RT Journal Article
SR Electronic
T1 Effect of social factors on winter hospital admission for respiratory disease: a case–control study of older people in the UK
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e1
OP e9
DO 10.3399/bjgp08X302682
VO 58
IS 551
A1 Rachel E Jordan
A1 Jeremy I Hawker
A1 Jon G Ayres
A1 Peymané Adab
A1 William Tunnicliffe
A1 Babatunde Olowokure
A1 Joe Kai
A1 Richard J McManus
A1 Ros Salter
A1 Kar Keung Cheng
YR 2008
UL http://bjgp.org/content/58/551/e1.abstract
AB Background Every winter, hospitals in the UK and other developed countries experience a surge in respiratory admissions. Ecological studies suggest that social circumstances may be an important determinant.Aim To establish the most important factors associated with winter hospital admissions among older people presenting with acute respiratory disease, especially the relative effect of social factors.Design of study case–control study.Setting Seventy-nine general practices in central England.Method Of a cohort of patients consulting medical services with lower respiratory tract infection or exacerbation of chronic respiratory disease, 157 hospitalised cases were compared to 639 controls. Social, medical, and other factors were examined by interview and GP records.Results Measures of material deprivation were not significant risk factors for admission at either individual or area level, although social isolation (odds ratio [OR] 4.5; 95% confidence interval [CI] = 1.3 to 15.8) resulted in an increased risk of admission. The most important independent risk factor was the presence of chronic obstructive pulmonary disease (COPD; OR 4.0; 95% CI = 1.4 to 11.4), other chronic disease (OR 2.9; 95% CI = 1.2 to 7.0), or both (OR 6.7; 95% CI = 2.4 to 18.4). Being housebound was also an independent risk factor (OR 2.2; 95% CI = 1.0 to 4.8).Conclusion Socioeconomic factors had little relative effect compared with medical and functional factors. The most important was the presence of long-term medical conditions (especially COPD), being housebound, and having received two or more courses of oral steroid treatment in the previous year. This combination of factors could be used by primary medical services to identify older patients most vulnerable to winter admissions. Clinicians should ensure that patients with COPD are better supported to manage their condition.