Socio-economic determinants and use of emergency hospital services

BACKGROUND: Socioeconomic level is a key determinant for health status. It may also influence on the utilization of hospital emergency services, although the factor responsible for that is not known. The main objective of the present report is to assess whether patients using frequently hospital emergency services have one or more variables related to low socioeconomic level. PATIENTS AND METHODS: A standardized questionnaire was applied to 800 patients randomly selected from those attending the emergency services of a provincial reference hospital. It was gathered information on: income, education level, employment, loneliness, domestic violence, occupational accidents, and life style. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated. Stepwise logistic regression analysis was used to ascertain the independent predictors for attending for than once to the emergency services. RESULTS: In crude analysis, low income and low educational level were significantly related to the use of emergency services (both chi(2) for a trend < 0,05). Alcoholism (OR = 2.3, 95% CI = 1.2-4.7) and domestic violence (OR = 2.6, 95% CI = 0.9-8.1) were also related. Stepwise logistic regression analysis selected income (OR for intermediate level = 1.6, 95% CI = 1.0-2.7, and OR for low level = 2.3, 95% CI = 1.4-3.7) and alcoholism (OR = 2.9, 95% CI = 1.3-6.4) as independent predictors. CONCLUSIONS: Patients with low income and/or alcoholism use emergency hospital services more frequently.