Association between ethnicity and emergency department visits in the last three months of life in England: a retrospective population-based study using electronic health records

Abstract

Introduction Emergency department (ED) visits are distressing yet common in the last months of life and many could be avoided. The association between ethnicity and ED visits in the last months of life has rarely been studied in detail and the intersection with area-based deprivation and other risk factors is not known.Methods Population-based, retrospective cohort study, using electronic health records for adults who died from all causes in 2019 and 2020 in England.Results Of 566 930 deaths in 2020, 356 700 (62.9%) had at least one ED visit in the last 3 months of life. Most ethnic minority groups had more ED visits than white British people and differences were larger for visits out-of-hours. After adjusting for social and clinical factors, compared with white British people, the out-of-hours visit rate for people with Bangladeshi, Pakistani and Indian ethnicities was 17% (95% CI 6% to 28%), 19% (95% CI 12% to 27%) and 14% (95% CI 6% to 22%) higher for women, and 16% (95% CI 9% to 23%), 13% (95% CI 8% to 19%) and 6% (95% CI 0% to 12%) higher for men. The rate of visits was lower in 2020 than in 2019, but differences between ethnic groups were similar. For white British people, there is a clear social gradient—those who live in more deprived areas have a higher rate of ED visits—but this is not seen for most other ethnic groups.Conclusion People with Bangladeshi, Indian and Pakistani ethnicities have higher rates of ED visits in the last 3 months of life that are not fully explained by other social and clinical factors. This difference is driven by visits out-of-hours, which may indicate a need for better support. Future work should try to understand why some ethnic minority groups use ED more and how this relates to differences in needs, preferences and experiences.