COMPARISON OF ASTHMATIC-PATIENTS ADMITTED TO HOSPITAL FROM HEALTH DISTRICTS EXPERIENCING HIGH AND LOW ASTHMA MORTALITY-RATES

Geographical variation in asthma mortality rates within the United Kin gdom could be a reflection of variability in effectiveness of medical care sen-ices, or epidemiological variation. In order to ascertain whe ther differing hospital admission processes could contribute to this v ariation, asthmatic patients admitted from two districts, experiencing above and below average mortality rates were compared. The present st udy was part of a cohort study of 1,200 consecutive acute adult admiss ions in 1987/88. In the main study, social data and information on ref erral were collected by interview for all patients. The admitting doct ors' 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 patien ts (treatment and physiological measurements) was retrieved from the n otes. Sixty-sis asthmatic patients resident in Wandsworth (a district with high asthma mortality rates) were admitted to St George's Hospita l 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 signifi cantly more patients by self-referral: 68% of patients called an ambul ance 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 admissi ons 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: 3 9 (85%) of patients admitted to WW had peak expiratory how less than 2 00 l/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 flo w on admission was 154 l/minute compared to 172 l/minute in ES; their mean peak how on discharge was 318 l/minute compared with 377 l/minute in ES. Twenty-one (38%) of admissions in W:W were considered to be ve ry urgent by the admitting hospital doctor compared to four (15%) in E SH (chi-squared = 4.67, d.f. = 1, P = 0.03). This opportunistic study found that, in an area experiencing high mortality rates, more patient s with severe disease were admitted to hospital compared to a low mort ality area. This does not appear to be due to differing hospital pract ices but rather to increased levels of morbidity in the community. As patients with more severe asthma are at a greater risk of dying, these findings reinforce the need to standardize asthma treatment in the co mmunity.