Abstract
ObjectivesTo demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality.MethodsWe used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex.ResultsHospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts.ConclusionsThe large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.
Highlights
Inter-country comparisons of health indicators are a powerful tool in health research
England’s admission rate with asthma as a primary diagnosis was seven times higher than Sweden’s (IRR 1⁄4 7.19; 95% CI: 6.79–7.61), but eleven times higher when using asthma recorded as any diagnosis (IRR 1⁄4 10.84; 95% CI: 10.45–11.23; Figure 2, Table S2)
We showed that asthma-related emergency department (ED) attendances were nine times higher in Sweden and Ontario, and fifty times higher in Iceland compared with asthma hospital admissions
Summary
Inter-country comparisons of health indicators are a powerful tool in health research. Key health indicators such as infant mortality and life expectancy at birth are used by international government organisations and research funders to monitor the state of nations’ health and compare health systems between countries.[1]. Since countries with similar levels of national income and comparable health systems could be expected to have analogous health outcomes, any observed differences between such countries could be due to the organisation or delivery of health care. For chronic ACSC, including asthma and diabetes, exacerbations requiring hospital admission are thought to be preventable through proactive management in primary care.[4] International comparisons of hospital admission rates for ACSCs may reflect differences in access to, or quality of, primary care services between countries
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