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Lookup NU author(s): Dr Sarah SowdenORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. Background: Reductions in local government funding implemented in 2010 due to austerity policies have been associated with worsening socioeconomic inequalities in mortality. Less is known about the relationship of these reductions with healthcare inequalities; therefore, we investigated whether areas with greater reductions in local government funding had greater increases in socioeconomic inequalities in emergency admissions. Methods: We examined inequalities between English local authority districts (LADs) using a fixed-effects linear regression to estimate the association between LAD expenditure reductions, their level of deprivation using the Index of Multiple Deprivation (IMD) and average rates of (all and avoidable) emergency admissions for the years 2010-2017. We also examined changes in inequalities in emergency admissions using the Absolute Gradient Index (AGI), which is the modelled gap between the most and least deprived neighbourhoods in an area. Results: LADs within the most deprived IMD quintile had larger pounds per capita expenditure reductions, higher rates of all and avoidable emergency admissions, and greater between-neighbourhood inequalities in admissions. However, expenditure reductions were only associated with increasing average rates of all and avoidable emergency admissions and inequalities between neighbourhoods in local authorities in England's three least deprived IMD quintiles. For a LAD in the least deprived IMD quintile, a yearly reduction of £100 per capita in total expenditure was associated with a yearly increase of 47 (95% CI 22 to 73) avoidable admissions, 142 (95% CI 70 to 213) all-cause emergency admissions and a yearly increase in inequalities between neighbourhoods of 48 (95% CI 14 to 81) avoidable and 140 (95% CI 60 to 220) all-cause emergency admissions. In 2017, a LAD average population was ∼170 000. Conclusion: Austerity policies implemented in 2010 impacted less deprived local authorities, where emergency admissions and inequalities between neighbourhoods increased, while in the most deprived areas, emergency admissions were unchanged, remaining high and persistent.
Author(s): Castro-Avila AC, Cookson R, Doran T, Shaw R, Brittain J, Sowden S
Publication type: Article
Publication status: Published
Journal: Emergency Medicine Journal
Year: 2024
Volume: 41
Issue: 7
Pages: 389-396
Print publication date: 01/07/2024
Online publication date: 13/06/2024
Acceptance date: 20/04/2024
Date deposited: 24/06/2024
ISSN (print): 1472-0205
ISSN (electronic): 1472-0213
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/emermed-2022-212845
DOI: 10.1136/emermed-2022-212845
Data Access Statement: Data may be obtained from a third party and are not publicly available. This study used data aggregated at lower super output area level from the Secondary Uses Service dataset. We cannot publish this dataset, but other researchers can use it by applying for access to NHS England. All other datasets used are publicly available.
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