Is relying on hospital admissions data biasing our understanding of self-harm rates?
PHE ePoster Library. Polling C. Sep 12, 2019; 274361; 167
Dr. Catherine Polling
Dr. Catherine Polling
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Abstract BackgroundHospital admissions are the only comprehensive, reliably coded data available for self-harm in England and so widely used in research and public health. Differences in hospital admissions practices may bias the conclusions drawn when comparing rates between areas and population groups. MethodA dataset of Emergency Department (ED) attendances and admissions following self-harm was created using linked electronic patient record data and Hospital Episode Statistics (HES). Proportion admitted following ED attendance for self-harm and length of stay was compared between four hospitals in South East London, 2009-2016. Variation and spatial patterning of self-harm rates by small area using attendance and admission data was compared.
There were 20,750 ED attendances, 7614 (37%) resulted in admission. Proportion admitted varied substantially between hospitals with a risk ratio of 2.45 (95% CI 2.30-2.61) comparing most and least likely to admit. This was not altered by adjustment for patient demographics, deprivation and type of self-harm. Hospitals which admitted more had a higher proportion of admissions lasting less than 24 hours. A previously demonstrated pattern of lower rates of self-harm admission closer to the city centre was reduced when ED attendance rates were used to represent self-harm.
Hospitals vary substantially in likelihood of admission of ED self-harm presentations. This is likely due to differences in hospital practices rather than in the patient population or severity of self-harm seen. Public health policy that directs resources based on self-harm admissions data risks exacerbating existing health inequalities in inner-city areas where relative rates are underestimated. External funding details CP is funded by a Wellcome Trust Research Training Fellowship. This paper represents independent research part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.
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