HEALTH-SERVICE ACCESSIBILITY AND DEATHS FROM ASTHMA IN 401 LOCAL-AUTHORITY DISTRICTS IN ENGLAND AND WALES, 1988-92

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.