Neighbourhood unemployment and other socio-demographic predictors of emergency hospitalisation for infectious intestinal disease in England: A longitudinal ecological study

Highlights • We examined trends in infectious intestinal disease (IID) hospitalisations in England.• Overall IID admission rates for children and older adults declined between 2012 & 2017.• Increasing unemployment was associated with increasing IID admission rates.• Healthcare access, underlying morbidity and ethnicity were also associated with IID rates.• Policies should address inequalities in emergency IID hospitalisations.


Supplementary file Data sources and measures
The following variables were included in the analysis:

Variable Details
Unemployment Unemployment prevalence per year was calculated using claimant data provided by the ONS. Unemployment was measured as the percentage of people aged 16-64 years claiming Jobseeker's Allowance or Universal Credit principally for the reason of being unemployed.

Number of general practitioners (GPs) per capita serving the population
Weighted averages of the number of full-time employed GPs per 1000 population were calculated using annual data provided by NHS Digital on the number of GPs and patients registered per general practice per LSOA.
Experience of making a GP or nurse appointment General Practice Patient Survey (GPPS) data were used to derive a measure for the proportion of the population who would describe their experience of making an appointment the last time they wanted to see or speak to a GP or nurse from their surgery, as fairly poor or very poor. Weighted averages of the indicator per LSOA and year were calculated using annual data provided by NHS Digital on the total number of patients registered per general practice per LSOA.

Ethnic group
The proportion of the population who classify their own perceived ethnic group and cultural background as: Black / African / Caribbean / Black British / any other Black / African / Caribbean background; Asian / Asian British -Indian; Asian / Asian British -Pakistani; Asian / Asian British -Bangladeshi; Asian / Asian British -Chinese.
The ONS provide data about the ethnic group of the usual resident population of England as at census day, 27 March 2011.

Prevalence of long-term health problems
The proportion of the population who report having a long-term health problem or disability was calculated for three age groups (0-14; 15-64; 65+ years) using census data. The 2011 Census defines a long-term health problem or disability as that which limits a person's day-to-day activities, and has lasted or is expected to last at least 12 months, including problems that are related to old age. Where Y ij is the number of IID emergency admissions for LSOA i at year j and u i is the random effect for LSOA i. T is an annual time-trend term. Health is the percent of the population who report having a long-term health problem or disability. EthnicityBlack is the percent of the population who classify their ethnic group as: Black / African / Caribbean / Black British / Black Other. EthnicityIndian is the percent of the population who classify their ethnic group as: Asian / Asian British -Indian. EthnicityPakistani is the percent of the population who classify their ethnic group as: Asian / Asian British -Pakistani. EthnicityBangladeshi is the percent of the population who classify their ethnic group as: Asian / Asian British -Bangladeshi. EthnicityChinese is the percent of the population who classify their ethnic group as: Asian / Asian British -Chinese. Unemployment is the percent of the working age population (aged 16-64 years) claiming Jobseeker's Allowance or Universal Credit principally for the reason of being unemployed. Appointment is the percent of the population who would describe their experience of making a GP/nurse appointment as fairly poor or very poor. GPperCapita is the number of full-time employed GPs per 1000 population. Distance is the average road network distance in kilometres to the nearest hospital with an A&E department. Population is an offset variable with a parameter estimate constrained to 1.