Background
Our recent research has shown that in east London, people from socially and economically deprived communities and minority ethnic groups admitted to hospital are around 10 years younger than inpatients of majority background. These patient groups also experience more long-term disease at a younger age. The consequences of new short-term declines in health also known as acute illness for long-term health are not well studied but it is likely that acute illness will worsen existing health and increase the likelihood of developing long-term disease. We believe that acute illness is a key but unrecognised cause of long-term poor health, and that inequalities in acute illness are a key driver of inequalities in long-term health.
Aims and objectives
This study will determine if the patterns of healthcare inequality we have described in east London are present throughout the UK. We will use anonymised data from GP and hospital records to examine if people in socially and economically deprived communities and minority ethnic groups have more acute hospital admissions. We will assess the impact of acute illness on long-term health through development of long-term disease. We will then examine if factors such as differences in access to GP services influence these relationships.
Impact
This research will substantially improve our understanding of how acute illness affects development of long-term disease, allow us to better understand social inequalities in long-term health, and find ways to change these during hospital admission. Ultimately, we believe our work is critical to the elimination of health inequalities.
Background
Our recent research has shown that in east London, acute hospitalisation is more frequent and occurs at a younger age amongst patients from more deprived socioeconomic groups and minority ethnic backgrounds. Similarly, these patient groups experience higher prevalence of long-term disease. Events during an acute illness such as acute kidney injury can transition to chronic kidney disease, but this is not widely recognised as a cause of long-term disease. We hypothesise that acute illness and hospitalisation is an unrecognised determinant of long-term poor health, and that inequalities in incidence and outcomes of acute illness are therefore a key driver of inequalities in long-term health.
Aims and objectives
We will perform a cohort study examining whether the demographic patterns we have described amongst acutely ill patients in east London exist more widely across the UK using integrated primary and secondary care data from Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics. This study will be primarily descriptive focusing on identifying differences in rate of acute hospitalisation across different socioeconomic and ethnic groups, and quantify the impact of acute hospitalisation on long-term health through accumulation of long-term disease and healthcare use. We will then evaluate factors that may explain or confound these relationships including differences in access to primary care using multivariable regression modelling and estimate proportion of the impact of socioeconomic deprivation and ethnicity on long-term health outcomes that is explained by acute hospitalisation using causal mediation analysis.
Impact
This research will confirm the generalisability of our previous findings, and improve our understanding of acute illness in development of long-term disease, in turn allowing us to better understand social inequalities in long-term health, and identify opportunities to modify these during secondary healthcare encounters.
Primary outcome measure:
Rate of acute hospitalisation defined as an admitted patient care spell comparing different socioeconomic and ethnic groups. Hospitalisations related to maternity care will be excluded.
Secondary outcome measures:
- Accumulation of long-term disease following acute hospitalisation comparing changes between the year before and the year after date of index hospitalisation in i) number of long-term physical and mental health conditions; ii) electronic frailty index recorded in primary care; iii) all-cause mortality within one year of the date of index hospitalisation.
- Increase in healthcare use following acute hospitalisation comparing changes between the year before and the year after date of index hospital admission in i) number of primary and secondary healthcare encounters defined as GP consultations, outpatient appointments and A&E attendances; ii) earliest hospital readmission; iii) number of hospital readmissions in the year after index hospitalisation; iv) proportion of days alive spent in contact with a healthcare professional in primary or secondary care in the year after index hospitalisation.
Yize Wan - Chief Investigator - Queen Mary University of London
Yize Wan - Corresponding Applicant - Queen Mary University of London
John Prowle - Collaborator - Queen Mary University of London
Rupert Pearse - Collaborator - Barts and the London Queen Mary's School of Medicine and Dentistry
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record;CPRD GOLD Ethnicity Record