Admission to hospital for bronchiolitis in England: trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma.
BACKGROUND
Admission of infants to hospital with bronchiolitis consumes considerable healthcare resources each winter. We report an analysis of hospital admissions in England over five decades.


METHODS
Data were analysed from the Hospital In-Patient Enquiry (HIPE, 1968-1985), Hospital Episode Statistics (HES, 1989-2011), Oxford Record Linkage Study (ORLS, 1963-2011) and Paediatric Intensive Care Audit Network (PICANet, 2003-2012). Cases were identified using International Classification of Diseases (ICD) codes in discharge records. Bronchiolitis was given a separate code in ICD9 (used in England from 1979). Geographical variation was analysed using Local Authority area boundaries. Maternal and perinatal risk factors associated with bronchiolitis and subsequent admissions for asthma were analysed using record-linkage.


RESULTS
All-England HIPE and HES data recorded 468 138 episodes of admission for bronchiolitis in infants aged <1 year between 1979 and 2011. In 2011 the estimated annual hospital admission rate was 46.1 (95% CI 45.6 to 46.6) per 1000 infants aged <1 year. Between 2004 and 2011 the rates rose by an average of 1.8% per year in the all-England HES data, whereas admission rates to paediatric intensive care changed little (1.3 to 1.6 per 1000 infants aged <1 year). A fivefold geographical variation in hospital admission rates was observed. Young maternal age, low social class, low birth weight and maternal smoking were among factors associated with an increased risk of hospital admission with bronchiolitis.


CONCLUSIONS
Hospital admissions for infants with bronchiolitis have increased substantially in recent years. However, cases requiring intensive care have changed little since 2004.
Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, UK.
Christopher A
CA
Green
Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
David
D
Yeates
Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Allie
A
Goldacre
Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, UK.
Charles
C
Sande
Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
Roger C
RC
Parslow
Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
Philip
P
McShane
Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, UK.
Andrew J
AJ
Pollard
Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Michael J
MJ
Goldacre
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D001724:Birth Weight; D001988:Bronchiolitis / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data / Q000639:trends; D008423:Maternal Age; D008498:Medical Record Linkage; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D012923:Social Class; D055815:Young Adult
Epidemiology; General Paediatrics; Infectious Diseases; Intensive Care; Respiratory