Spatial proximity and childhood hospital admissions in a densely populated conurbation: evidence fro m Hong Kong’s “Children of 1997” birth cohort

Abstract

INTRODUCTION: Physical distance is a barrier to hospital utilisation. In a very densely populated city in China, we examined whether use of public hospitals by children was associated with individual-level residential proximity, and whether these associations varied with type of admission. METHODS: The authors used multivariable negative binomial regression in a large, population-representative birth cohort to examine the adjusted associations of proximity to hospitals with Accidents and Emergency services, proxied by distance to the nearest such hospital, with hospital admissions, bed-days and average length of stay from 8 days to 8 years of age. RESULTS: Physical proximity was positively associated with emergency admissions in children (incidence rate ratio (IRR) 1.23, 95% CI 1.11 to 1.35 for <1 km compared to $2 km) and bed-days but not with average length of stay, adjusted for age, sex and socio-economic position. However, in a similar comparison there was no such association for other (ie, planned) admissions (IRR 1.04, 95% CI 0.85 to 1.27). CONCLUSION: Proximity was associated with hospital use for emergency admissions. Given the societal costs of such use and the risks of iatrogenesis, attention should focus on achieving a more effective use of scarce resources.