Effect of social deprivation on the admission rate and outcomes of adult respiratory emergency admissions

Abstract

Background: Patients with respiratory disorders constitute a major source of activity for Acute Medicine. We have examined the impact of Socio-Economic Status (SES) and weather factors on the outcomes (30-day in-hospital mortality) of emergency hospitalisations with a respiratory presentation.

Methods: All emergency respiratory admissions to St. James Hospital, Dublin, from 2002 to 2014 were evaluated. Patients were categorized by quintile of Deprivation Index, and evaluated against hospital admission rate (/1000 population) and 30-day in-hospital mortality. Univariate and multivariable risk estimates (Odds Ratios (OR) or Incidence Rate Ratios (IRR)) were calculated, using logistic or zero truncated Poisson regression as appropriate.

Results: There were 32,538 episodes in 14,093 patients, representing 39.5% of medical emergency episodes over the 13-yr period. Deprivation Quintile independently predicted the admission rate, with incidence rate ratios (IRR) of Q3 2.02 (95% CI: 1.27, 3.23), Q4 2.55 (95% CI: 1.35, 4.83) and Q5 5.68 (95% CI: 3.56, 9.06). The 30-day in-hospital mortality for the highest quintile was increased (p < 0.01), Q5 1.31 (95% CI: 1.07, 1.61). Particulate matter (PM₁₀) was predictive for the top two quintiles (>17.2 and 23.8 μg/m³ respectively) with an OR for a worse outcome of Q4 1.22 (95% CI: 1.07, 1.40) and Q5 1.24 (95% CI: 1.08, 1.42). Weather (season) and the daily temperature did not affect the admission rate but were significantly associated with worse outcome.

Conclusion: Socio-Economic Status influences the admission rate incidence and hospital mortality of respiratory emergency admissions; local environmental conditions (air pollution and temperature) appear only relevant to the mortality outcomes.

Keywords: Air pollution; Deprivation; Emergency respiratory admission; Weather.