Article Text

Children and young people's use of emergency and inpatient services by age and socio-economic status: an analysis of national hospital episode statistics in England
  1. A Djafari Marbini1,
  2. DS Hargreaves2
  1. 1Specialist Services, Imperial NHS trust, London, UK
  2. 2General and Adolescent Paediatrics, University College London Institute of Child Health, London, UK


Background The 2010 Kennedy Report into children and young people's services suggests that difficulty in accessing primary care services may lead to inappropriate use of emergency departments (EDs), particularly among marginalised groups. Inappropriate use of EDs may be reflected in a high ratio of ED to inpatient activity.

Objectives In children and young people (aged 1-25), to investigate the effect of area socio-economic status (SES) on:

  1. attendance at an ED;

  2. b) the ratio of ED to inpatient care.

Methods ED and inpatient data (2008-9) were obtained from the NHS Information Centre ( ED attendance and the ratio of ED attendance to inpatient care episodes were analysed by age, sex, and Index of Multiple Deprivation (IMD) decile. Chi squared tests were used to compare differences between the most deprived and least deprived deciles (IMD10 and IMD1).

Results Young people's attendance at an ED is higher in more deprived areas (figure 1). The difference in attendance rates is greatest in very young children and young adults (Age 1: Male 36269 (IMD10) vs 11295 (IMD1), ratio 3.2; Female 28936 (IMD10) vs 8907 (IMD1), ratio 3.2. Age 25: Male 20810 (IMD10) versus 5525 (IMD1), ratio 3.8; Female 19684 (IMD10) versus 4333 (IMD1), ratio 4.5).

Abstract G301(P) Figure 1

Age trends in total ED care episodes by gender and deprivation

The ratio of ED to inpatient care is shown in figure 2. At age 1, the ratio is higher in more deprived areas (Male 2.5 vs 1.9, p<.001, Female 2.7 vs 2.1, p<.001). This difference disappears by age 11, and differences thereafter largely reflect sex rather than IMD group (figure 2).

Abstract G301(P) Figure 2

Age trends in ratio of ED to inpatient care episodes

Conclusions Children and young people living in more deprived areas receive more ED care. The higher ratio of ED to inpatient care in more deprived young children may reflect difficulties in accessing primary care. Future work should integrate these findings with analysis of GP consultations by age and SES.

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