Title: Acute illness as a driver of long-term disease and health inequality across socioeconomic and ethnic groups
Funder: The Academy of Medical Sciences

Abstract: Background Our recent research has shown that in east London, acute hospitalisation is more frequent and occurs at a younger age amongst patients from more deprived socioeconomic groups and minority ethnic backgrounds. Similarly, these patient groups experience higher prevalence of long-term disease. Events during an acute illness such as acute kidney injury can transition to chronic kidney disease, but this is not widely recognised as a cause of long-term disease. We hypothesise that acute illness and hospitalisation is an unrecognised determinant of long-term poor health, and that inequalities in incidence and outcomes of acute illness are therefore a key driver of inequalities in long-term health. Aims and objectives We will perform an epidemiological study examining whether the demographic patterns we have described amongst acutely ill patients in east London exist more widely across the UK using integrated primary and secondary care data from Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics. We will determine rates of acute hospitalisation within different socioeconomic and ethnic groups, and quantify the impact of acute hospitalisation on long-term health through accumulation of long-term disease and healthcare use. We will then evaluate factors that may explain or confound these relationships including differences in access to primary care. Impact This research will confirm the generalisability of our previous findings, and improve our understanding of acute illness in development of long-term disease, in turn allowing us to better understand social inequalities in long-term health, and identify opportunities to modify these during secondary healthcare encounters.

Lay abstract: Background Our recent research has shown that in east London, people from socially and economically deprived communities and minority ethnic groups admitted to hospital are around 10 years younger than inpatients of majority background. These patient groups also experience more long-term disease at a younger age. The consequences of new short-term declines in health also known as acute illness for long-term health are not well studied but it is likely that acute illness will worsen existing health and increase the likelihood of developing long-term disease. We believe that acute illness is a key but unrecognised cause of long-term poor health, and that inequalities in acute illness are a key driver of inequalities in long-term health. Aims and objectives This study will determine if the patterns of healthcare inequality we have described in east London are present throughout the UK. We will use anonymised data from GP and hospital records to examine if people in socially and economically deprived communities and minority ethnic groups have more acute hospital admissions. We will assess the impact of acute illness on long-term health through development of long-term disease. We will then examine if factors such as differences in access to GP services influence these relationships. Impact This research will substantially improve our understanding of how acute illness affects development of long-term disease, allow us to better understand social inequalities in long-term health, and identify ways to change these during hospital admission. Ultimately, we believe our work is critical to the elimination of health inequalities.

Research activity codes: 1.2 PSYCHOLOGICAL AND SOCIOECONOMIC PROCESSES;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: GENERIC HEALTH RELEVANCE