Intersectional inequality in emergency department (ED) visits, in-hours and out-of-hours, in the last 3 months of life for people who died in England in 2020
Our earlier analyses for CovPall Connect have shown that: 1) there were notable changes in care for people approaching the end of life that occurred during the Covid-19 pandemic including a shift from hospital to home deaths; 2) socioeconomic inequalities in place of death increased during the pandemic; 3) the rate of ED visits increases steeply as people approach the end of life; 4) end of life ED visits in 2020 demonstrated a clear deprivation gradient, being higher for people who live in more deprived areas.
The rate of ED visits in the general population is twice as high for people living in the 10% most deprived neighbourhoods, compared to the 10% least deprived areas, and varies with ethnicity, with ‘other ethnic groups’ having an ED visit rate that is 5 times higher than White, Asian or Asian British and Black or Black British groups.
The rate of ED visit may act as a ‘barometer’ for pressures on and access to community-based care.
Living in a more deprived area is a risk factor for indicators of poorer care towards the end of life including, increased risk of death in hospital and higher use of hospital care in the last months of life. Non-white ethnicity is also a risk factor for these indicators of poorer end of life care including more emergency admissions towards the end of life.
However, very little is known about how ethnicity and area-based deprivation intersect with each other and with other factors in terms of risk of ED visits towards the end of life.
This study will provide the first analysis of ethnicity, area-based deprivation, geographical location, and morbidity as intersectional risk factors for ED visits in the last 3 months of life.
Citation details to follow
This is a sub-project of project CCU024 approved by the CVD-COVID-UK / COVID-IMPACT Approvals & Oversight Board (sub-project: CCU024_02).
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