While disadvantaged people use emergency departments more frequently than the most advantaged, the reasons for their visit are just as often legitimate. This is the finding of a study by an Inserm team interested in the reasons for this increased use by certain patients.
Disadvantaged people use emergency departments more frequently than the most advantaged, but their reasons for consulting are no less appropriate. This is the finding of a study conducted on data from the French Midi-Pyrénées region. This region set up an Emergency Departments Observatory in 2002 to gain a deeper understanding of the visits made to and the organization of its various emergency departments, in both public and private establishments.
The authors of this study had access to all 496,388 visits made in 2012: their duration, reason for consultation and level of severity. For each case, they used the patient's address to estimate their socioeconomic position. The researchers used French National Statistical Institute (Insee) data assigned to geographical zones - with each comprising no more than 2,000 inhabitants, to build a "deprivation" index based on numbers of single-parent households, overcrowded homes, homes with no access to central or electric heating, people with no access to a car, unemployment, level of education and people with a foreign nationality.
After assigning the patients to five groups according to their estimated sociodemographic position, the researchers observed an inversely-proportional number of visits to the emergency departments. In other words, the greater the deprivation, the more frequent the visits. Their visit rate was practically double that of the most advantaged group (approximately one visit per year for three disadvantaged individuals versus one per six in the second group). And while 13.7% of the reasons for consulting were deemed non-severe in the latter group, this proportion was 14.7% in the disadvantaged group: a very small difference given the sample size.
This study therefore indicates that the most vulnerable do not use emergency departments any less appropriately, unlike what previous data had us believe.
Less healthy and with deferred problems
Two other factors help shed light on this difference in use: "The health of socioeconomically disadvantaged people is generally less good, with acute and chronic diseases more common and sometimes not as well monitored, which leads to more frequent complications. The other factor is that healthcare use differs according to socioeconomic position, with consultation for health issues that are usually a matter for community primary care providers put off until a later date, by which time they have become more severe and likely to require emergency attention", explains the paper’s lead author, Hélène Colineaux.
A study carried out in 2012 in the same region showed that healthcare consumption (visits to primary care practitioners and gynecologists at least once a year, dental care, reimbursement of optical expenses, performance of mammograms and smear tests) decreased in the event of socioeconomic deprivation, like a veritable social gradient. The roles of the various reasons for this poor access to healthcare and the time elapsing before medical advice is sought remain to be clarified. Is it a lack of resources, lack of time, the distance to travel, culture, or other reasons?
In the meantime, the authors have calculated that were everyone to move to the upper socioeconomic category of their study, annual emergency department visits would fall by 23.7%…
*Inserm/Université de Toulouse 3 unit 1027 Cancer and chronic diseases: social inequalities in health, access to primary and secondary care team, Toulouse
Colineaux et coll. Is the use of emergency departments socially patterned? Int J Public Health, online edition of January 13, 2018