Socio-economic determinants of casualty and NHS Direct use

There is limited evidence on the social determinants of A&E use and concerns over the equity of NHS Direct utilization.

We analysed data from the 2004-05 British General Household Survey, which included 20,421 participants. Logistic regression was used to examine individual casualty use in the last 3 months and household NHS Direct use in the last year.

Casualty use was higher for individuals living in rented accommodation or without car access, lower income groups, unskilled manual workers, current smokers and for individuals with limiting illness. In contrast, NHS Direct use was lower in households with older residents, low income, no car access and where the head of household was from a manual occupational group, a minority ethnic group or born outside the UK. The odds ratio for use of NHS Direct for households in the lowest equivalized income quintile was 0.67 (0.55-0.81). Adjustment for limiting illness increased the effect of socio-economic factors on NHS Direct use.

Reduced access to A&E services will disproportionately affect poorer individuals, whereas increased investment in telephone services will benefit affluent populations. Current national policy may widen inequities in access to emergency care.