title: Effect of social factors on winter hospital admission for respiratory disease: a case-control study of older people in the UK.
abstract: BACKGROUND
  Every winter, hospitals in the UK and other developed countries experience a surge in respiratory admissions. Ecological studies suggest that social circumstances may be an important determinant.
  
  
  OBJECTIVE
  To establish the most important factors associated with winter hospital admissions among older people presenting with acute respiratory disease, especially the relative effect of social factors.
  
  
  METHODS
  case-control study.
  
  
  METHODS
  Seventy-nine general practices in central England.
  
  
  METHODS
  Of a cohort of patients consulting medical services with lower respiratory tract infection or exacerbation of chronic respiratory disease, 157 hospitalised cases were compared to 639 controls. Social, medical, and other factors were examined by interview and GP records.
  
  
  RESULTS
  Measures of material deprivation were not significant risk factors for admission at either individual or area level, although social isolation (odds ratio [OR] 4.5; 95% confidence interval [CI] = 1.3 to 15.8) resulted in an increased risk of admission. The most important independent risk factor was the presence of chronic obstructive pulmonary disease (COPD; OR 4.0; 95% CI = 1.4 to 11.4), other chronic disease (OR 2.9; 95% CI = 1.2 to 7.0), or both (OR 6.7; 95% CI = 2.4 to 18.4). Being housebound was also an independent risk factor (OR 2.2; 95% CI = 1.0 to 4.8).
  
  
  CONCLUSIONS
  Socioeconomic factors had little relative effect compared with medical and functional factors. The most important was the presence of long-term medical conditions (especially COPD), being housebound, and having received two or more courses of oral steroid treatment in the previous year. This combination of factors could be used by primary medical services to identify older patients most vulnerable to winter admissions. Clinicians should ensure that patients with COPD are better supported to manage their condition.
authors.affiliation: Department of Public Health and Epidemiology, University of Birmingham, Birmingham. r.e.jordan@bham.ac.uk
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Jordan
authors.forename: Jeremy I
authors.initials: JI
authors.lastname: Hawker
authors.forename: Jon G
authors.initials: JG
authors.lastname: Ayres
authors.forename: Peymané
authors.initials: P
authors.lastname: Adab
authors.forename: William
authors.initials: W
authors.lastname: Tunnicliffe
authors.forename: Babatunde
authors.initials: B
authors.lastname: Olowokure
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
authors.forename: Ros
authors.initials: R
authors.lastname: Salter
authors.forename: Kar Keung
authors.initials: KK
authors.lastname: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000628:therapy; D012621:Seasons; D012934:Social Isolation; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology