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What are the social predictors of accident and emergency attendance in disadvantaged neighbourhoods? Results from a cross-sectional household health survey in the north west of England
  1. Clarissa Giebel1,2,
  2. Jason Cameron McIntyre3,
  3. Konstantinos Daras4,
  4. Mark Gabbay1,2,
  5. Jennifer Downing2,5,
  6. Munir Pirmohamed2,4,
  7. Fran Walker2,
  8. Wojciech Sawicki6,
  9. Ana Alfirevic2,5,
  10. Ben Barr1,2
  1. 1 Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
  2. 2 NIHR Collaboration for Leadership in Applied Health Research and Care, North West Coast, UK
  3. 3 School of Natural Sciences and Psychology, Liverpool John Moore’s University, Liverpool, UK
  4. 4 Geographic Data Science Lab, University of Liverpool, Liverpool, UK
  5. 5 Institute of Translational Medicine, The University of Liverpool, Liverpool, UK
  6. 6 Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  1. Correspondence to Dr Clarissa Giebel; clarissa.giebel{at}


Objectives The aim of this study was to identify the most important determinants of accident and emergency (A&E) attendance in disadvantaged areas.

Design, setting and participants A total of 3510 residents from 20 disadvantaged neighbourhoods in the North West Coast area in England completed a comprehensive public health survey.

Main outcome measures Participants were asked to complete general background information, as well as information about their physical health, mental health, lifestyle, social issues, housing and environment, work and finances, and healthcare service usage. Only one resident per household could take part in the survey. Poisson regression analysis was employed to assess the predictors of A&E attendance frequency in the previous 12 months.

Results 31.6% of the sample reported having attended A&E in the previous 12 months, ranging from 1 to 95 visits. Controlling for demographic and health factors, not being in employment and living in poor quality housing increased the likelihood of attending an A&E service. Service access was also found to be predictive of A&E attendance insofar as there were an additional 18 fewer A&E attendances per 100 population for each kilometre closer a person lived to a general practitioner (GP) practice, and 3 fewer attendances per 100 population for each kilometre further a person lived from an A&E department.

Conclusions This is one of the first surveys to explore a comprehensive set of socio-economic factors as well as proximity to both GP and A&E services as predictors of A&E attendance in disadvantaged areas. Findings from this study suggest the need to address both socioeconomic issues, such as employment and housing quality, as well as structural issues, such as public transport and access to primary care, to reduce the current burden on A&E departments.

  • accident and emergency
  • service access
  • deprivation
  • housing quality

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Patient consent for publication Not required.

  • Contributors CG and JMI jointly wrote the article. JMI and BB performed statistical analysis. KD, MP, MG, JD, FW, WS, AA and BB edited and provided feedback on drafts of the manuscript and approved the final version.

  • Funding This work was supported by the National Institute for Health Research, Collaboration for Leadership and Health Research and Care North West Coast (NIHR CLAHRC NWC) and the state Department of Health and Social Care.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests We have read and understood BMJ policy on declaration of interests and declare the following: All authors have completed the ICMJE uniform disclosure form.

  • Ethics approval The research was approved by the University of Liverpool Committee on Research Ethics (Ref: RETH00836).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The dataset from the North West Coast Household Health Survey will be made publicly available after an embargo period.

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