Sheringham, J; Asaria, M; Barratt, H; Raine, R; Cookson, R; (2016) Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas. Journal of Health Services Research and Policy , 22 (2) pp. 83-90. 10.1177/1355819616679198.

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Abstract

OBJECTIVES: Reducing health inequalities is an explicit goal of England's health system. This study used new methods to compare the performance of English local administrative areas in reducing inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions between 2004/5 and 2011/12. METHODS: We used local authority area as a stable proxy for health and longterm care administrative geography over the study time period. We linked inpatient hospital activity, deprivation, primary care and population data to small area neighbourhoods (typical population 1,500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age-sex adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in inequalities and change in within-area deprivation (“gentrification”). Finally, we used administrative area level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. RESULTS: 316 administrative areas were included in analysis. Local inequalities were fairly stable between consecutive years, but 32/316 areas (10%) showed steadily improving or worsening equity. In “improving” areas (n=21), the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, whilst in those “worsening” (n=11), the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in inequality. CONCLUSIONS: Local equity performance in reducing inequality in emergency admissions varies both in cross-section and over time. Identifying this variation could provide insights into which local delivery strategies are most effective in reducing such inequalities.

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