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Journal of Public Health Advance Access originally published online on February 7, 2008
Journal of Public Health 2008 30(1):91-98; doi:10.1093/pubmed/fdn003
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© The Author 2008, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Acute respiratory infections and winter pressures on hospital admissions in England and Wales 1990–2005



Alex J. Elliot, Primary Care Scientist

Kenneth W. Cross, Statistician

Douglas M. Fleming, Director
Birmingham Research Unit of the Royal College of General Practitioners, Lordswood House, 54 Lordswood Road, Harborne, Birmingham B17 9DB, UK

Address correspondence to Alex J. Elliot, E-mail: aelliot{at}rcgpbhamresunit.nhs.uk, alex.elliot{at}hpa.org.uk


  Abstract

Background Hospitals experience winter surges in admissions due to respiratory infections. The roles of acute bronchitis and influenza-like illness (ILI) in the timing and severity of these surges are examined over the years 1990–91 to 2004–05.

Methods Respiratory admissions of persons aged ≥65 years in England and Wales were analysed in relation to patients with ILI or acute bronchitis diagnosed by community-based general practitioners from a sentinel surveillance network.

Results Acute bronchitis and ILI accounted for 46 and 7% of the variation in respiratory admissions, respectively: when admissions were lagged by 1 week, these estimates were 20 and 14%, respectively. Admissions peaked in weeks 52, 01 or 02 (late December to early January) in 14 of the 15 winters. Acute bronchitis peaked during weeks 01 or 02; ILI exhibited greater variability and peaks ranged from weeks 46 (mid-November) to 07 (mid-February). During winters where acute bronchitis and ILI peaked concurrently, surges on hospitals were most severe.

Conclusions During each winter acute bronchitis provides a consistent and major contribution to the winter admissions surge in the elderly. The variable incidence of ILI can increase the surge in admissions, especially when ILI and acute bronchitis peak together.

Keywords: acute bronchitis, general practitioner, hospital admissions, influenza-like illness, sentinel surveillance, respiratory syncytial virus


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