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. 1999 Jul;49(444):551–554.

Emergency medical admissions in Glasgow: general practices vary despite adjustment for age, sex, and deprivation.

O Blatchford 1, S Capewell 1, S Murray 1, M Blatchford 1
PMCID: PMC1313475  PMID: 10621990

Abstract

BACKGROUND: Emergency admission rates have been rising rapidly in Britain. Studies defining the underlying factors are needed. AIM: To determine the principal diagnoses, demographic, and socioeconomic factors associated with emergency medical admissions. METHOD: Cohort study based on the Greater Glasgow Health Board population of 810,423 adults. A fully anonymized dataset linkage of 43,247 adult emergency admissions to Glasgow medical beds in 1997 was obtained. Emergency admission rates were analysed by diagnosis, age, sex, Carstairs' deprivation category, and by individual general practices (after adjustment for other factors). RESULTS: The commonest principal diagnoses were chest pain (9.6%), chronic obstructive airways disease (5.6%), angina (5.4%), heart failure (4.1%), and acute myocardial infarction (3.9%). Twenty-one per cent of patients were coded as having 'ill-defined signs or symptoms'. Emergency medical admission rates rose with the age of the patient, doubling with every two decades' age increase. Admission rates for patients from deprived areas were twice those from affluent areas. Males were more frequently admitted than females (adjusted odds ratio = 1.19). After adjustment for age, sex, and deprivation, the general practices' emergency medical admission rates showed an almost twofold difference between the top and bottom deciles. CONCLUSION: Emergency medical admission rates are higher among the elderly, males, and deprived populations. This has implications for equitable resource distribution in the National Health Service. Admissions for exclusion of myocardial disease were common; however, myocardial infarction was not the final diagnosis in two-thirds of these patients. The large variation between the general practices' admission rates requires further investigation.

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Selected References

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  1. Bernard S., Smith L. K. Emergency admissions of older people to hospital: a link with material deprivation. J Public Health Med. 1998 Mar;20(1):97–101. doi: 10.1093/oxfordjournals.pubmed.a024727. [DOI] [PubMed] [Google Scholar]
  2. Blatchford O., Capewell S. Emergency medical admissions: taking stock and planning for winter. BMJ. 1997 Nov 22;315(7119):1322–1323. doi: 10.1136/bmj.315.7119.1322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blatchford O., Davidson L. A., Murray W. R., Blatchford M., Pell J. Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ. 1997 Aug 30;315(7107):510–514. doi: 10.1136/bmj.315.7107.510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Coast J., Inglis A., Morgan K., Gray S., Kammerling M., Frankel S. The hospital admissions study in England: are there alternatives to emergency hospital admission? J Epidemiol Community Health. 1995 Apr;49(2):194–199. doi: 10.1136/jech.49.2.194. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Conway H. Emergency medical care. Br Med J. 1976 Aug 28;2(6034):511–513. doi: 10.1136/bmj.2.6034.511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Davie A. P., Caesar D., Caruana L., Clegg G., Spiller J., Capewell S., Starkey I. R., Shaw T. R., McMurray J. J. Outcome from a rapid-assessment chest pain clinic. QJM. 1998 May;91(5):339–343. doi: 10.1093/qjmed/91.5.339. [DOI] [PubMed] [Google Scholar]
  7. Edwards N. The growth in emergency admissions--a challenge for health services research. J Health Serv Res Policy. 1996 Jul;1(3):125–126. doi: 10.1177/135581969600100301. [DOI] [PubMed] [Google Scholar]
  8. Hanlon P., Beck S., Robertson G., Henderson M., McQuillan R., Capewell S., Dorward A. Coping with the inexorable rise in medical admissions: evaluating a radical reorganisation of acute medical care in a Scottish district general hospital. Health Bull (Edinb) 1997 May;55(3):176–184. [PubMed] [Google Scholar]
  9. Hippisley-Cox J., Hardy C., Pringle M., Fielding K., Carlisle R., Chilvers C. The effect of deprivation on variations in general practitioners' referral rates: a cross sectional study of computerised data on new medical and surgical outpatient referrals in Nottinghamshire. BMJ. 1997 May 17;314(7092):1458–1461. doi: 10.1136/bmj.314.7092.1458. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hobbs R. Rising emergency admissions. BMJ. 1995 Jan 28;310(6974):207–208. doi: 10.1136/bmj.310.6974.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kendrick S. The pattern of increase in emergency hospital admissions in Scotland. Health Bull (Edinb) 1996 Mar;54(2):169–183. [PubMed] [Google Scholar]
  12. Maheswaran R., Elliott P., Strachan D. P. Socioeconomic deprivation, ethnicity, and stroke mortality in Greater London and south east England. J Epidemiol Community Health. 1997 Apr;51(2):127–131. doi: 10.1136/jech.51.2.127. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Morrison C., Woodward M., Leslie W., Tunstall-Pedoe H. Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register. BMJ. 1997 Feb 22;314(7080):541–546. doi: 10.1136/bmj.314.7080.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Poole P. J., Bagg B., Brodie S. M., Black P. N. Characteristics of patients admitted to hospital with chronic obstructive pulmonary disease. N Z Med J. 1997 Jul 25;110(1048):272–275. [PubMed] [Google Scholar]
  15. Smith G. D., Hart C., Watt G., Hole D., Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study. J Epidemiol Community Health. 1998 Jun;52(6):399–405. doi: 10.1136/jech.52.6.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Smith T. Differences between general practices in hospital admission rates for self-inflicted injury and self-poisoning: influence of socioeconomic factors. Br J Gen Pract. 1995 Sep;45(398):458–462. [PMC free article] [PubMed] [Google Scholar]
  17. Watson J. P., Cowen P., Lewis R. A. The relationship between asthma admission rates, routes of admission, and socioeconomic deprivation. Eur Respir J. 1996 Oct;9(10):2087–2093. doi: 10.1183/09031936.96.09102087. [DOI] [PubMed] [Google Scholar]
  18. Woodward M. Small area statistics as markers for personal social status in the Scottish heart health study. J Epidemiol Community Health. 1996 Oct;50(5):570–576. doi: 10.1136/jech.50.5.570. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. van Loon A. J., Goldbohm R. A., Kant I. J., Swaen G. M., Kremer A. M., van den Brandt P. A. Socioeconomic status and lung cancer incidence in men in The Netherlands: is there a role for occupational exposure? J Epidemiol Community Health. 1997 Feb;51(1):24–29. doi: 10.1136/jech.51.1.24. [DOI] [PMC free article] [PubMed] [Google Scholar]

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