BMJ 1994;308:1596-1600 (18 June)

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Rates of admission to hospital for asthma

S J Hyndman, D R R Williams, S L Merrill, J M Lipscombe, C R Palmer 

Health Services Reaserch Group, University Department of Community Medicine, Institute of Public Health, University of Cambridge, University Forvie Site, Cambridge CB2 2SR Correspondence to: Dr Hyndman.

Abstract

Objective : To describe trends in hospital admission rates for asthma in England and Wales (1976-85), the East Anglian region (from 1976 to 1991- 2), and Wales (1980-90).
Design : Descriptive study.
Setting : Hospitals in England and Wales; hospitals in the East Anglian Regional Health Authority; hospitals in Wales.
Main outcome measures : Hospital admissions for asthma as principal diagnosis in England and Wales (Hospital In-patient Enquiry, 1976-85), for the East Anglian region (Hospital In-patient Enquiry, 1976-7; Hospital Activity Analysis, 1978-86; Regional Information System, 1987-8 to 1991-2), and for Wales (Hospital Activity Analysis, 1980-90). Results - Rates for England and Wales as a whole showed a steady upward trend throughout the period examined. Rates in East Anglia, though they were similar to the national trends in the early years, showed a peak in 1985 (for males and females) with some indication of a decline in rates thereafter. Rates for Wales showed an upward trend until 1988 (for both males and females) after which they showed a decline.
Conclusions : Interpretation of the East Anglian trends is made more difficult by the change in England in 1987 of the system for the collection of hospital admission data. The fact that the rates for the East Anglian region seem to decline before this change and other considerations suggest that the observed trends, although partly reflecting the disruption of the coding during the changeover in systems, may not be entirely artefactual. The possible roles of diagnostic transfer and changes in the delivery of care, asthma treatment, admission and readmission policies, and the severity and prevalence of asthma in changing admission rates are considered. The changing trends in admission rates for East Anglia and Wales reflect recently published trends for mortality from asthma in England.

Clinical implications

  • Clinical implications

  • Hospital admissions attributed to asthma have been increasing for the past three decades

  • No truly satisfactory explanation for these trends has been put forward, although several potential reasons have been discussed

  • This study indicates that in the East Anglian region and Wales at least there may now be a change, even a decline, in asthma admission rates

  • This possible decline is given some support by a recent decline in mortality for asthma

  • If asthma admission rates are changing, it is important to consider why this may be. Several factors, both real and artefactual, are discussed


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