spirituality as a protective health asset for young people: an international comparative analysis from three countries

Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment

Effect of the national screening program on malignancy status of cervical cancer in Northern Thailand