Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1994 Feb;70(820):92–99. doi: 10.1136/pgmj.70.820.92

Comparison of asthmatic patients admitted to hospital from health districts experiencing high and low asthma mortality rates.

P Littlejohns 1, J Hollowell 1, P Hayward 1, S Prance 1
PMCID: PMC2397652  PMID: 8170898

Abstract

Geographical variation in asthma mortality rates within the United Kingdom could be a reflection of variability in effectiveness of medical care services, or epidemiological variation. In order to ascertain whether differing hospital admission processes could contribute to this variation, asthmatic patients admitted from two districts, experiencing above and below average mortality rates were compared. The present study was part of a cohort study of 1,200 consecutive acute adult admissions in 1987/88. In the main study, social data and information on referral were collected by interview for all patients. The admitting doctors' perception of the patient's severity was assessed on the basis of the severity of symptoms, and likelihood of morbidity or mortality if the patient was not admitted. Further information on asthmatic patients (treatment and physiological measurements) was retrieved from the notes. Sixty-six asthmatic patients resident in Wandsworth (a district with high asthma mortality rates) were admitted to St George's Hospital or St James' Hospital (WW) and 31 patients resident in East Surrey (ES) (a district with low asthma mortality rates) were admitted to the East Surrey Hospital (ESH). Notes were obtained on 55 (83%) and 27 (87%) of patients in the two districts, respectively. WW received significantly more patients by self-referral: 68% of patients called an ambulance or came directly to casualty compared with 30% in ES (chi-squared = 13.7, d.f. = 2, P = < 0.001). There was a tendency for more admissions to ESH to be taking oral steroids (chi-squared = 3.2, d.f. = 1, P = 0.07). Patients admitted in WW tended to have more severe disease: 39 (85%) of patients admitted to WW had peak expiratory flow less than 200 1/minute on admission compared to 14 (58%) in ES (chi-squared = 6, d.f. = 1, P = 0.01). In WW the mean first recorded peak expiratory flow on admission was 154 1/minute compared to 172 1/minute in ES; their mean peak flow on discharge was 318 1/minute compared with 377 1/minute in ES. Twenty-one (38%) of admissions in WW were considered to be very urgent by the admitting hospital doctor compared to four (15%) in ESH (chi-squared = 4.67, d.f. = 1, P = 0.03). This opportunistic study found that, in an area experiencing high mortality rates, more patients with severe disease were admitted to hospital compared to a low mortality area. This does not appear to be due to differing hospital practices but rather to increased levels of morbidity in the community. As patients with more severe asthma are at a greater risk of dying, these finding reinforce the need to standardize asthma treatment in the community.

Full text

PDF
96

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson H. R., Freeling P., Patel S. P. Decision-making in acute asthma. J R Coll Gen Pract. 1983 Feb;33(247):105–108. [PMC free article] [PubMed] [Google Scholar]
  2. Bell D., Layton A. J., Gabbay J. Use of a guideline based questionnaire to audit hospital care of acute asthma. BMJ. 1991 Jun 15;302(6790):1440–1443. doi: 10.1136/bmj.302.6790.1440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bolliger C. T., Fourie P. R., Kotze D., Joubert J. R. Relation of measures of asthma severity and response to treatment to outcome in acute severe asthma. Thorax. 1992 Nov;47(11):943–947. doi: 10.1136/thx.47.11.943. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bucknall C. E., Robertson C., Moran F., Stevenson R. D. Differences in hospital asthma management. Lancet. 1988 Apr 2;1(8588):748–750. doi: 10.1016/s0140-6736(88)91549-8. [DOI] [PubMed] [Google Scholar]
  5. Bucknall C. E., Robertson C., Moran F., Stevenson R. D. Management of asthma in hospital: a prospective audit. Br Med J (Clin Res Ed) 1988 Jun 11;296(6637):1637–1639. doi: 10.1136/bmj.296.6637.1637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Burney P. G., Papacosta A. O., Withey C. H., Colley J. R., Holland W. W. Hospital admission rates and the prevalence of asthma symptoms in 20 local authority districts. Thorax. 1991 Aug;46(8):574–579. doi: 10.1136/thx.46.8.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Charlton J. R., Hartley R. M., Silver R., Holland W. W. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet. 1983 Mar 26;1(8326 Pt 1):691–696. doi: 10.1016/s0140-6736(83)91981-5. [DOI] [PubMed] [Google Scholar]
  8. Cochrane G. M., Clark J. H. A survey of asthma mortality in patients between ages 35 and 64 in the Greater London hospitals in 1971. Thorax. 1975 Jun;30(3):300–305. doi: 10.1136/thx.30.3.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Crombie D. L., Fleming D. M. General practitioner referrals to hospital: the financial implications of variability. Health Trends. 1988 May;20(2):53–56. [PubMed] [Google Scholar]
  10. Eason J., Markowe H. L. Controlled investigation of deaths from asthma in hospitals in the North East Thames region. Br Med J (Clin Res Ed) 1987 May 16;294(6582):1255–1258. doi: 10.1136/bmj.294.6582.1255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fraser P. M., Speizer F. E., Waters S. D., Doll R., Mann N. M. The circumstances preceding death from asthma in young people in 1968 to 1969. Br J Dis Chest. 1971 Apr;65(2):71–84. [PubMed] [Google Scholar]
  12. Jarman B. Underprivileged areas: validation and distribution of scores. Br Med J (Clin Res Ed) 1984 Dec 8;289(6458):1587–1592. doi: 10.1136/bmj.289.6458.1587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Jones K. P., Charlton I. H., Middleton M., Preece W. J., Hill A. P. Targeting asthma care in general practice using a morbidity index. BMJ. 1992 May 23;304(6838):1353–1356. doi: 10.1136/bmj.304.6838.1353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lipworth B. J., Jackson C. M., Ziyaie D., Winter J. H., Dhillon P. D., Clark R. A. An audit of acute asthma admissions to a respiratory unit. Health Bull (Edinb) 1992 Sep;50(5):389–398. [PubMed] [Google Scholar]
  15. Littlejohns P., Ebrahim S., Anderson R. Prevalence and diagnosis of chronic respiratory symptoms in adults. BMJ. 1989 Jun 10;298(6687):1556–1560. doi: 10.1136/bmj.298.6687.1556. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Littlejohns P., Ebrahim S., Anderson R. Treatment of adult asthma: is the diagnosis relevant? Thorax. 1989 Oct;44(10):797–802. doi: 10.1136/thx.44.10.797. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Littlejohns P., Macdonald L. D. The relationship between severe asthma and social class. Respir Med. 1993 Feb;87(2):139–143. doi: 10.1016/0954-6111(93)90142-m. [DOI] [PubMed] [Google Scholar]
  18. MacDonald J. B., MacDonald E. T., Seaton A., Williams D. A. Asthma deaths in Cardiff 1963-74: 53 deaths in hospital. Br Med J. 1976 Sep 25;2(6038):721–723. doi: 10.1136/bmj.2.6038.721. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Macdonald J. B., Seaton A., Williams D. A. Asthma deaths in Cardiff 1963-74: 90 deaths outside hospital. Br Med J. 1976 Jun 19;1(6024):1493–1495. doi: 10.1136/bmj.1.6024.1493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mackenbach J. P., Bouvier-Colle M. H., Jougla E. "Avoidable" mortality and health services: a review of aggregate data studies. J Epidemiol Community Health. 1990 Jun;44(2):106–111. doi: 10.1136/jech.44.2.106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Morgan M., Mays N., Holland W. W. Can hospital use be a measure of need for health care? J Epidemiol Community Health. 1987 Dec;41(4):269–274. doi: 10.1136/jech.41.4.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rea H. H., Scragg R., Jackson R., Beaglehole R., Fenwick J., Sutherland D. C. A case-control study of deaths from asthma. Thorax. 1986 Nov;41(11):833–839. doi: 10.1136/thx.41.11.833. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Strachan D. P., Golding J., Anderson H. R. Regional variations in wheezing illness in British children: effect of migration during early childhood. J Epidemiol Community Health. 1990 Sep;44(3):231–236. doi: 10.1136/jech.44.3.231. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES