Ap. Jones et G. Bentham, HEALTH-SERVICE ACCESSIBILITY AND DEATHS FROM ASTHMA IN 401 LOCAL-AUTHORITY DISTRICTS IN ENGLAND AND WALES, 1988-92, Thorax, 52(3), 1997, pp. 218-222
Background - The possible contribution of healthy service accessibilit
y to asthma mortality has not previously been studied in the UK. Metho
ds - Using regression analysis, the relationship between geographical,
isolation from large acute hospital services and mortality from asthm
a for 401 local authority districts in England and Wales was examined
for the period 1988-92. Results - Asthma mortality was found to be str
ongly associated with the proportion of district households where the
head was of social class 4 or 5 (adjusted relative risk 1.61, 95% conf
idence interval (CT) 4.12 to 2.33), and the proportion of households w
ithout access to a car (adjusted relative risk 1.59, 95% CI 0.97 to 2.
62). After controlling for these factors, there was a tendency for mor
tality to rise with increasing distance from hospital, with a relative
risk of 1.01 for an increase in distance of one kilometre (95% CI 1.0
0 to 1.02). Conclusions - The findings suggest that problems of access
ibility of care may mean that the control of asthma amongst sufferers
living in districts most remote from major health service units might
be less than optimal, and this could result in a number of potentially
avoidable deaths.