Socioeconomic position and Emergency Department attendance rates at an Irish University Hospital

Lower socioeconomic position (SEP) is associated with poorer health and higher emergency department (ED) attendances globally. Irish data is lacking. The ED at University Hospital Limerick (UHL) in the Mid West region is the most overcrowded in Ireland. The region also has the most disadvantaged geographic Small Areas (SAs) based on Census 2022 data. This study examines the relationship between SEP and UHL ED attendance, and the influence distance using geocoding. It is the first known Irish study of its kind. Random, anonymised patient administration data for 4836 paediatric and 4613 adult ED attendances in 2023 were analysed using ‘R’ software. Chi Square, binomial logistic regression, negative binomial modelling and geocoding were used to analyse patient referrals, presenting complaints, outcomes and distance. SEP was categorised using Pobal HP Deprivation Index categories based on Census 2022 data. Adults from ‘very disadvantaged’ SAs were 2.64 (95% CI 2.06-3.39, P < 0.001) times more likely to attend ED than those from ‘affluent’ SAs. Children from ‘extremely disadvantaged’ SAs were 1.81(1.28-2.58, p < 0.001) times more likely to attend. Self-referral and ambulance transfer were more common among patients from disadvantaged SAs. Increased distance was associated with lower ED attendance (IRR 0.97, 95% CI 0.97–0.98, p < 0.001). When adjusting for distance, those from disadvantaged SAs still had significantly higher attendance rates. No statistically significant differences in patient outcomes were observed based on SEP. This study confirms a strong, graded association between low SEP and increased attendance at UHL ED, which persists after controlling for distance. These findings have significant implications for health service planning in the HSE Mid West region and have informed the establishment of Ireland’s first Health Equity Region. Higher rates of self-referral and ambulance use suggest opportunities for improving primary care access and health literacy.

Key messages

• Lower socioeconomic position is associated with higher rates of attendance at University Hospital Limerick emergency department.

• The study highlights the importance of considering the social determinants of health in health care planning and policy.