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Small area variation in hospital admission: random or systematic?
1West Surrey Health Authority, The Ridgewood Centre, Old Bisley Road, Camberley, Surrey GU16 5QE, UK.
Public Health
|October 18, 2000
Summary
Hospital admission variability differs by condition. For some, like heart disease, longer travel times meant fewer admissions, while others showed no clear pattern related to distance or deprivation.
Area of Science:
- Health Services Research
- Medical Geography
- Epidemiology
Background:
- Hospital admission rates can vary significantly across geographic areas.
- Understanding factors influencing admission variability, such as travel time and socioeconomic status, is crucial for healthcare planning.
- Discretionary admissions are hypothesized to show greater variability and distance decay than mandatory admissions.
Purpose of the Study:
- To investigate the relationship between non-random variability in hospital admission rates and travel time to hospitals.
- To examine how factors like travel time and deprivation influence admission rates for specific health conditions.
- To determine if systematic coefficient of variation (SCV) correlates with travel time dependence in hospital admissions.
Main Methods:
- Analysis of hospital admission data for seven conditions across 62 small areas in Surrey, England.
- Calculation of age and sex standardized admission ratios (SAR).
- Multiple linear regression models adjusted for spatial correlation to assess the dependence of SAR on travel time and deprivation (Jarman score).
Main Results:
- An inverse relationship was observed between travel time to the hospital and admission ratios for ischaemic heart disease, bronchopneumonia, and chronic bronchitis.
- Admission ratios for diabetes mellitus and stroke showed no significant relationship with either deprivation or travel time.
- No straightforward correlation was found between systematic coefficient of variation (SCV) and travel time dependence across the seven studied conditions.
Conclusions:
- Travel time to hospital significantly impacts admission rates for certain conditions, suggesting discretionary elements in their admission process.
- Admission patterns for conditions like diabetes and stroke appear less influenced by geographical access or socioeconomic factors in this region.
- The study highlights condition-specific variations in the influence of travel time and deprivation on hospital admissions, with no universal relationship between admission variability and distance decay.