Inequalities in emergency care use across transition from paediatric to adult care: a retrospective cohort study of young people with chronic kidney disease in England

Jasmin Abbott, Lorna Katharine Fraser, Stuart William Jarvis

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Transition of young people with chronic kidney disease (CKD) from paediatric to adult healthcare has been associated
with poor outcomes, but few population-level studies examine trends in subgroups. We aimed to assess sociodemographic
inequalities in changes in unplanned secondary care utilisation occurring across transfer to adult care for people with CKD in
England. A cohort was constructed from routine healthcare administrative data in England of young people with childhooddiagnosed CKD who transitioned to adult care. The primary outcome was the number of emergency inpatient admissions and
accident and emergency department (A&E) attendances per person year, compared before and after transfer. Injury-related
and maternity admissions were excluded. Outcomes were compared via sociodemographic data using negative binomial
regression with random effects. The cohort included 4505 individuals. Controlling for age, birth year, age at transfer, region
and sociodemographic factors, transfer was associated with a significant decrease in emergency admissions (IRR 0.75, 95%
CI 0.64–0.88) and no significant change in A&E attendances (IRR 1.10, 95% CI 0.95–1.27). Female sex was associated with
static admissions and increased A&E attendances with transfer, with higher admissions and A&E attendances compared to
males pre-transfer. Non-white ethnicities and higher deprivation were associated with higher unplanned secondary care use.
Conclusion: Sociodemographic inequalities in emergency secondary care usage were evident in this cohort across
the transition period, independent of age, with some variation between admissions and A&E use, and evidence of effect
modification by transfer. Such inequalities likely have multifactorial origin, but importantly, could represent differential
meetings of care needs.
Original languageEnglish
Number of pages11
JournalEuropean journal of pediatrics
Publication statusPublished - 26 Apr 2024

Bibliographical note

© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. This is an author-produced version of the published paper. Uploaded in accordance with the University’s Research Publications and Open Access policy.


  • transition
  • chronic kidney disease
  • health inequalities
  • population study

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