Hospital Admission Rates For Asthma Research Articles

The UK Soft Drinks Industry Levy and childhood hospital admissions for asthma in England

Sugar sweetened beverage consumption has been suggested as a risk factor for childhood asthma symptoms. We examined whether the UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in National Health Service hospital admission rates for asthma in children, 22 months post-implementation of SDIL. We conducted interrupted time series analyses (2012-2020) to measure changes in monthly incidence rates of hospital admissions. Sub-analysis was by age-group (5-9,10-14,15-18 years) and neighbourhood deprivation quintiles. Changes were relative to counterfactual scenarios where the SDIL wasn’t announced, or implemented. Overall, incidence rates reduced by 20.9% (95%CI: 29.6-12.2). Reductions were similar across age-groups and deprivation quintiles. These findings give support to the idea that implementation of a UK tax intended to reduce childhood obesity may have contributed to a significant unexpected and additional public health benefit in the form of reduced hospital admissions for childhood asthma.

A forecasting tool for predicting asthma related emergency department visits and hospitalizations using heterogeneous data sources

New Zealand (NZ) is one of the countries with the highest prevalence and mortality rate due to asthma. Organisation for Economic Co-operation and Development (OECD) statistics [3] indicate NZ has one of the highest hospital admission rates for asthma of OECD countries. According to recent records [1], on average 77 New Zealanders each year lost their battle to asthma. Furthermore, the cost burden of asthma to the NZ economy has not improved over the years [2]. Not much work has been accomplished in the direction of population health forecasting for asthma in NZ. The aim of this study is to develop a prediction model for anticipating asthma-related hospitalisations in Auckland, NZ while exploiting diverse heterogeneous data sources. These sources accounts for triggers that exacerbate asthma conditions like meteorological and air quality factors plus the social media resource accessed through Google search trends. The research work is divided into two parts; in the first phase I analysed the relationship between trigger parameters and asthma using the Pearson Correlation Coefficient. Subsequently, in part two a comparative examination has been conducted based upon the prediction models developed using different machine learning techniques on the continuous data of 1097 days. The experimental evaluation shows that the best forecasting tool could predict asthma-related hospitalisation with an accuracy of 78.87% while the precision and recall for the model were 79.80% and 78.87%. The outcome achieved from implementing such a model would be beneficial for public health surveillance, thereby helping in more efficient and timely healthcare resource deployment.

Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison.

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.

The Role of Place as a Modifier of Asthma Associations among Children in Seattle

Asthma is the most common chronic illness of childhood and its prevalence is increasing, causing much concern for identification of risk factors. Previous work in Seattle has identified strong associations between air pollution and pediatric asthma emergency department (ED) visits. According to the CDC, Washington State’s asthma prevalence is among the highest in the nation and steadily increasing. Higher rates of asthma are found in African American children, and while many factors including socio-economic status and birth weight have been shown to be related to asthma prevalence, it has been difficult to account for the difference between various races. Here we examine whether this racial difference can be explained by neighborhood characteristics, such as racial composition, socioeconomic status, and land use. We use the Comprehensive Hospital Abstract Reporting System (CHARS) data from 2009-2016 in Seattle, WA and air pollution data from the Community Multiscale Air Quality Modeling System (CMAQ) along with neighborhood socioeconomic data (median income, percent below poverty, percent unemployed and percent white) from the American Community Survey (ACS) and land use data to explore the relationship between hospital admission rates for asthma and air pollution, race, and neighborhood characteristics. We use panel data statistical methods to explore these associations. Preliminary results demonstrate that in Seattle there are 8,315 ER visits for a primary or secondary diagnosis of asthma in children between the ages of 0-18. African Americans represent 7.0% of the population in Seattle yet of the pediatric visits, 1,225 (14.7%) were for African American children. The zipcodes with the highest counts of asthma also have higher ethnic diversity (> 20% black and < 30% white), high population density (> 5300/ mile2 compared to the average in Seattle of 4721/ mile2) and are lower income neighborhoods (median household income < $67,000 compared to $75,000 in Seattle).

Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions

BackgroundAir pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with cardiovascular morbidity. We explored the relation between spatial variation in nitrogen dioxide (NO2) concentrations and cardiopulmonary hospital admissions. MethodsThis ecological study was based on hospital admissions data (2001–2004) from the National Medical Registration and general population data for the West of the Netherlands (population 4.04 million). At the 4-digit postcode area level (n=683) associations between modeled annual average outdoor NO2 concentrations and hospital admissions for respiratory and cardiovascular causes were evaluated by linear regression with the log of the postcode-specific percentage of subjects that have been admitted at least once during the study period as the dependent variable. All analyses were adjusted for differences in composition of the population of the postcode areas (age, sex, income). ResultsAt the postcode level, positive associations were found between outdoor NO2 concentrations and hospital admission rates for asthma, chronic obstructive pulmonary disease (COPD), all cardiovascular causes, ischemic heart disease and stroke (e.g. adjusted relative risk (95% confidence interval) for the second to fourth quartile relative to the first quartile of exposure were 1.87 (1.46–2.40), 2.34 (1.83–3.01) and 2.81 (2.16–3.65) for asthma; 1.44 (1.19–1.74), 1.50 (1.24–1.82) and 1.60 (1.31–1.96) for COPD). Associations remained after additional (indirect) adjustment for smoking (COPD admission rate) and degree of urbanization. ConclusionsOur study suggests an increased risk of hospitalization for respiratory and cardiovascular causes in areas with higher levels of NO2. Our findings add to the currently limited evidence of a long-term effect of air pollution on hospitalization. The ecological design of our study is a limitation and more studies with individual data are needed to confirm our findings.

Childhood Overweight Increases Hospital Admission Rates for Asthma

Carroll CL, Stoltz P, Raykov N, Smith SR, Zucker AR. Pediatrics. 2007;120(4):734–740 PURPOSE OF THE STUDY. To determine if childhood overweight increases the risk of hospitalization for asthma among children presenting to an emergency department with an asthma exacerbation. STUDY POPULATION. Children who were >2 years old and presented to the emergency department of a Connecticut children's hospital with an asthma exacerbation in 2005 were included in the study. METHODS. A retrospective chart review was completed. Children were classified as overweight (>95th weight-for-age percentile) or nonoverweight (≤95th weight-for-age percentile). Children with chronic medical conditions other than asthma were excluded. RESULTS. There were 884 visits for 813 children. Overall, 238 (27%) were admitted to the hospital, and 33 (4%) were admitted to the ICU. Overweight children (202 [23%]) were significantly more likely to be older (8.5± 4.4 vs 7.3 ± 4.3 years) and to inhabit an impoverished area (37% vs 28%). Overall, hospital admission was associated with higher clinical asthma score but not with age, gender, or poverty status. Despite similar asthma scores and therapeutic management in the emergency department, hospital and ICU admission was significantly more likely for overweight than nonoverweight children (odds ratio: 1.76 [95% confidence interval: 1.23–2.51]; P = .002). CONCLUSIONS. Overweight children with an acute episode of asthma seen in an emergency department are significantly more likely to be admitted than their nonoverweight counterparts. Overweight status clearly impacts asthma management and health in children. REVIEWER COMMENTS. The limitations of this study include its retrospective nature and the failure to use BMI because of lack of height data. However, the weight-for-age percentiles used in this study are most commonly used in practice. When children younger than 5 years, in which asthma diagnosis is difficult, are excluded, the conclusion still holds with overweight children ≥5 years old being significantly more likely to be admitted than nonoverweight children (33% vs 24%; P = .03). Whether the results reflect comorbidity, differences in lung mechanics, differences in response to therapy, more severe asthma, or socioeconomic or behavioral factors remains to be determined.

Childhood Overweight Increases Hospital Admission Rates for Asthma

Although childhood overweight has been associated with increased hospital lengths of stay for patients with asthma, the possible relationship between overweight and hospital admission for asthma has not been well studied. We hypothesized that overweight children who presented to the emergency department with asthma exacerbations were more likely to be admitted to the hospital than nonoverweight children. A retrospective chart review was conducted of all children who were older than 2 years and presented to the emergency department with an asthma exacerbation in calendar year 2005. Children with chronic medical conditions other than asthma were excluded. Children were classified as nonoverweight (< or = 95% weight-for-age percentile) or overweight (> 95% weight for age). During the study period, there were 884 visits to the emergency department for an asthma exacerbation by 813 children; 238 (27%) were admitted to the hospital, and 33 (4%) were admitted to the ICU. Overall, hospital admission was associated with higher clinical asthma score but not with age, gender, or poverty status (as quantified as home in zip-code areas designated as "impoverished"). Overweight children (n = 202 [23%]) were significantly older (8.5 +/- 4.4 vs 7.3 +/- 4.3 years) and more likely to live in an impoverished area (37% vs 28%). Presenting clinical asthma score and therapeutic interventions in the emergency department were similar for overweight and nonoverweight children; however, overweight children were significantly more likely to be admitted to the hospital. Overweight children who present to the emergency department with acute asthma exacerbations are significantly more likely to be admitted to the hospital than nonoverweight children. This identifies an important area in which childhood overweight has a significant impact on the health of children with asthma.

Association of population and practice factors with potentially avoidable admission rates for chronic diseases in London: cross sectional analysis

To examine the association between underlying ill health, material deprivation and primary care supply factors and hospital admission rates for potentially avoidable admissions in primary care trusts in London. Cross sectional analysis at primary care trusts level using routine data from multiple sources. All 31 primary care trusts in London with a total resident population of 7 million patients. Age-standardized hospital admission rates for asthma, diabetes, heart failure, hypertension and chronic obstructive pulmonary disease. Admission rates varied widely for the conditions examined across the 31 primary care trusts. In 2001, age adjusted admission rates for asthma varied from 76 to 189 per 100,000 and for diabetes from 38 to 183 per 100,000. There was a significant association between higher admission rates and measures of underlying ill health and material deprivation but not quantitative measures of primary care service provision. Provision of specialist chronic disease services in primary care for diabetes but not for asthma were significantly associated with reduced admission rates. There was no association of prescribing levels in primary care trusts with admission rates for any of the conditions examined. Although hospital admission for some chronic diseases is potentially avoidable and rates of hospital admission for these conditions are possible indicators of the quality of care, they should be interpreted in conjunction with measures of population composition and deprivation. Failure to do this may result in primary care trusts and general practitioners being criticized for aspects of health care utilization that are not under their direct control.

Association of Population and Practice Factors with pOtentially Avoidable Admission Rates for Chronic Diseases in London: Cross Sectional Analysis

To examine the association between underlying ill health, material deprivation and primary care supply factors and hospital admission rates for potentially avoidable admissions in primary care trusts in London. Cross sectional analysis at primary care trusts level using routine data from multiple sources. All 31 primary care trusts in London with a total resident population of 7 million patients. Age-standardized hospital admission rates for asthma, diabetes, heart failure, hypertension and chronic obstructive pulmonary disease. Admission rates varied widely for the conditions examined across the 31 primary care trusts. In 2001, age adjusted admission rates for asthma varied from 76 to 189 per 100,000 and for diabetes from 38 to 183 per 100,000. There was a significant association between higher admission rates and measures of underlying ill health and material deprivation but not quantitative measures of primary care service provision. Provision of specialist chronic disease services in primary care for diabetes but not for asthma were significantly associated with reduced admission rates. There was no association of prescribing levels in primary care trusts with admission rates for any of the conditions examined. Although hospital admission for some chronic diseases is potentially avoidable and rates of hospital admission for these conditions are possible indicators of the quality of care, they should be interpreted in conjunction with measures of population composition and deprivation. Failure to do this may result in primary care trusts and general practitioners being criticized for aspects of health care utilization that are not under their direct control.

Hospital Admissions for Wheezing and Asthma in Childhood—Are They Avoidable?

Hospital admission rates for asthma and wheezing are still high, especially in younger children. We performed a prospective study of children admitted for asthma or wheezing to Stavanger University Hospital during one year. Prehospital emergency treatment, prophylactic asthma treatment, and possible risk factors for hospital admission were registered. A total of 337 admissions for 288 children were included. Recommended inhaled emergency treatment was administered prior to only 33% of the admissions. Inhaled steroids had been prescribed before 43% of admissions for asthma, and symptomatic treatment with a β2-agonist prior to 74% of admissions. Parental smoking was frequent. There seems to be a high potential to prevent admissions for asthma and wheezing by improving prophylactic asthma care and prehospital emergency treatment, as well as avoiding parental smoking. An increased focus should be on education and implementation of guidelines.

Hospitalizations for childhood asthma in Athens, Greece, from 1978 to 2000

Trends in rates of asthma admissions among children have shown a variety of patterns in different countries in the last decades. We undertook the present study to determine the time trends in asthma admissions and readmissions of children in Athens, Greece. Data were obtained retrospectively from hospital registries of the three main children's hospitals in Athens from 1978 to 2000. Children admitted with the diagnoses of asthma, asthmatic bronchitis or wheezy bronchitis were included. Hospital admission rate for asthma among children 0-14 yr from 1978 to 2000 rose by 271% (p <0.001). The rise in rates among those aged 0-4 and 5-15 yr were 250% and 276%, respectively. The mean annual increase in admission rate was 12.2% for 1978-1987, 4.7% for 1988-1993 and 0.6% for 1994-2000. The readmission rate among children 0-14 yr was increased from 15.3% to 23.3%. A positive correlation between admission and readmission rates in all age groups was observed. In conclusion, our findings show an increase in the childhood asthma admission rate in Athens in late 1970's and during the 1980's, which has decelerated in the 1990's, particularly in the second-half of the decade. The readmission rate paralleled that of admissions over the entire study period.

Do inhaled steroids differ from cromones in terms of hospital admission rates for asthma in children?

The aim of the present study was to investigate the characteristics of hospital admissions in two child populations receiving different types of drugs as their regular medication for steady-state asthma. Annual data on children aged under 16 y treated for asthma, including consumption of regular medication for asthma, numbers of hospital periods, lengths of hospitalizations and annual proportions of readmissions, were collected using patient-specific medical records from 1995 to 1999. In the Kuopio province, on average, 35.6-36.7/1000 children were on maintenance for asthma, of which 23% were receiving cromones, 51% were taking inhaled steroids and 26% were treated with cromones plus intermittent steroids. In the Oulu province, the respective prevalence was 32.7-34.9/1000, and the respective proportions were 5%, 93% and 2%. Total and first admissions, as well as hospital days were clearly less in the Oulu province. In the children aged > or = 6y, the average annual total admissions were 0.3/1000 (Oulu) vs 1.2/1000 (Kuopio) (p < 0.001). Similarly, the first admissions were 0.2/1000 vs 1.0/1000 (p < 0.001), proportions of readmissions 6.3% vs 19.3% (p < 0.05), and numbers of hospital days 0.7/1000 vs 3.8/1000 (p < 0.001). The differences were in the same direction, though less prominent, also among children 2-5 y of age. Our results suggest that inhaled steroids are better than cromones in preventing admissions for asthma when two provinces with different practices for maintenance medication of steady-state asthma were compared.

Do inhaled steroids differ from cromones in terms of hospital admission rates for asthma in children?

Aim: The aim of the present study was to investigate the characteristics of ho spital admissions in two child populations receiving different types of drugs as their regular medication for steady-state asthma. Methods: Annual data on chil dren aged under 16 y treated for asthma, including consumption of regular medica tion for asthma, numbers of hospital periods, lengths of hospitalizations and an nual proportions of readmissions, were collected using patient-specific medical records from 1995 to 1999.In the Kuopio province, on average, 35.6-36.7/100 0 children were on maintenance for asthma, of which 23%were receiving cromones, 51%were taking inhaled steroids and 26%were treated with cromones plus interm ittent steroids. In the Oulu province, the respective prevalence was 32.7-34. 9/1000, and the respective proportions were 5%, 93%and 2%. Results: Total and first admissions, as well as hospital days were clearly less in the Oulu provin ce. In the children aged ≥6 y, the average annual total admissions were 0.3/10 00 (Oulu) vs 1.2/1000 (Kuopio) (p 0.001). Similarly, the first admissions we re 0.2/1000 vs 1.0/1000 (p 0.001), proportions of readmissions 6.3%vs 19 .3%(p 0.05), and numbers of hospital days 0.7/1000 vs 3.8/1000 (p 0.00 1). The differences were in the same direction, though less prominent, also amon g children 2-5 y of age. Conclu sion: Our results suggest that inhaled steroids are better than cromones in pr eventing admissions for asthma when two provinces with different practices for m aintenance medication of steady-state asthma were compared.

A specialist nurse led liaison model of care reduced unscheduled care for acute asthma in a deprived multiethnic area

Griffiths C, Foster G, Barnes N, et al . Specialist nurse intervention to reduce unscheduled asthma care in a deprived multiethnic area: the east London randomised controlled trial for high...

Comparative Study of Different Inhaler Devices in Asthmatic Children

The inhaler is an important drug delivery system in the treatment of asthma, but inhaler technique is often inadequate. We assessed technique in children diagnosed with asthma, comparing the performance of three devices. In a cross-sectional survey, 523 children (271 boys, 252 girls, ages 5 to 12 years; mean+/-SD 7.53+/-1.79 years) demonstrated inhalation technique according to Netherlands Asthma Foundation criteria during a first visit to a primary care clinic in Abha, Saudi Arabia. Patients used the device with which they were most familiar (either pMDI, Turbuhaler or Diskus). Two hundred children (38% of total population) used a pMDI, while 323 (62% of total population) used one of the dry powder inhalers 173 (58%) the Turbuhaler and 150 (47%) the Diskus. Only 49 children (25% of the total population) completed the assessment without making a mistake. The remaining 474 (75% of the total population) performed one or more manuevers poorly. Only 80 children who used an MDI (40% of those using the device) completed 50% or more of the maneuvers correctly compared with 111 (69% of those using the device) and 100 (67% of those using the device) of those using the Turbuhaler and Diskus, respectively (P=0.001 for comparison of MDI with dry powder inhalers). Children whose mothers had intermediate school or higher education performed better than those whose mothers had less education (P=0.001). The father's education had no bearing on performance with the inhaler. The inhaler technique of most asthmatic children is poor, but technique is better in children who use a dry powder compared a metered-dose inhaler. The level of the mother's education is positively associated with better inhalation technique in the child.

Social deprivation and asthma

This study was conducted to see whether children living in socially deprived areas were more likely than other children to be admitted to hospital for asthma, and, if so, whether their excess risk was attributable to a higher prevalence of asthma or poorer treatment. Hospital admission rates for asthma were obtained for Cardiff electoral wards and compared with the Townsend indices of deprivation. A survey of respiratory symptoms was conducted in schoolchildren; prevalence of symptoms was compared with Townsend index and asthma admission rate for the schools' catchment areas. Asthma admissions were strongly correlated with Townsend indices at all ages. The prevalence of reported asthma and various degrees of wheeze in the schools was not significantly correlated with Townsend index or hospital admission rate in the corresponding areas. The presence of a smoker in the house was strongly associated with Townsend index and admission rate; children whose houses contained a smoker were more likely than others to have wheezed in the past year and to have disturbed nights due to wheezing. There was a non-significant negative association between Townsend index and regular use of inhaled steroids. The relationship between hospital admission for asthma and social deprivation is not explained by variations in prevalence, but it may be attributable to the aggravation of symptoms by active or passive smoking, and perhaps also to differences in management.

Hospitalization of adults for asthma and inhaled corticosteroid use in an island population

Inhaled corticosteroids have been shown to reduce morbidity and the need for hospitalization from asthma. Despite improvements in the therapy of asthma, epidemiologic data from several countries has shown that the hospital admission rates for asthma among adults at a population level are on the increase. The prevalence rate of hospital admission for asthma among Maltese adults aged 15–59 years was determined retrospectively from 1989 to 1993. Concurrent yearly total dispensal of inhaled corticosteroids for the whole population was also calculated. This study was undertaken amongst a well-defined island population served by a single medical facility offering emergency services, and a possible association between these two trends was investigated by means of logistic regression. The age-specific hospital admission rates for asthma decreased from 96.2 (95% CI: 109·7, 82·7) per 100 000 in 1989 to 38·1 (95% CI: 46·4, 29·8) per 100 000 in 1993. The prevalence rates of admission from asthma decreased from 67·6 (95% CI: 78·9, 56·3) per 100 000 in 1989 to 30·6 (95% CI: 38·0, 23·2) per 100 000 in 1993. The dispensal of inhaled beclomethasone dipropionate (BDP) increased from 0·99 defined daily dose (DDD) per 1000 population in 1989 to 3·28 DDD per 1000 in 1993. Logistic regression showed that increasing dispensal of inhaled BDP by 1 DDD per 1000 decreased the odds of an admission from asthma to 0·71 (95% CI: 0·65, 0·78) times their previous value. Similarly, the odds of an individual being hospitalized because of asthma decreased to 0·75 (95% CI: 0·67, 0·83) times their previous value. This study concludes that there was a progressive decrease in hospital admission rates for asthma in adults, and this trend correlates well with increasing use of inhaled corticosteroids at a community level. This must, however, be interpreted with care in light of the fact that increase in utilization of anti-inflammatory therapy probably also reflected improved general and widespread care for asthma.

Is the ratio of inhaled corticosteroid to bronchodilator a good indicator of the quality of asthma prescribing? Cross sectional study linking prescribing data to data on admissions.

To investigate the ratio of inhaled corticosteroid to bronchodilator as a measure of the quality of asthma prescribing by general practitioners. Ecological cross sectional study linking general practitioner asthma prescribing with hospital admission data and a measure of deprivation. 11 family health services authorities in the West Midlands region and 99 general practices in North Staffordshire. Hospital admission rates for asthma; the ratio of inhaled corticosteroid to bronchodilator; and Townsend deprivation scores. No overall significant correlation was found between admission rates for asthma and corticosteroid:bronchodilator ratios for family health services authorities (Spearman's rs = -0.109, P = 0.750) or general practices (rs = -0.084, P = 0.407). In deprived family health services authority areas and general practices an inverse non-significant correlation existed between admission rates for asthma and corticosteroid:bronchodilator ratios (rs = -0.300, P = 0.624; rs = -0.218, P = 0.136). In contrast, in more affluent areas and general practices a positive non-significant correlation existed between admission rates and corticosteroid:bronchodilator ratios (rs = 0.371, P = 0.468; rs = 0.038, P = 0.792). Although the corticosteroid:bronchodilator ratio may be a valid indicator of the quality of prescribing for individual patients with asthma, caution should be applied in interpreting aggregated ratios. Differences in the severity of asthma or the prevalence of chronic obstructive pulmonary disease may explain inconsistent associations between admission rates for asthma and corticosteroid:bronchodilator ratios in family health services authorities and general practices with different deprivation scores.

Referring for knowledge base: What is the case for referral?

Referring for knowledge base: What is the case for referral?

Hospital admission rates for asthma and respiratory disease in the West Midlands: their relationship to air pollution levels.

A study was undertaken to determine the relationship between hospital admissions for asthma and all respiratory conditions in electoral wards in the West Midlands and ambient levels of smoke, sulphur dioxide, and nitrogen dioxide, and to establish whether the relationship is independent of social deprivation and ethnicity, and is different for young children and older individuals. Data on hospital admissions for acute respiratory conditions were obtained by electoral ward from the West Midlands Regional Health Authority Information Department Körner inpatient data including asthma (ICD 493) and all acute respiratory disease (466, 480-486, 490-496) for the period April 1988 to March 1990. The population for each electoral ward, percentage of ward population that was from non-white ethnic groups, and Townsend deprivation score were all calculated from 1991 census information. Data on smoke and sulphur dioxide (SO2) levels were obtained for 24 wards in Birmingham, Coventry, Wolverhampton, Dudley, Stafford, and Burton-on-Trent, and on nitrogen dioxide (NO2) levels from 39 wards in the same local authority areas. All were background urban sites and most participated in the Warren Spring national quality control programme for SO2 and smoke monitoring. Indirect age-sex standardised hospitalisation rates (SHR) for all respiratory conditions and asthma were calculated using the 1991 rates for the West Midlands RHA as the standard. Multivariate regression models were used to assess the relationship between individual pollutants and the SHR. The Townsend score and percentage of the population from non-white ethnic groups were included in all models to adjust for ethnicity and socioeconomic deprivation. The SHR for asthma varied almost fourfold across the region, and all respiratory SHR showed more than three fold variation. Bivariate regression revealed both Townsend score and percentage of non-white individuals to be associated with SHR for asthma and all respiratory conditions at all ages, but not for children under 5 years. NO2 was associated with hospital admission rates for all ages including children under 5. SO2 and smoke were not associated with hospital admissions. Multivariate analysis including Townsend score and percentage of non-white subjects in the model revealed that NO2 was associated with hospital admission rates for all respiratory conditions only for children under 5. The Townsend score was associated with SHR for all respiratory conditions, and both the Townsend score and percentage of non-white subjects were associated with SHR for asthma in children under 5 in two of three models. The association between SHR for asthma and percentage of non-white subjects was negative. Socioeconomic deprivation, as measured by the Townsend score, is a significant predictor of hospital admission rates for respiratory disease in older individuals, and both the percentage of non-white subjects and the Townsend score are significant predictors of hospital admission rates for asthma in children. After correction for socioeconomic deprivation and ethnicity, background urban NO2 levels in the ward of residence are significantly associated with standardised hospital admission rates for all respiratory disease in children under 5. This may represent a causal effect of NO2 on the respiratory health of children, or the effect of confounding factors not corrected by use of the Townsend score.