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Association of population and primary healthcare factors with hospital admission rates for chronic obstructive pulmonary disease in England: national cross-sectional study
  1. Amaia Calderón-Larrañaga1,2,
  2. Leanne Carney1,
  3. Michael Soljak1,
  4. Alex Bottle1,
  5. Martyn Partridge3,
  6. Derek Bell4,
  7. Gerrard Abi-Aad5,
  8. Paul Aylin1,
  9. Azeem Majeed1
  1. 1Department of Primary Care & Public Health, Imperial College London, London, UK
  2. 2Aragon Health Sciences Institute, Zaragoza, Spain
  3. 3National Heart and Lung Institute, Imperial College London, London, UK
  4. 4Division of Medicine, Imperial College London, London, UK
  5. 5Intelligence, Information, Policy and Research, Care Quality Commission, London, UK
  1. Correspondence to Dr Michael Soljak, Department of Primary Care & Public Health, Imperial College London, 3rd Floor, Reynolds Building, Charing Cross Campus, Imperial College London, London, UK; m.soljak07{at}


Background Hospital admission rates for chronic obstructive pulmonary disease (COPD) are known to be strongly associated with population factors. Primary care services may also affect admission rates, but there is little direct supporting evidence.

Objectives To determine associations between population characteristics, diagnosed and undiagnosed COPD prevalence, primary healthcare factors, and COPD admission rates primary care trust (PCT) and general practice levels in England.

Design, setting, and participants National cross-sectional study (53,676,051 patients in 8,064 practices in 152 English PCTs), combining data on hospital admissions, populations, primary healthcare staffing, clinical practice quality and access, and prevalence.

Main outcome measures Directly and indirectly standardised hospital admission rates for COPD, for PCT and practice populations.

Results Mean annual COPD admission rates per 100 000 population varied from 124.7 to 646.5 for PCTs and 0.0 to 2175.2 for practices. Admissions were strongly associated with population deprivation at both levels. In a practice-level multivariate Poisson regression, registered and undiagnosed COPD prevalence, smoking prevalence and deprivation were risk factors for admission (p<0.001), while healthcare factors- influenza immunisation, patient-reported access to consultations within two days, and primary care staffing, were protective (p<0.05).

Conclusion Associations of COPD admission rates with deprivation, primary healthcare access and supply highlight the need for adequate services in deprived areas. An association between admission rates and undiagnosed COPD prevalence suggests that case-finding strategies should be evaluated. Of the COPD clinical quality indicators, only influenza immunisation was associated with reduced admission rates. Patients' experience of access to primary care may also be clinically important.

  • Pulmonary disease, chronic obstructive
  • utilisation
  • primary healthcare
  • healthcare quality, access, and evaluation
  • clinical epidemiology
  • COPD epidemiology

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  • See Editorial, p 185

  • Linked article 153569.

  • Funding This study was supported by the Department of Public Health & Primary Care at Imperial College London. The Dr Foster Unit at Imperial College London is funded by Dr Foster Intelligence. AC is funded by a Grant for Spanish Professionals' Training Abroad (MAPFRE foundation, 2009) and the XXI European Programme for Research Fellowships (Caja Inmaculada grant-making foundation, 2009). LC is funded by the London Deanery. MS is funded by the Economic & Social Research Council. AB is funded by Dr Foster Intelligence. GA was an employee of the Care Quality Commission. The views expressed in the article are those of the authors.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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