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Children in disadvantaged neighbourhoods have more out-of-hospital emergencies: a population-based study
  1. Heli Salmi1,2,
  2. Markku Kuisma3,
  3. Eero Rahiala1,
  4. Mitja Lääperi2,
  5. Heini Harve-Rytsälä3
  1. 1Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  2. 2Anaesthesiology and Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  3. 3Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Section of EMS, Helsinki University Hospital, Helsinki, Finland
  1. Correspondence to Dr Heli Salmi, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; heli.salmi{at}hus.fi

Abstract

Objective We wanted to study whether the socioeconomic status of a neighbourhood can predict the incidence of paediatric out-of-hospital emergencies.

Methods We conducted a population-based prospective study with all paediatric (0–15 years) out-of-hospital emergencies in Helsinki, Finland, in 2012–2013. We compared the geographical distribution of the emergencies in the paediatric population with those of mean income, unemployment level and educational level. The comparison was made both by the scene of the emergency and by the domicile of the patient. We also separately analysed the distribution of emergency medical (EM) contacts that were deemed medically unnecessary.

Results The incidence of out-of-hospital emergencies was higher in areas with lower socioeconomic status and among children living inside those areas. Higher mean income was associated with lower incidence (risk ratio (RR) 0.970, 95% CI 0.957 to 0.983), and lower unemployment level to higher incidence (RR 1.046, 95% CI 1.002 to 1.092) of out-of-hospital emergencies inside a district. Higher mean income was associated with lower incidence of emergencies in the paediatric population living inside a district (RR 0.983, 95% CI 0.974 to 0.993). The distribution of medically unnecessary EM contacts was similar in all areas.

Conclusions The socioeconomic status of a neighbourhood was associated with the need for EM services (EMS) in the area, and in children living in the area. Overusing EMS for non-urgent or non-medical problems did not explain these findings. Instead, they seem to represent true differences in the incidence of paediatric emergencies.

  • epidemiology
  • health services research

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Footnotes

  • Contributors HS and HHR conceptualised and designed the study, collected the data, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. ER and MK participated in the design of the study, critically reviewed the initial data collection and initial analyses, and reviewed and revised the manuscript. ML designed the data analysis instruments, and coordinated and supervised data analysis, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The writing of this manuscript has been funded by the Foundation for Pediatric Research, Finland.

  • Competing interests None declared.

  • Ethics approval Helsinki University Central Hospital, decision number §232 and §10/Helsingin ja Uudenmaan Sairaanhoitopiiri, HYKS-sairaanhoitoalue 2015, Akuutti.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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