Pneumothorax. 2000/2
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Pneumothorax is the presence of air in the pleural cavity and
can either be primary without an obvious underlying cause or secondary
to underlying lung disease. The incidence of pneumothorax can
be identified from GP consultations, hospital admissions and mortality
data. Pneumothoraces due to traumatic or iatrogenic causes are
excluded from this factsheet.
Incidence
In the UK between 1991 and 1995 the incidence of GP consultations
for pneumothorax (both primary and secondary combined) was 24.0
per 100,000 per year for males and 9.8 per 100,000 per year for
females. The incidence of emergency hospital admissions for pneumothorax
was 16.7 and 5.8 per 100,000 per year for males and females respectively.
Age and Sex Distribution
Figure 1:Rates of hospital admissions
and patients consulting a GP for pneumothorax
The age and sex distributions of GP consultations and emergency
hospital admissions for pneumothorax are shown here. In males
there is a marked increase in early adult life which peaks in
the 20's and then falls until the 40's when it increases again.
In females, the incidence is lower than in males but there is
a similar tendency for a rise and fall in early adult life followed
by an increase after the 50's. The younger age group (15-34 years)
accounts for nearly half of cases with incidences in general practice
of 37 per 100,000 per year for males and 15 per 100,000 per year
for females and for hospital admissions, 26 and 9 per 100,000
per year respectively. The older age group (55+ years) accounts
for about third of cases, with male and female incidence rates
in general practice of 33 and 11 per 100,000 per year respectively,
while equivalent figures for hospital admissions are 25 and 6
per 100,000 per year respectively.
Geographical Distribution
In the younger group there is no apparent association of admissions
for pneumothorax with urbanisation.
Figure 2:Hospital admissions for
pneumothorax by rural/urban classification
In contrast, in those over 55 years there is a clear trend towards
increasing rate with increasing urbanisation.
Figure 3:Hospital admissions for
pneumothorax by regions
The incidence of pneumothorax admissions in both younger and
older age groups is highest in the North West region of the UK,
although other regions with high rates are South Thames for younger
and Northern & Yorkshire for older people. Lower rates are
seen in Anglia & Oxford, North Thames and West Midlands for
both age groups. The geographical distribution of pneumothorax
follows that of COPD (LAIA 99/2) and smoking, risk factors for
secondary pneumothorax.
Mortality
Figure 4:Mortality rates for pneumothorax
by age and sex
Death from pneumothorax is rare. The overall mortality between
1991 and 1995 was 1.26 per million per year for males and 0.62
per million per year for females. The majority of deaths occurred
in the elderly, presumably because of underlying lung disease.
Time trends
Table 1:Rates of emergency
hospital admissions, patients consulting a GP and mortality for
pneumothorax
There was no significant trend over time for GP consultations,
hospital admissions or mortality for pneumothorax during 1991-1995.
Figure 5:Mortality rates for pneumothorax
Mortality rates for pneumothorax in the older age group (55+
years) increased markedly between 1960 and 1990 and have since
fallen steeply. These changes have been predominantly in males.
Mortality for the younger age group (15-34 years) has remained
consistently low.
Summary
- GP consultations and hospital admissions for pneumothorax
show similar bimodal age distributions.
- The incidence of pneumothorax is higher in males than females
at all ages.
- Hospital admission rates for pneumothorax increase with increasing
urbanisation in the 55+ age group.
- Between 1991 and 1995, GP consultations and hospital admissions
for pneumothorax show no significant trend over time.
- Deaths from pneumothorax occur mainly in the elderly. Mortality
in men aged 55+ increased markedly between 1960 and 1990 but
has since declined.
We would like to thank Dr Dheeraj Gupta for preparing this factsheet.
Reference
Gupta D, Hansell A, Nicholas T,
Duong T, Ayres J, Strachan D. The epidemiology of pneumothorax
in England. Thorax 2000; 55: 666-671
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