Bernard S, Smith L K
Department of Epidemiology and Public Health, University of Leicester.
J Public Health Med. 1998 Mar;20(1):97-101. doi: 10.1093/oxfordjournals.pubmed.a024727.
The aim was to investigate whether variations in emergency admission to hospital amongst older people in Leicestershire vary with the level of material deprivation of the area in which they live.
Data were extracted from the Trent Patient Information System for patients aged 65 and over, admitted as an emergency medical admission to Leicestershire's acute and community hospitals on at least one occasion during the period October 1993-September 1994. The 1991 Census was used to examine the nature of the areas from which these emergency admissions were drawn and variations in emergency admission rates across Leicestershire. The relationship between emergency medical admissions and age, sex and material deprivation as measured by the Townsend deprivation score was examined.
There were 13,305 people aged 65 or over with at least one emergency medical admission out of an estimated population (65 and over) in 1994 of 134,608 (9.9 per cent). Unconditional logistic regression showed that the risk of emergency admission increased with age and was also higher for men than for women. Emergency admissions increased significantly with increasing deprivation for each age group. This was most notable in the 65-74 years age group, yielding an odds ratio of 2.06 [95 per cent confidence interval (1.86, 2.29)], when comparing those from the most deprived areas with those from the least deprived areas.
The increased risk of emergency medical admission to hospital, which is associated with residence in areas characterized as deprived by Census-based indicators, suggests there are enduring inequalities in health or health care amongst older people. Inequalities noted for all ages persist into old age, although in the 'oldest' age groups, the effect is weaker. Material deprivation may also be a proxy for other factors, such as differences in social support and the type of care received.
目的是调查莱斯特郡老年人急诊入院情况的差异是否随其居住地区的物质匮乏程度而变化。
从特伦特患者信息系统中提取1993年10月至1994年9月期间至少有一次急诊入院记录的65岁及以上患者的数据，这些患者被收治于莱斯特郡的急症和社区医院。利用1991年人口普查数据来研究这些急诊入院患者所在地区的性质以及莱斯特郡各地急诊入院率的差异。研究了急诊入院与年龄、性别以及用汤森匮乏分数衡量的物质匮乏之间的关系。
在1994年估计有134,608人的65岁及以上人口中，有13,305人至少有一次急诊入院记录（9.9%）。无条件逻辑回归显示，急诊入院风险随年龄增加而增加，男性的风险也高于女性。每个年龄组的急诊入院率都随着匮乏程度的增加而显著上升。这在65 - 74岁年龄组最为明显，将最贫困地区与最不贫困地区的人群进行比较时，优势比为2.06 [95%置信区间(1.86, 2.29)]。
基于人口普查指标被归类为贫困地区的居民急诊入院风险增加，这表明老年人在健康或医疗保健方面存在长期不平等。各年龄段都存在的不平等一直持续到老年，不过在“最年长”年龄组中，这种影响较弱。物质匮乏也可能是其他因素的替代指标，比如社会支持和所接受护理类型的差异。
