{
  "abstract": "ObjectivesTo investigate the association between time spent in NHS Type 1 emergency departments (EDs, consultant led 24-hour services with full resuscitation facilities) and risk of leaving employment and hospitalisation after leaving the department alive up to two years after attendance.\n\nMethodsWe conducted a retrospective cohort study using linked administrative data from the NHS Emergency Care Dataset, Hospital Episode Statistics, Census 2021, and mortality records. ED length of stay was categorised from under 2 hours to 12 hours or more. Cox proportional hazards models were fitted to estimate the association between ED length of stay and subsequently leaving employment or being hospitalised over a two-year follow-up period, adjusting for demographic, socioeconomic, and clinical characteristics.\n\nResultsOur study population comprised 3,347,008 individuals aged 25-64 who attended a Type 1 ED in England between April 2021 and March 2023. For leaving employment, adjusted hazard ratios (aHRs) increased from 1.04 (95% CI 1.03-1.06) for stays of 2 to <4 hours to 1.21 (1.17-1.24) for 12 hours or more, compared with stays under 2 hours. A similar but more pronounced gradient was observed for post-discharge hospitalisation, with aHRs rising from 1.06 (1.04-1.07) at 2 to <4 hours to 1.95 (1.91-1.99) for stays of 12 hours or more.\n\nConclusionsProlonged time spent in the ED is associated with poorer outcomes among working-age employees, including reduced labour market participation and increased hospital use. These findings suggest that long ED stays may have wider and longer-term implications beyond immediate clinical outcomes, including potentially for national labour markets and economic growth.",
  "abstract_shown": true,
  "affiliations": [
    "Office for National Statistics"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "H. Aston"
    },
    {
      "name": "V. Nafilyan"
    },
    {
      "name": "A. Boyle"
    },
    {
      "name": "D. Ayoubkhani"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9d932h3pmqy5e.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.05.26364765",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.05.26364765v1.full",
  "id": "9d932h3pmqy5e",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.05.26364765v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health economics"
    ],
    [
      "openalex",
      "2711|Emergency and Acute Care Studies"
    ]
  ],
  "openalex": "W7220932646",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.05.26364765v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/9d932h3pmqy5e.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:20Z",
      "native_id": "10.64898/2026.10.05.26364765",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.05.26364765v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health economics",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Emergency Department Length of Stay, Employment Status, and Subsequent Risk of Hospitalisation: A survival analysis of linked administrative records in England",
  "title_text": "Emergency Department Length of Stay, Employment Status, and Subsequent Risk of Hospitalisation: A survival analysis of linked administrative records in England",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:20Z",
  "url": "https://research.draconitic.com/paper/9d932h3pmqy5e",
  "venue": "medRxiv",
  "versions": []
}