Seeking evidence of intersectional effects in emergency hospital readmissions of adults in England (2016-2019)
Spencer, Jonathan Ward, Richard Bortnowschi, Mara Mulla, Abeda Brake, Simon Wyatt, Steven Gill, Paramjit
Spencer, Jonathan
Ward, Richard
Bortnowschi, Mara
Mulla, Abeda
Brake, Simon
Wyatt, Steven
Gill, Paramjit
Affiliation
NHS Midlands and Lancashire Commissioning Support Unit, Birmingham; University of Warwick, Coventry; South Warwickshire University NHS Foundation Trust; University of Birmingham
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Publication date
2025-11-14
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Abstract
Background: Using a large administrative dataset, we explore intersectional effects in the risk of unplanned readmission after hospital discharge in England. We test whether the size and direction of these effects aligns with societal power dynamics that underpin theories of intersectionality.
Methods: We use logistic regression to explore the risk amongst adults in England, of an unplanned readmission within 30 days of discharge from hospital between 2016 and 2019. The model covariates include the patient's age, sex, ethnicity, socio-economic deprivation, morbidity levels, admission method, prior hospital use and hospital provider. We use two-way interaction terms between (a) sex and ethnicity, (b) sex and socio-economic deprivation, and (c) ethnicity and socio-economic deprivation, to test for intersectional effects. We identify 10 intersections which would theoretically be associated with increased or decreased advantage.
Findings: Of the 10.8 million eligible patient admissions in our study population, 17.2 % were readmitted to hospital within 30 days of discharge. For 2 of the 10 two-way intersections that we tested, we found evidence of increased or decreased risk of readmission that aligned with theories of intersectionality. For 6 intersections, we found no evidence of effect, and in 2 intersections we found evidence of an effect at odds with our prior theory.
Interpretation: Whilst sex, ethnicity, and deprivation influence the risk of readmission, we found limited evidence that these factors combine to increase or decrease a patient's risk. Where evidence was found, the direction of these effects did not always align with widely accepted societal power dynamics.
Citation
Spencer J, Ward R, Bortnowschi M, Mulla A, Brake S, Wyatt S, Gill P. Seeking evidence of intersectional effects in emergency hospital readmissions of adults in England (2016-2019). Soc Sci Med. 2026 Feb;390:118773. doi: 10.1016/j.socscimed.2025.118773. Epub 2025 Nov 14.
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