Franklin Courtney, Mason Kate, Akanni Lateef, Daras Konstantinos, Rose Tanith, Carter Bernie, Carrol Enitan D, Taylor-Robinson David
Institute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia.
BMJ Paediatr Open. 2025 Jan 19;9(1):e002991. doi: 10.1136/bmjpo-2024-002991.
Ambulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socioeconomic disadvantage have higher rates of emergency admissions for ACSCs than their more affluent counterparts. Emergency admissions for ACSCs have been increasing, but few studies have assessed how changing socioeconomic conditions (SECs) have impacted this. This study investigates the association between local SECs and emergency ACS hospital admissions in children in England.
We examined longitudinal trends in emergency admission rates for ACSCs and investigate the association between local SECs and these admissions in children over time in England, using time-varying neighbourhood unemployment as a proxy for SECs. Fixed-effect regression models assessed the relationship between changes in neighbourhood unemployment and admission rates, controlling for unmeasured time-invariant confounding of each neighbourhood. We also explore the extent to which this relationship differs by acute and chronic ACSCs and is explained by access to primary and secondary care.
Between 2012 and 2017, paediatric emergency admissions for acute ACSCs increased, while admissions for chronic ACSCs decreased. At the neighbourhood level, each 1% point increase in unemployment was associated with a 3.9% and 2.7% increase in the rate of emergency admissions for acute ACSCs, for children aged 0-9 years and 10-19 years, respectively. A 2.6% increase in admission rates for chronic ACSCs was observed, driven by an association in 0-9 years old. Adjustment for primary and secondary care access did not meaningfully attenuate the magnitude of this association.
Increasing trends in neighbourhood unemployment were associated with increases in paediatric emergency admission rates for ACSCs in England. This was not explained by available measures of differential access to care, suggesting policy interventions should address the causes of unemployment and poverty in addition to health system factors to reduce emergency admissions for ACSCs.
门诊可预防疾病（ACSCs）是指那些通过初级保健干预可避免住院治疗的疾病。社会经济地位不利的儿童因ACSCs而急诊入院的比例高于较为富裕的儿童。因ACSCs而急诊入院的情况一直在增加，但很少有研究评估社会经济状况（SECs）的变化对此有何影响。本研究调查了英格兰当地SECs与儿童ACSCs急诊入院之间的关联。
我们研究了ACSCs急诊入院率的纵向趋势，并调查了随着时间推移，英格兰当地SECs与儿童这些入院情况之间的关联，使用随时间变化的邻里失业率作为SECs的代理指标。固定效应回归模型评估邻里失业率变化与入院率之间的关系，同时控制每个邻里未测量的时间不变混杂因素。我们还探讨了这种关系在急性和慢性ACSCs方面的差异程度，以及获得初级和二级保健服务对此的解释程度。
2012年至2017年期间，急性ACSCs的儿科急诊入院人数增加，而慢性ACSCs的入院人数减少。在邻里层面，失业率每增加1个百分点，0至9岁儿童和10至19岁儿童因急性ACSCs急诊入院率分别增加3.9%和2.7%。在0至9岁儿童中观察到慢性ACSCs入院率增加2.6%。对初级和二级保健服务可及性进行调整后，并未显著减弱这种关联的程度。
邻里失业率上升与英格兰儿童因ACSCs急诊入院率增加有关。这无法通过现有的医疗服务可及性差异指标来解释，这表明除了卫生系统因素外，政策干预还应解决失业和贫困的原因，以减少因ACSCs而急诊入院的情况。
