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

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.

Parental migration, socioeconomic deprivation and hospital admissions in preschool children: national cohort study

“…We also selected the following variables to be summarised given their association with migration and/or hospital admission rates as shown in the research literature: maternal self-reported ethnicity, child’s sex, region of residence, presence of congenital anomaly, year of birth and maternal age (see Supplementary Table 2 for definitions). 1,17,21,22 To help guide the selection of confounders for our final statistical models, we constructed a directed acyclic graph (DAG) of variables that are related to parental migration and child hospital admissions. Supplementary Figure 1 shows a simplified DAG of maternal country of birth and child emergency admissions.…”

“…We repeated the above analyses stratifying the cohort by London or non-London region of birth to account for known geographical variability in migrant populations and incidence rates of hospital admissions, particularly in differential thresholds for admissions. 21 Secondly, since data on embarkations from the UK were not available and very few emigrations are captured in HES, we ran simulations to assess how different levels of international emigration could affect the final results (see Appendix C for details).…”