O. Blatchford et al., Emergency medical admissions in Glasgow: general practices vary despite adjustment for age, sex, and deprivation, BR J GEN PR, 49(444), 1999, pp. 551-554
Background Emergency admission rates have been rising rapidly in Britain. S
tudies defining the underlying factors are needed.
Aim. To determine the principal diagnoses, demographic, and socioeconomic f
actors associated with emergency medical admissions.
Method. Cohort study based on the Greater Glasgow Health Board population o
f 810 423 adults. A fully anonymized dataset linkage of 43 247 adult emerge
ncy admissions to Glasgow medical beds in 1997 was obtained. Emergency admi
ssion rates were analysed by diagnosis, age, sex, Carstairs' deprivation ca
tegory, and by individual general practices (after adjustment for other fac
tors).
Results. The commonest principal diagnoses were chest pain (9.6%), chronic
obstructive airways disease (5.6%), angina (5.4%), heart failure (4.1%), an
d 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' a
ge increase. Admission rates for patients from deprived areas were twice th
ose 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.
Conclusion. Emergency medical admission rates are higher among the elderly,
males, and deprived populations. This has implications for equitable resou
rce distribution in the National Health Service. Admissions for exclusion o
f myocardial disease were common; however, myocardial infarction was not th
e final diagnosis in two-thirds of these patients. The large variation betw
een the general practices' admission rates requires further investigation.