TY - JOUR
T1 - Association of socioeconomic status with outcomes in older adult community-dwelling patients after visiting the emergency department
T2 - a retrospective cohort study
AU - Wachelder, Joyce J. H.
AU - van Drunen, Isabelle
AU - Stassen, Patricia M.
AU - Brouns, Steffie H. A.
AU - Lambooij, Suze L. E.
AU - Aarts, Mieke J.
AU - Haak, Harm R.
PY - 2017/12
Y1 - 2017/12
N2 - Objectives Older adults frequently visit the emergency department (ED). Socioeconomic status (SES) has an important impact on health and ED utilisation; however, the association between SES and ED utilisation in elderly remains unclear. The aim of this study was to investigate the association between SES in older adult patients visiting the ED on outcomes.Design A retrospective study.Participants Older adults (>= 65 years) visiting the ED, in the Netherlands. SES was stratified into tertiles based on average household income at zip code level: low ((sic)2300/month).Primary outcomes Hospitalisation, inhospital mortality and 30-day ED return visits. Effect of SES on outcomes for all groups were assessed by logistic regression and adjusted for confounders.Results In total, 4828 older adults visited the ED during the study period. Low SES was associated with a higher risk of hospitalisation among community-dwelling patients compared with high SES (adjusted OR 1.3, 95% CI 1.1 to 1.7). This association was not present for intermediate SES (adjusted OR 1.1, 95% CI 0.95 to 1.4). Inhospital mortality was comparable between the low and high SES group, even after adjustment for age, comorbidity and triage level (low OR 1.4, 95% CI 0.8 to 2.6, intermediate OR 1.3, 95% CI 0.8 to 2.2). Thirty-day ED revisits among community-dwelling patients were also equal between the SES groups (low: adjusted OR 1.0, 95% CI 0.7 to 1.4, and intermediate: adjusted OR 0.8, 95% CI 0.6 to 1.1).Conclusion In older adult ED patients, low SES was associated with a higher risk of hospitalisation than high SES. However, SES had no impact on inhospital mortality and 30-day ED revisits after adjustment for confounders.
AB - Objectives Older adults frequently visit the emergency department (ED). Socioeconomic status (SES) has an important impact on health and ED utilisation; however, the association between SES and ED utilisation in elderly remains unclear. The aim of this study was to investigate the association between SES in older adult patients visiting the ED on outcomes.Design A retrospective study.Participants Older adults (>= 65 years) visiting the ED, in the Netherlands. SES was stratified into tertiles based on average household income at zip code level: low ((sic)2300/month).Primary outcomes Hospitalisation, inhospital mortality and 30-day ED return visits. Effect of SES on outcomes for all groups were assessed by logistic regression and adjusted for confounders.Results In total, 4828 older adults visited the ED during the study period. Low SES was associated with a higher risk of hospitalisation among community-dwelling patients compared with high SES (adjusted OR 1.3, 95% CI 1.1 to 1.7). This association was not present for intermediate SES (adjusted OR 1.1, 95% CI 0.95 to 1.4). Inhospital mortality was comparable between the low and high SES group, even after adjustment for age, comorbidity and triage level (low OR 1.4, 95% CI 0.8 to 2.6, intermediate OR 1.3, 95% CI 0.8 to 2.2). Thirty-day ED revisits among community-dwelling patients were also equal between the SES groups (low: adjusted OR 1.0, 95% CI 0.7 to 1.4, and intermediate: adjusted OR 0.8, 95% CI 0.6 to 1.1).Conclusion In older adult ED patients, low SES was associated with a higher risk of hospitalisation than high SES. However, SES had no impact on inhospital mortality and 30-day ED revisits after adjustment for confounders.
KW - HEALTH-CARE
KW - NETHERLANDS
KW - POPULATION
KW - SERVICES
KW - PERSPECTIVE
KW - MORTALITY
KW - ADMISSION
KW - COUNTRIES
KW - ONTARIO
KW - FRAILTY
U2 - 10.1136/bmjopen-2017-019318
DO - 10.1136/bmjopen-2017-019318
M3 - Article
C2 - 29282273
SN - 2044-6055
VL - 7
JO - BMJ Open
JF - BMJ Open
IS - 12
M1 - e019318
ER -