In Scotland, rates were comparable to England & Wales and showed a similar increase in all ages up to 1990. There has been a downturn only in children, which occurred in the early 1990s, later than in England and Wales.

Changes in coding and information systems are unlikely to explain these trends. Hospital admissions can vary due to changes in medical practice or patient behaviour. Other studies have shown that the rising trend in admissions was not due to an increase in re-admission rates or diagnostic transfer from related conditions. Admission rates could also reflect changes in underlying morbidity. This can relate to the prevalence of asthma itself or the prevalence or severity of asthma exacerbations. There is evidence from general practice of fewer asthma attacks (factsheet 2000/1) and also evidence that suggests patients are being prescribed more medication, both of which would correspond to this explanation (factsheet 99/1). The underlying prevalence of asthma may have also increased, but little is known about trends in UK prevalence through the 1990s.


Community Health Sciences Division, St George's University of London, Cranmer Terrace London SW17 0RE