A&E waiting times longer for disadvantaged teens

Young people from more deprived neighbourhoods have to wait up to 15 minutes longer for accident and emergency (A&E) treatment than their more advantaged peers with similar healthcare needs, according to new findings from the Next Steps study.

Using hospital records data, the Imperial College London research finds that while disadvantaged teens are more likely to use NHS mental health services, their wealthier peers are more regular users of orthodontic care.

The researchers examined data from more than 4,700 millennials living in England, who were born in 1989-90 and have taken part in Next Steps since secondary school. They looked at information on how deprived the participants’ local neighbourhoods were at age 14, measured by the proportion of local families on low wages or out of work. The researchers then analysed data on the young people’s physical and mental health at ages 14/15 and 16/17, as well as records of their use of A&E and outpatient services at age 16/17.

“This is the first study to combine cohort survey data with hospital administrative records to measure inequalities in NHS care among adolescents from different socioeconomic backgrounds.”

Dr Mario Martínez-Jiménez, Imperial College London

Longer A&E waiting times

There was no variation in the use of A&E and general hospital outpatient services between young people from different socioeconomic backgrounds who had similar healthcare needs. However, there were stark inequalities in A&E waiting times, and use of specialist outpatient care at age 16/17.

Adolescents living in the poorest half of areas tended to wait longer for A&E treatment than their wealthier counterparts with similar healthcare needs. At age 16/17, disadvantaged males waited, on average, 15 minutes longer than their wealthier peers, while females waited 11 minutes more.

Young people from less affluent neighbourhoods were more likely to use mental health and reproductive/sexual health services at age 16/17 compared to similar teens from richer areas. In contrast, wealthier adolescents were more likely to use orthodontic care compared to their less advantaged peers.

Does wealth equal health?

Across mid to late adolescence, young males from poorer areas were more likely to report long-term illness or disability compared to their counterparts from better-off neighbourhoods. The researchers found no differences in long-term illness or disability among young females.

The picture for young people’s mental health in mid-adolescence was more complex. Responding to a questionnaire measuring 12 elements of mental health, teens from poorer neighbourhoods were more likely to report issues feeling useful, making decisions, and facing up to problems. Young people from wealthier areas were more likely to report losing sleep over worry, feeling under strain and that they could not overcome their difficulties.

In late adolescence, advantaged females were at greater risk of psychological difficulties than their disadvantaged peers. At age 16/17, there were no socioeconomic inequalities in mental ill health among males.

Lead author, Dr Mario Martínez-Jiménez (Imperial College London) said: “This is the first study to combine cohort survey data with hospital administrative records to measure inequalities in NHS care among adolescents from different socioeconomic backgrounds. We also take advantage of detailed geographical data which pinpoints neighbourhoods across England with the highest levels of deprivation.

“Our research finds that the NHS’s core services are available to everyone based on their health needs, and not their ability to pay. However, we discover unequal use of some specialist services, and longer A&E delays for disadvantaged young people. Our findings also reinforce previous research showing there are stark socioeconomic inequalities in young people’s physical health.

“This study adds significant new insights about adolescent health and mental health at an opportune moment for the nation. With the new government aiming to cut NHS waiting times and employ 8,500 additional mental health staff, our findings support more targeted and effective policies aimed at reducing health disparities. With Labour pledging to embed a focus on prevention across the NHS, addressing health and care issues as early as adolescence will not only help to improve public health, but reduce pressures on the health service.”

Further information

‘Socioeconomic deprivation, health and healthcare utilisation among millennials,’ by Mario Martínez-Jiménez, Bruce Hollingsworth and Eugenio Zucchelli was published in Social Science and Medicine in June 2024.