Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review
Objectives Multimorbidity is one of the greatest challenges facing healthcare internationally. Emergency department (ED) attendance and hospitalisation rates are higher in people with multimorbidity, but most research focuses on associations with individual characteristics, ignoring household or are...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/10/e063441.full |
| _version_ | 1828343114548379648 |
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| author | Andrew Lawson Jamie Pearce Chris Dibben Clare MacRae Alan Marshall Thomas Connor Harry William Fisken Edward Lawrence |
| author_facet | Andrew Lawson Jamie Pearce Chris Dibben Clare MacRae Alan Marshall Thomas Connor Harry William Fisken Edward Lawrence |
| author_sort | Andrew Lawson |
| collection | DOAJ |
| description | Objectives Multimorbidity is one of the greatest challenges facing healthcare internationally. Emergency department (ED) attendance and hospitalisation rates are higher in people with multimorbidity, but most research focuses on associations with individual characteristics, ignoring household or area mediators of service use.Design Systematic review reported using the synthesis without meta-analysis framework.Data sources Twelve electronic databases (1 January 2000–21 September 2021): MEDLINE/OVID, Embase, Global Health, PsycINFO, ASSIA, CAB Abstracts, Science Citation Index Expanded/ISI Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the Cochrane Library, and OpenGrey.Eligibility criteria Adults aged ≥16 years, with multimorbidity. Exposure(s) were household and/or area determinants of health. Outcomes were ED attendance and/or hospitalisation. The literature search was limited to publications in English.Data extraction and synthesis Independent double screening of titles and abstracts to select relevant full-text studies. Methodological quality was assessed using an adaptation of the Newcastle-Ottawa Quality Assessment Scale tool. Given high study heterogeneity, narrative synthesis was performed.Results After deduplication, 10 721 titles and abstracts were screened, and 142 full-text articles were reviewed, of which 10 were eligible for inclusion. In people with multimorbidity, household food insecurity was associated with hospitalisation (OR 1.58 (95% CI 1.06 to 2.36) in concordant multimorbidity). People with multimorbidity living in the most versus least deprived areas attended ED more frequently (8.9% (95% CI 8.6 to 9.1) in most versus 6.3% (95% CI 6.1 to 6.6) in least), had higher rates of hospitalisation (26% in most versus 22% in least), and higher probability of hospitalisation (6.4% (95% CI 5.8 to 7.2) in most versus 4.2% (95% CI 3.8 to 4.7) in least). There was non-conclusive evidence that household income is associated with ED attendance and hospitalisation. No statistically significant relationships were found between marital status, living with others with multimorbidity, or rurality with ED attendance or hospitalisation.Conclusions There is some evidence that household and area contexts mediate associations of multimorbidity with ED attendance and hospitalisation, but firm conclusions are constrained by the small number of studies published and study design heterogeneity. Further research is required on large population samples using robust analytical methods.PROSPERO registration number CRD42021283515. |
| first_indexed | 2024-04-13T23:38:26Z |
| format | Article |
| id | doaj.art-e7f43af75b0549b08408b03535d226ff |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-13T23:38:26Z |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-e7f43af75b0549b08408b03535d226ff2022-12-22T02:24:38ZengBMJ Publishing GroupBMJ Open2044-60552022-10-01121010.1136/bmjopen-2022-063441Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic reviewAndrew Lawson0Jamie Pearce1Chris Dibben2Clare MacRae3Alan Marshall4Thomas Connor5Harry William Fisken6Edward Lawrence7Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USAInstitute of Geography, University of Edinburgh Institute of Geography, Edinburgh, UKInstitute of Geography, University of Edinburgh, Edinburgh, UKUsher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UKDepartment of Social Policy, The University of Edinburgh Social Policy, Edinburgh, UKThe University of Edinburgh Edinburgh Medical School, Edinburgh, Edinburgh, UKThe University of Edinburgh Edinburgh Medical School, Edinburgh, Edinburgh, UKNinewells Hospital and Medical School, Dundee, UKObjectives Multimorbidity is one of the greatest challenges facing healthcare internationally. Emergency department (ED) attendance and hospitalisation rates are higher in people with multimorbidity, but most research focuses on associations with individual characteristics, ignoring household or area mediators of service use.Design Systematic review reported using the synthesis without meta-analysis framework.Data sources Twelve electronic databases (1 January 2000–21 September 2021): MEDLINE/OVID, Embase, Global Health, PsycINFO, ASSIA, CAB Abstracts, Science Citation Index Expanded/ISI Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the Cochrane Library, and OpenGrey.Eligibility criteria Adults aged ≥16 years, with multimorbidity. Exposure(s) were household and/or area determinants of health. Outcomes were ED attendance and/or hospitalisation. The literature search was limited to publications in English.Data extraction and synthesis Independent double screening of titles and abstracts to select relevant full-text studies. Methodological quality was assessed using an adaptation of the Newcastle-Ottawa Quality Assessment Scale tool. Given high study heterogeneity, narrative synthesis was performed.Results After deduplication, 10 721 titles and abstracts were screened, and 142 full-text articles were reviewed, of which 10 were eligible for inclusion. In people with multimorbidity, household food insecurity was associated with hospitalisation (OR 1.58 (95% CI 1.06 to 2.36) in concordant multimorbidity). People with multimorbidity living in the most versus least deprived areas attended ED more frequently (8.9% (95% CI 8.6 to 9.1) in most versus 6.3% (95% CI 6.1 to 6.6) in least), had higher rates of hospitalisation (26% in most versus 22% in least), and higher probability of hospitalisation (6.4% (95% CI 5.8 to 7.2) in most versus 4.2% (95% CI 3.8 to 4.7) in least). There was non-conclusive evidence that household income is associated with ED attendance and hospitalisation. No statistically significant relationships were found between marital status, living with others with multimorbidity, or rurality with ED attendance or hospitalisation.Conclusions There is some evidence that household and area contexts mediate associations of multimorbidity with ED attendance and hospitalisation, but firm conclusions are constrained by the small number of studies published and study design heterogeneity. Further research is required on large population samples using robust analytical methods.PROSPERO registration number CRD42021283515.https://bmjopen.bmj.com/content/12/10/e063441.full |
| spellingShingle | Andrew Lawson Jamie Pearce Chris Dibben Clare MacRae Alan Marshall Thomas Connor Harry William Fisken Edward Lawrence Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review BMJ Open |
| title | Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review |
| title_full | Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review |
| title_fullStr | Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review |
| title_full_unstemmed | Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review |
| title_short | Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review |
| title_sort | household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity a systematic review |
| url | https://bmjopen.bmj.com/content/12/10/e063441.full |
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