Blatchford O, Capewell S, Murray S, Blatchford M
Department of Public Health, University of Glasgow.
Br J Gen Pract. 1999 Jul;49(444):551-4.
Emergency admission rates have been rising rapidly in Britain. Studies defining the underlying factors are needed.
To determine the principal diagnoses, demographic, and socioeconomic factors associated with emergency medical admissions.
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).
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.
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.
在英国，急诊入院率一直在迅速上升。需要开展研究来确定其潜在因素。
确定与急诊医疗入院相关的主要诊断、人口统计学和社会经济因素。
基于大格拉斯哥健康委员会810,423名成年人的队列研究。获取了1997年43,247例成人急诊入院与格拉斯哥医疗床位的完全匿名数据集链接。按诊断、年龄、性别、卡斯尔斯贫困类别以及各个全科医疗诊所（在对其他因素进行调整后）分析急诊入院率。
最常见的主要诊断为胸痛（9.6%）、慢性阻塞性气道疾病（5.6%）、心绞痛（5.4%）、心力衰竭（4.1%）和急性心肌梗死（3.9%）。21%的患者被编码为有“不明确的体征或症状”。急诊医疗入院率随患者年龄增长而上升，每增加20岁便翻倍。贫困地区患者的入院率是富裕地区患者的两倍。男性入院频率高于女性（调整后的优势比 = 1.19）。在对年龄、性别和贫困程度进行调整后，全科医疗诊所的急诊医疗入院率在最高十分位数和最低十分位数之间显示出近两倍的差异。
老年人、男性和贫困人群的急诊医疗入院率较高。这对国民医疗服务体系中公平的资源分配具有影响。因排除心肌疾病而入院的情况很常见；然而，在这些患者中，三分之二的最终诊断并非心肌梗死。全科医疗诊所入院率之间的巨大差异需要进一步调查。
