Aims and Objectives The past decade has seen a collapse in the achievement of the 4-hour target (the most commonly used tool in assessing performance of emergency care in England), paired with a levelling off, or worsening, of a number of health outcomes. The ‘health gap’ between those in more, or less, deprived regions is increasing (figure 1). Given the firm evidence that poorer emergency care performance and overcrowding is leading to patient harm; this piece sets out to find evidence whether deprivation is having an impact on achievement of the 4-hour target, which could be causing disproportionate harm to those people from more deprived parts of England.

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Abstract 2851 Figure 1

shows the calculated deprivation index on a local authority level as an x-axis (displayed here as weighted_deprivation), versus a linear prediction of achievement of 4-hour target (as a y-axis), as modelled through linear regression. Different trend lines represent labelled years. Note that 2016 refers to 2016–17, 2017 refers to 2017–18 etc

Method and Design This piece constructs multiple linear regression models, to initially assess correlation between deprivation and 4-hour target achievement, from 2016-2021 in England. English region, and local authority are used as the units of comparison of deprivation. Following on from this, A&E attendances will be modelled against deprivation over time to investigate possible drivers of the worsening performance in emergency care.

Results and Conclusion Hospitals providing emergency care to more deprived populations in England perform less well in achieving the 4-hour target than those in less deprived regions. The gap in performance has widened, between areas of more and less deprivation, since 2016. When looking at A&E attendances, hospitals in more-deprived parts of England have seen a much greater increase in attendances since 2016, which could be contributing to worsening performance. The linear regression models constructed for this piece provided statistically significant evidence of the above conclusions.

This piece provides support that increasing attendances in more-deprived areas may be contributing to the poorer performance. The investigators propose that the way in which people seek care is different dependent on the communities, and regions they come from, and encourage future work to focus on the specific requirements of populations in need.