Deaths certified as asthma and use of medical services: a national case-control study.

P. M. Sturdy, B. K. Butland, H. R. Anderson, Jonathan Geoffrey Ayres, J. M. Bland, Natl Asthma Campaign Mortality Sev

    Research output: Contribution to journalArticle

    31 Citations (Scopus)

    Abstract

    Background: Studies have linked asthma death to either increased or decreased use of medical services.

    Methods: A population based case-control study of asthma deaths in 1994-8 was performed in 22 English, six Scottish, and five Welsh health authorities/boards. All 681 subjects who died were under the age of 65 years with asthma in Part I on the death certificates. After exclusions, 532 hospital controls were matched to 532 cases for age, district, and date of asthma admission/death. Data were extracted blind from primary care records.

    Results: The median age of the subjects who died was 53 years; 60% of cases and 64% of controls were female. There was little difference in outpatient attendance (55% and 55%), hospital admission for asthma (51% and 54%), and median inpatient days (20 days and 15 days) in the previous 5 years. After mutual adjustment and adjustment for sex, using conditional logistic regression, three variables were independently associated with asthma death: fewer general practice contacts (odds ratio 0.82 (95% confidence interval (CI) 0.74 to 0.91) per 5 contacts) in the previous year, more home visits (1.14 (95% CI 1.08 to 1.21) per visit) in the previous year, and fewer peak expiratory flow recordings (0.83 (95% CI 0.74 to 0.92) per occasion) in the previous 3 months. These associations were similar after adjustment for markers of severity, psychosocial factors, systemic steroids, short acting bronchodilators and antibiotics, although the association with peak flow was weakened and just lost significance.

    Conclusion: Asthma death is associated with less use of primary care services. Both practice and patient factors may be involved and a better understanding of these may offer possibilities for reducing asthma death.

    Original languageEnglish
    Pages (from-to)909-915
    Number of pages6
    JournalThorax
    Volume60
    DOIs
    Publication statusPublished - 2005

    Keywords

    • NEAR-FATAL ASTHMA
    • CONFIDENTIAL INQUIRY
    • PRESCRIBED FENOTEROL
    • RISK-FACTORS
    • HEALTH-CARE
    • NEW-ZEALAND

    Cite this

    Sturdy, P. M., Butland, B. K., Anderson, H. R., Ayres, J. G., Bland, J. M., & Natl Asthma Campaign Mortality Sev (2005). Deaths certified as asthma and use of medical services: a national case-control study. Thorax, 60, 909-915. https://doi.org/10.1136/thx.2004.025593

    Deaths certified as asthma and use of medical services: a national case-control study. / Sturdy, P. M.; Butland, B. K.; Anderson, H. R.; Ayres, Jonathan Geoffrey; Bland, J. M.; Natl Asthma Campaign Mortality Sev.

    In: Thorax, Vol. 60, 2005, p. 909-915.

    Research output: Contribution to journalArticle

    Sturdy, PM, Butland, BK, Anderson, HR, Ayres, JG, Bland, JM & Natl Asthma Campaign Mortality Sev 2005, 'Deaths certified as asthma and use of medical services: a national case-control study.', Thorax, vol. 60, pp. 909-915. https://doi.org/10.1136/thx.2004.025593
    Sturdy PM, Butland BK, Anderson HR, Ayres JG, Bland JM, Natl Asthma Campaign Mortality Sev. Deaths certified as asthma and use of medical services: a national case-control study. Thorax. 2005;60:909-915. https://doi.org/10.1136/thx.2004.025593
    Sturdy, P. M. ; Butland, B. K. ; Anderson, H. R. ; Ayres, Jonathan Geoffrey ; Bland, J. M. ; Natl Asthma Campaign Mortality Sev. / Deaths certified as asthma and use of medical services: a national case-control study. In: Thorax. 2005 ; Vol. 60. pp. 909-915.
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    abstract = "Background: Studies have linked asthma death to either increased or decreased use of medical services.Methods: A population based case-control study of asthma deaths in 1994-8 was performed in 22 English, six Scottish, and five Welsh health authorities/boards. All 681 subjects who died were under the age of 65 years with asthma in Part I on the death certificates. After exclusions, 532 hospital controls were matched to 532 cases for age, district, and date of asthma admission/death. Data were extracted blind from primary care records.Results: The median age of the subjects who died was 53 years; 60{\%} of cases and 64{\%} of controls were female. There was little difference in outpatient attendance (55{\%} and 55{\%}), hospital admission for asthma (51{\%} and 54{\%}), and median inpatient days (20 days and 15 days) in the previous 5 years. After mutual adjustment and adjustment for sex, using conditional logistic regression, three variables were independently associated with asthma death: fewer general practice contacts (odds ratio 0.82 (95{\%} confidence interval (CI) 0.74 to 0.91) per 5 contacts) in the previous year, more home visits (1.14 (95{\%} CI 1.08 to 1.21) per visit) in the previous year, and fewer peak expiratory flow recordings (0.83 (95{\%} CI 0.74 to 0.92) per occasion) in the previous 3 months. These associations were similar after adjustment for markers of severity, psychosocial factors, systemic steroids, short acting bronchodilators and antibiotics, although the association with peak flow was weakened and just lost significance.Conclusion: Asthma death is associated with less use of primary care services. Both practice and patient factors may be involved and a better understanding of these may offer possibilities for reducing asthma death.",
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    TY - JOUR

    T1 - Deaths certified as asthma and use of medical services: a national case-control study.

    AU - Sturdy, P. M.

    AU - Butland, B. K.

    AU - Anderson, H. R.

    AU - Ayres, Jonathan Geoffrey

    AU - Bland, J. M.

    AU - Natl Asthma Campaign Mortality Sev

    PY - 2005

    Y1 - 2005

    N2 - Background: Studies have linked asthma death to either increased or decreased use of medical services.Methods: A population based case-control study of asthma deaths in 1994-8 was performed in 22 English, six Scottish, and five Welsh health authorities/boards. All 681 subjects who died were under the age of 65 years with asthma in Part I on the death certificates. After exclusions, 532 hospital controls were matched to 532 cases for age, district, and date of asthma admission/death. Data were extracted blind from primary care records.Results: The median age of the subjects who died was 53 years; 60% of cases and 64% of controls were female. There was little difference in outpatient attendance (55% and 55%), hospital admission for asthma (51% and 54%), and median inpatient days (20 days and 15 days) in the previous 5 years. After mutual adjustment and adjustment for sex, using conditional logistic regression, three variables were independently associated with asthma death: fewer general practice contacts (odds ratio 0.82 (95% confidence interval (CI) 0.74 to 0.91) per 5 contacts) in the previous year, more home visits (1.14 (95% CI 1.08 to 1.21) per visit) in the previous year, and fewer peak expiratory flow recordings (0.83 (95% CI 0.74 to 0.92) per occasion) in the previous 3 months. These associations were similar after adjustment for markers of severity, psychosocial factors, systemic steroids, short acting bronchodilators and antibiotics, although the association with peak flow was weakened and just lost significance.Conclusion: Asthma death is associated with less use of primary care services. Both practice and patient factors may be involved and a better understanding of these may offer possibilities for reducing asthma death.

    AB - Background: Studies have linked asthma death to either increased or decreased use of medical services.Methods: A population based case-control study of asthma deaths in 1994-8 was performed in 22 English, six Scottish, and five Welsh health authorities/boards. All 681 subjects who died were under the age of 65 years with asthma in Part I on the death certificates. After exclusions, 532 hospital controls were matched to 532 cases for age, district, and date of asthma admission/death. Data were extracted blind from primary care records.Results: The median age of the subjects who died was 53 years; 60% of cases and 64% of controls were female. There was little difference in outpatient attendance (55% and 55%), hospital admission for asthma (51% and 54%), and median inpatient days (20 days and 15 days) in the previous 5 years. After mutual adjustment and adjustment for sex, using conditional logistic regression, three variables were independently associated with asthma death: fewer general practice contacts (odds ratio 0.82 (95% confidence interval (CI) 0.74 to 0.91) per 5 contacts) in the previous year, more home visits (1.14 (95% CI 1.08 to 1.21) per visit) in the previous year, and fewer peak expiratory flow recordings (0.83 (95% CI 0.74 to 0.92) per occasion) in the previous 3 months. These associations were similar after adjustment for markers of severity, psychosocial factors, systemic steroids, short acting bronchodilators and antibiotics, although the association with peak flow was weakened and just lost significance.Conclusion: Asthma death is associated with less use of primary care services. Both practice and patient factors may be involved and a better understanding of these may offer possibilities for reducing asthma death.

    KW - NEAR-FATAL ASTHMA

    KW - CONFIDENTIAL INQUIRY

    KW - PRESCRIBED FENOTEROL

    KW - RISK-FACTORS

    KW - HEALTH-CARE

    KW - NEW-ZEALAND

    U2 - 10.1136/thx.2004.025593

    DO - 10.1136/thx.2004.025593

    M3 - Article

    VL - 60

    SP - 909

    EP - 915

    JO - Thorax

    JF - Thorax

    SN - 0040-6376

    ER -