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PubMed2001

Accessing and using hospital activity data.

Hospital activity data can be accessed from a variety of sources ranging from hospitals to the Department of Health. These data provide valuable and widely used information, but care is needed in their use and interpretation. Hospital activity rates reflect not only the underlying prevalence and severity of disease, individual factors and referral practices, but also variations related to provider-specific factors: the 'provider effect'. This includes completeness in the data, supply of hospital beds, admission policies, hospital access and distance from hospital. The provider effect can be controlled to a certain extent in statistical analyses. Although data quality has improved considerably in the last decade, this should still be investigated where trusts are being compared and in small area studies because missing data may lead to artefactual differences in rates. 'Dump' postcodes, where missing or unknown postcodes are assigned to a local postcode such as that of the hospital, may affect small area analyses and linkage if a proxy patient identifier is constructed that includes postcode.

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PubMed2001

Proximity to coke works and hospital admissions for respiratory and cardiovascular disease in England and Wales.

BACKGROUND: The incidence of hospital admissions for respiratory and cardiovascular diseases in areas close to operating coke works in England and Wales was investigated. METHODS: A small area study using distance from source as a proxy for exposure was undertaken in subjects aged 65 or over and children under 5 years within 7.5 km of four coke works (1991 estimated populations 87 760 and 43 932, respectively). The main outcome measures were emergency hospital admissions in 1992/3-1994/5 with a primary diagnosis of coronary heart disease (ICD 410-414), stroke (ICD 431-438), all respiratory diseases (ICD 460-519), chronic obstructive pulmonary disease (ICD 491-492), and asthma (ICD 493) in those aged 65 or over, and all respiratory and asthma admissions in children under 5 years of age. RESULTS: At age 65 or over the combined estimate of relative risk with proximity to coke works (per km) ranged from 0.99 (95% CI 0.90 to 1.09) for chronic obstructive pulmonary disease to 1.03 (95% CI 0.94 to 1.13) for asthma. For children under 5 years the combined estimate of risk was 1.08 (95% CI 0.98 to 1.20) for all respiratory disease and 1.07 (95% CI 0.98 to 1.18) for asthma. There was evidence of significant heterogeneity in risk estimates between coke work groups, especially in children under 5 years (p<0.001 and p=0.004 for respiratory disease and asthma, respectively). For the Teesside coke works in North East England the relative risk with proximity (per km) was 1.09 (95% CI 1.06 to 1.12) for respiratory disease and 1.09 (95% CI 1.04 to 1.15) for asthma. CONCLUSIONS: No evidence overall was found for an association between hospital admissions and living near operational coke works in England and Wales. Trends of a higher risk of hospital admission for respiratory disease and asthma among children with proximity to the Teesside plant require further investigation.

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