• Joyce J H Wachelder, Isabelle van Drunen, Patricia M Stassen, BrounsSteffie H ASHADepartment of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands.Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.CAPHRI School for Public Health and Primary Care, Maastricht , LambooijSuze L ESLEDepartment of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands., Mieke J Aarts, and Harm R Haak.
• Department of Internal Medicine, Maxima Medisch Centre, Eindhoven, The Netherlands.
• BMJ Open. 2017 Dec 26; 7 (12): e019318.

ObjectivesOlder adults frequently visit the emergency department (ED). Socioeconomic status (SES) has an important impact on health and ED utilisation; however, the association between SES and ED utilisation in elderly remains unclear. The aim of this study was to investigate the association between SES in older adult patients visiting the ED on outcomes.DesignA retrospective study.ParticipantsOlder adults (≥65 years) visiting the ED, in the Netherlands. SES was stratified into tertiles based on average household income at zip code level: low (<€1800/month), intermediate (€1800-€2300/month) and high (>€2300/month).Primary OutcomesHospitalisation, inhospital mortality and 30-day ED return visits. Effect of SES on outcomes for all groups were assessed by logistic regression and adjusted for confounders.ResultsIn total, 4828 older adults visited the ED during the study period. Low SES was associated with a higher risk of hospitalisation among community-dwelling patients compared with high SES (adjusted OR 1.3, 95% CI 1.1 to 1.7). This association was not present for intermediate SES (adjusted OR 1.1, 95% CI 0.95 to 1.4). Inhospital mortality was comparable between the low and high SES group, even after adjustment for age, comorbidity and triage level (low OR 1.4, 95% CI 0.8 to 2.6, intermediate OR 1.3, 95% CI 0.8 to 2.2). Thirty-day ED revisits among community-dwelling patients were also equal between the SES groups (low: adjusted OR 1.0, 95% CI 0.7 to 1.4, and intermediate: adjusted OR 0.8, 95% CI 0.6 to 1.1).ConclusionIn older adult ED patients, low SES was associated with a higher risk of hospitalisation than high SES. However, SES had no impact on inhospital mortality and 30-day ED revisits after adjustment for confounders.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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