Where you live could save your life, says new study

28 Jan 2016

The figures suggest up to 1,000 lives a year could be saved if every county had the same outcomes as Dublin.

The Study of the Impact of Reconfiguration on Emergency and Urgent Care Networks uses data on 16 serious conditions that require emergency treatment, such as heart attack and stroke.

It’s based on CSO data on deaths from emergency conditions from 2010-12 with data on the number of emergency cases as detailed by the Hospital In-Patient Enquiry database.

It estimates the number of deaths per 10,000 cases nationally is 1,588 — an overall figure deemed respectable compared to international norms, but which masks substantial variation at the county level.

Professor John Browne of the Department of Epidemiology and Public Health at UCC, who is overseeing the research, said: “The message from the analysis is there is substantial geographical variation. It matters where you live.”

The best fatality estimates are for counties Dublin, Meath, Sligo and Waterford (all 14%). The worst performing counties are Cork (17%), Limerick (18%), Mayo, Leitrim and Kerry (all 19%), and Roscommon (22%), although Prof Browne said there was a warning attached to the data relating to Roscommon for the period in question, due to issues with coding of episodes by Roscommon County Hospital.

The emergency department in the hospital has since closed and patients are now treated at other hospitals, such as Galway and Ballinasloe.

“If you just look at the adjusted death rates on their own and assume the risk of suffering a serious health emergency is the same across all areas, you discover that it is not as simple as saying ‘living in a city protects you’, as the death rate on its own is higher on average in Cork and Limerick cities, much higher than Dublin.

“Some cities do very badly and some do quite well,” he said.

“One simple statement is ‘if the whole country had the same death rate for emergency conditions as Dublin we would save around 1,000 lives a year,” Prof Browne said.

With respect to the possible causes for the regional variations, Prof Browne acknowledged that rurality and deprivation may play an important role in reducing the likelihood of surviving a serious health emergency, but are insufficient to explain all of the geographical variation observed.

He said this raises questions as to whether other causes might play a role, as well as the possibility of an inequitable distribution of healthcare resources, with some counties and cities having better access to services.

Prof Browne said the data does not yet include admissions to private hospitals.

The study involved UCC, TCD, the HSE, the Royal College of Surgeons in Ireland and the Health Research Board.