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BMC Health Services Research
Published in: BMC Health Services Research 1/2022

Open Access 01-12-2022 | Care | Research

Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study

Authors: Selina Nath, Ania Zylbersztejn, Russell M. Viner, Mario Cortina-Borja, Kate Marie Lewis, Linda P. M. M. Wijlaars, Pia Hardelid

Published in: BMC Health Services Research | Issue 1/2022

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Abstract

Background

There is limited understanding of the drivers of increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations.

Methods

Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1-April-2012 and 31-March-2019 were followed up for 1 year; from 1-April-2013 (from the discharge date of their birth admission) until their first birthday, death or 31-March-2019.
Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted for individual-level factors and included a random effect for local authority (LA).

Results

The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendances and emergency admissions were highest amongst: infants born < 32 weeks gestation; with presence of congenital anomaly; and to mothers < 20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority.

Conclusions

Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. The impact of these services requires further investigation. Substantial geographical variations in rates were not explained by individual-level factors. This suggests more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.
Appendix
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Literature
1.
2.
3.
4.
Greenfield G, Blair M, Aylin PP, Saxena S, Majeed A, Hoffman M, et al. Frequent attendances at emergency departments in England. Emerg Med J. 2020;37(10):597–9.PubMedCrossRef
5.
Johnson L, Cornish R, Boyd A, Macleod J. Socio-demographic patterns in hospital admissions and accident and emergency attendances among young people using linkage to NHS Hospital Episode Statistics: results from the Avon Longitudinal Study of Parents and Children. BMC health services research. 2019;19(1):134.PubMedPubMedCentralCrossRef
6.
McHale P, Wood S, Hughes K, Bellis MA, Demnitz U, Wyke S. Who uses emergency departments inappropriately and when - a national cross-sectional study using a monitoring data system. BMC Med. 2013;11(1):258.PubMedPubMedCentralCrossRef
7.
Jones E, Taylor B, Rudge G, MacArthur C, Jyothish D, Simkiss D, et al. Hospitalisation after birth of infants: cross sectional analysis of potentially avoidable admissions across England using hospital episode statistics. BMC Pediatr. 2018;18(1):390.PubMedPubMedCentralCrossRef
8.
9.
Gill PJ, Goldacre MJ, Mant D, Heneghan C, Thomson A, Seagroatt V, et al. Increase in emergency admissions to hospital for children aged under 15 in England, 1999–2010: national database analysis. Arch Dis Child. 2013;98(5):328–34.PubMedCrossRef
10.
Saxena S, Bottle A, Gilbert R, Sharland M. Increasing short-stay unplanned hospital admissions among children in England; Time Trends Analysis’ 97–‘06. PLoS ONE. 2009;4(10): e7484.PubMedPubMedCentralCrossRef
11.
Sands R, Shanmugavadivel D, Stephenson T, Wood D. Medical problems presenting to paediatric emergency departments: 10 years on. Emerg Med J. 2012;29(5):379–82.PubMedCrossRef
12.
Harron K, Gilbert R, Cromwell D, Oddie S, Guttmann A, van der Meulen J. International comparison of emergency hospital use for infants: data linkage cohort study in Canada and England. BMJ Qual Saf. 2018;27(1):31–9.PubMedCrossRef
13.
14.
15.
16.
17.
18.
19.
Satokangas M, Arffman M, Antikainen H, Leyland AH, Keskimäki I. Individual and Area-level Factors Contributing to the Geographic Variation in Ambulatory Care Sensitive Conditions in Finland: A Register-based Study. Med Care. 2021;59(2):123.PubMedCrossRef
20.
Wallar LE, Rosella LC. Individual and neighbourhood socioeconomic status increase risk of avoidable hospitalizations among Canadian adults: A retrospective cohort study of linked population health data. Int J Popul Data Sci. 2020;5(1):1315.
21.
Lemer C. Annual report of the Chief Medical Officer 2012: our children deserve better: prevention pays. 2013.
22.
23.
24.
25.
Coon JT, Martin A, Abdul-Rahman A-K, Boddy K, Whear R, Collinson A, et al. Interventions to reduce acute paediatric hospital admissions: a systematic review. Arch Dis Child. 2012;97(4):304–11.PubMedCrossRef
26.
27.
28.
Barr R, Carande EJ, Pollard AJ, Drysdale SB. Change in viral bronchiolitis management in hospitals in the UK after the publication of NICE guideline. J Clin Virol. 2018;105:84–7.PubMedCrossRef
29.
Herbert A, Wijlaars L, Zylbersztejn A, Cromwell D, Hardelid P. Data resource profile: hospital episode statistics admitted patient care (HES APC). Int J Epidemiol. 2017;46(4):1093–i.PubMedPubMedCentralCrossRef
30.
Boyd A, Cornish R, Johnson L, Simmonds S, Syddall H, Westbury L, et al. Understanding Hospital Episode Statistics (HES). Bristol, UK: University of Bristol; 2018.
31.
Harron K, Gilbert R, Cromwell D, van der Meulen J. Linking Data for Mothers and Babies in De-Identified Electronic Health Data. PLoS ONE. 2016;11(10): e0164667.PubMedPubMedCentralCrossRef
32.
Zylbersztejn A, Gilbert R, Hjern A, Wijlaars L, Hardelid P. Child mortality in England compared with Sweden: a birth cohort study. The Lancet. 2018;391(10134):2008–18.CrossRef
33.
34.
35.
Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. The lancet. 2008;371(9606):75–84.CrossRef
36.
Hardelid P, Dattani N, Davey J, Pribramska I, Gilbert R. Overview of child deaths in the four UK countries. Child Health Reviews–UK. London: Royal College of Paediatrics and Child Health; 2013.
37.
Penman-Aguilar A, Carter M, Snead MC, Kourtis AP. Socioeconomic disadvantage as a social determinant of teen childbearing in the US. Public Health Reports. 2013;128(2_suppl 1):5–22.PubMedPubMedCentralCrossRef
38.
39.
40.
41.
Cleves M, Gould W, Gutierrez RG, Marchenko Y. An Introduction to Survival Analysis Using Stata (Revised 3rd Edition). StataCorp LP, Texas USA: Stata Press; 2016.
42.
Leckie G, Browne W, Goldstein H, Merlo J, Austin P. Variance partitioning in multilevel models for count data. Psychol Methods. 2020;25(6):787–801.PubMedCrossRef
43.
Cecil E, Bottle A, Ma R, Hargreaves DS, Wolfe I, Mainous AG, et al. Impact of preventive primary care on children’s unplanned hospital admissions: a population-based birth cohort study of UK children 2000–2013. BMC Med. 2018;16(1):1–11.CrossRef
44.
Harron K, Gilbert R, Cromwell D, Oddie S, van der Meulen J. Adversity and risk of poor birth and infant outcomes for young mothers: a population-based data-linkage cohort study. The Lancet. 2016;388:S54.CrossRef
45.
Coathup DD, Boyle E, Carson C, Johnson S, Kurinzcuk J, Macfarlane A, et al. Gestational age and hospital admissions during childhood, the TIGAR study: a population-based, record linkage study in England. BMJ. 2020;2020(055130):R1.
46.
Coathup V, Carson C, Kurinczuk JJ, Macfarlane AJ, Boyle E, Johnson S, et al. Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study. PLoS ONE. 2021;16(9): e0257341.PubMedPubMedCentralCrossRef
47.
Austin PC, Stryhn H, Leckie G, Merlo J. Measures of clustering and heterogeneity in multilevel Poisson regression analyses of rates/count data. Stat Med. 2018;37(4):572–89.PubMedCrossRef
48.
Kuha J. AIC and BIC: Comparisons of assumptions and performance. Sociol Methods Res. 2004;33(2):188–229.CrossRef
49.
Spiegelhalter DJ. Funnel plots for comparing institutional performance. Stat Med. 2005;24(8):1185–202.PubMedCrossRef
50.
Goldstein H, Browne W, Rasbash J. Partitioning variation in multilevel models. Understanding statistics: statistical issues in psychology, education, and the social sciences. 2002;1(4):223–31.CrossRef
51.
StataCorp. Stata Statistical Software: Release 15. 2017.
52.
53.
Zylbersztejn A, Gilbert R, Hardelid P. Developing a national birth cohort for child health research using a hospital admissions database in England: The impact of changes to data collection practices. PLoS ONE. 2020;15(12): e0243843.PubMedPubMedCentralCrossRef
54.
Hardelid P, Verfuerden M, McMenamin J, Smyth RL, Gilbert R. The contribution of child, family and health service factors to respiratory syncytial virus (RSV) hospital admissions in the first 3 years of life: birth cohort study in Scotland, 2009 to 2015. Eurosurveillance. 2019;24(1):1800046.PubMedCentralCrossRef
55.
Santhakumaran S, Statnikov Y, Gray D, Battersby C, Ashby D, Modi N. Survival of very preterm infants admitted to neonatal care in England 2008–2014: time trends and regional variation. Arch Dis Child Fetal Neonatal Ed. 2018;103(3):F208–15.PubMedCrossRef
56.
Murray J, Bottle A, Sharland M, Modi N, Aylin P, Majeed A, et al. Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study. PLoS ONE. 2014;9(2): e89186.PubMedPubMedCentralCrossRef
57.
Srinivasjois R, Slimings C, Einarsdóttir K, Burgner D, Leonard H. Association of gestational age at birth with reasons for subsequent hospitalisation: 18 years of follow-up in a Western Australian population study. PLoS ONE. 2015;10(6): e0130535.PubMedPubMedCentralCrossRef
58.
Ray KN, Lorch SA. Hospitalization of early preterm, late preterm, and term infants during the first year of life by gestational age. Hosp Pediatr. 2013;3(3):194–203.PubMedCrossRef
59.
Miller JE, Hammond GC, Strunk T, Moore HC, Leonard H, Carter KW, et al. Association of gestational age and growth measures at birth with infection-related admissions to hospital throughout childhood: a population-based, data-linkage study from Western Australia. Lancet Infect Dis. 2016;16(8):952–61.PubMedCrossRef
60.
Mally PV, Bailey S, Hendricks-Muñoz KD. Clinical issues in the management of late preterm infants. Curr Probl Pediatr Adolesc Health Care. 2010;40(9):218–33.PubMedCrossRef
61.
Luu T, Lefebvre F, Riley P, Infante-Rivard C. Continuing utilisation of specialised health services in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 2010;95(5):F320–5.PubMedCrossRef
62.
Colosia AD, Masaquel A, Hall CB, Barrett AM, Mahadevia PJ, Yogev R. Residential crowding and severe respiratory syncytial virus disease among infants and young children: a systematic literature review. BMC Infect Dis. 2012;12(1):1–13.CrossRef
63.
Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect. 2011;119(6):748–56.PubMedPubMedCentralCrossRef
64.
Henery PM, Dundas R, Katikireddi SV, Leyland A, Wood R, Pearce A. Social inequalities and hospital admission for unintentional injury in young children in Scotland: A nationwide linked cohort study. Lancet Reg Health-Eur. 2021;6: 100117.PubMedPubMedCentralCrossRef
65.
Agarwal S, Banerjee J, Baker R, Conroy S, Hsu R, Rashid A, et al. Potentially avoidable emergency department attendance: interview study of patients’ reasons for attendance. Emergency Medicine Journal. 2012;29(12):e3-e.CrossRef
66.
MacKichan F, Brangan E, Wye L, Checkland K, Lasserson D, Huntley A, et al. Why do patients seek primary medical care in emergency departments? An ethnographic exploration of access to general practice. BMJ Open. 2017;7(4): e013816.PubMedPubMedCentralCrossRef
67.
Kangovi S, Barg FK, Carter T, Long JA, Shannon R, Grande D. Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care. Health Aff. 2013;32(7):1196–203.CrossRef
68.
Buchanan S, Jardine C. The complex information needs of disadvantaged young first-time mothers: insights into multiplicity of needs. J Doc. 2020;76(6):1135–53.CrossRef
69.
70.
Busby J, Hollingworth W, Purdy S. The role of general practice in reducing unplanned hospital admissions. Br J Hosp Med. 2017;78(4):186–7.CrossRef
71.
Lewis KM, De Stavola B, Hardelid P. Is socioeconomic position associated with bronchiolitis seasonality? A cohort study. J Epidemiol Community Health. 2021;75(1):76–83.PubMed
72.
73.
Roland D, Harwood R, Bishop N, Hargreaves D, Patel S, Sinha I. Children’s emergency presentations during the COVID-19 pandemic. Lancet Child & Adolescent Health. 2020;4(8):e32–3.CrossRef
74.
75.
76.
Car J, Koh GC-H, Foong PS, Wang CJ. Video consultations in primary and specialist care during the covid-19 pandemic and beyond. BMJ. 2020;371:m3945.PubMedCrossRef
Metadata
Title
Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study
Authors
Selina Nath
Ania Zylbersztejn
Russell M. Viner
Mario Cortina-Borja
Kate Marie Lewis
Linda P. M. M. Wijlaars
Pia Hardelid
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2022
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-022-08319-1

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