Inequalities in Accident and Emergency department attendance by socio-economic characteristics: population based study
Authors: Gethings Owen , Machuel Perrine , Nafilyan Vahe 
Published: October 2023

Objectives

To examine the relationship between deprivation and Accident and Emergency department attendance.

Design

Retrospective cohort study.

Setting

England, United Kingdom, from 21 March 2021 to March 2022

Participants

All individuals in the 2021 Census, aged 0 to 95 with an Emergency Department attendance record within the Emergency Care Dataset (ECDS). Our full sample included 51,776,958 individuals and 11,498,520 A&E attendance records.

Main outcome measures

The primary outcome was any visit to an Accident and Emergency service in England between 21st March 2021 and 31st March 2022 as recorded in ECDS.

Results

After adjusting for age, sex and ethnicity, the odds of A&E attendance increased as the level of deprivation increased, with the odds for those in the most deprived decile being 1.69 (95% CI – 1.68 to 1.69) times greater than those in the least deprived decile. Adjusting for underlying health attenuated but did not fully explain the association between deprivation and A&E attendance, with the odds ratio of attendance for those in the most deprived decile reduced to 1.41 (95% CI – 1.40 to 1.41). This pattern was similar across age groups however the gradient of the slope was steeper for working age adults and the magnitude of the reduction in odds for the most deprived decile relative to the least deprived decile after adjusting for health was greatest in those aged 30 to 79. By acuity, those living in the most deprived decile had 2.26 times (95% CI = 2.23 to 2.28) higher odds of attending A&E for a condition classified as low acuity compared with those in the least deprived decile. Even after adjusting for health, those in the most deprived decile had 2.02 (95% CI = 1.99 to 2.02) times the odds of attending for a low acuity condition compared with those in the least deprived decile. This was true for all levels of acuity, except those classified as immediate care, where after adjustment for health, those in the most deprived decile had 0.83 (95% CI = 0.82 to 0.85) times the odds of attendance compared with those in the least deprived decile.

Conclusions

People living in more deprived areas were more likely to access A&E services than those living in less deprived areas and these differences are not fully explained by differences in underlying health. The differences were larger for A&E attendance for less severe conditions. Differences in access to primary care services may explain part of these differences in A&E access. Knowing which groups are more likely to attend A&E services will give valuable insight for health services providers, and allow decision makers to better understand how populations can access care differently depending on a range of factors.

Key messages

What is already known on this subject

Previous work has found a clear link between deprivation and health.

Small-scale or single-centre studies have found links between deprivation and Accident and Emergency attendance.

What this study adds

This study of 51,776,958 people, and 11,498,520 people with at least one Accident and Emergency department attendance shows a clear deprivation effect, even after adjusting for underlying health.

People living in more deprived areas were more likely to attend A&E, particularly for low conditions classed as low acuity.

Underlying health is less important a driver of attendance patterns for people under 30 and is more important a factor for people aged 30 to 65 years of age.