Trends in Emergency Hospital Admissions for lung disease. 2001/4

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Introduction

Hospital admissions in England are recorded using the Hospital Episode Statistics (HES) system. From April 1987 to March 1995 diagnoses in HES were classified using the International Classification of Diseases, 9th revision (ICD 9). From the financial year beginning April 1995 onwards these were classified using ICD 10. This factsheet presents an overview of trends for the most common causes of emergency admissions for lung diseases in England through the 1990s, a period covering the change in coding.

Table 1:ICD codes; number and rates of emergency admissions

For many conditions the definition has changed little from ICD 9 to ICD 10. For others, for example fibrosing alveolitis, the ICD10 description is less specific.

Current numbers of admissions

There were 162,000 emergency hospital admissions for chronic obstructive respiratory diseases in England during the financial year 1999/2000. These included 75,600 COPD admissions (excluding asthma) in the 65 year olds and over and 28,500 admissions for asthma in children. The lower respiratory infections, pneumonia and acute bronchitis, accounted for 97,000 admissions. Of these 47,200 were for pneumonia in the 65s and over and 21,800 were for acute bronchitis in children. The numbers of emergency admissions for the other conditions presented here are relatively low.

Trends in admission rates

Trends are apparent in several of these conditions. Except for fibrosing alveolitis, there is no evidence of a strong association with the update in ICD coding, though there were changes in rates for COPD and acute bronchitis from 1995/96.

Figure 1:COPD admission rates

Age-adjusted admission rates for COPD (excluding asthma) have risen over 50% in the last 9 years. Rises occurred in all the adult age groups particularly from 1995/96.

Figure 2:Asthma admission rates

Asthma admission rates have fallen 27% from 1991/92 to 1999/00. Rates have fallen in all ages groups with the greatest percentage decline (40%) occuring in children aged 0-14 (for more details see 96/2).

Figure 3:Pneumonia admission rates

Emergency admissions for pneumonia have risen in all adult age groups. In the over 65s rates have risen by 32%.

Figure 4:Acute bronchitus admission rates

Admissions for acute bronchitis have fluctuated over the period but there is no marked annual trend. Following the ICD change there was a drop in 1995/96, particularly in the adults (58% in 65s and over). In children, for whom these admissions may include various wheezing illnesses, rates were relatively stable.

Figure 5:Pneumothorax admission rates

There has been a slight fall in admission rates for primary pneumothorax over the period (see 2000/2 for more details of the disease) and in 15-44 year olds the rate has fallen from 158 to 130 per million.

Figure 6:Cystic fibrosis admission rates

Cystic fibrosis admission rates have remained stable in the 0-14 year olds, ranging from 130 to 167 per million over the period. In the 15-44 year olds rates have risen over 80%, possibly as a result of improved survival (see 95/2).

Figure 7:Fibrosing alveolitis/other IPD with fibrosis admission rates

From 1991/92 to 1994/95 there was an upward gradient in fibrosing alveolitis from 20 per million to 24 per million. After the change to ICD 10 the category expanded to 'Other interstitial pulmonary diseases with fibrosis' and there was a marked increase (40%) to 34 per million in 1995/96. The trend since then has continued upwards in adults.

Figure 8:Respiratory tuberculosis admission rates

Overall there does not appear to be any trend in national emergency admissions for respiratory tuberculosis, with rates between 30 and 35 per million over the period. In children the rates have risen slightly to 10.2 per million and in 65s and over they have fallen from 62 to 56 per million.