title: Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): a significant decline and convergence between areas.
abstract: Potentially Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. We estimate the population age-sex standardized relative risk of admission for COPD-PPH by year and area of residence in the Spanish National Health System (sNHS) during the period 2002-2013.
  
  
  
  The study was conducted in the 203 Hospital Service Areas of the sNHS, using the 2002 to 2013 hospital admissions for a COPD-PPH condition of patients aged 20 and over. We use conventional small area variation statistics and a Bayesian hierarchical approach to model the different risk structures of dependence in both space and time.
  
  
  
  COPD-PPH admissions declined from 24.5 to 15.5 per 10,000 persons-year (Men: from 40.6 to 25.1; Women: from 9.1 to 6.4). The relative risk declined from 1.19 (19 % above 2002-2013 average) in 2002 to 0.77 (30 % below average) in 2013. Both the starting point and the slope were different for the different regions. Variation among admission rates between extreme areas dropped from 6.7 times higher in 2002 to 4.6 times higher in 2013.
  
  
  
  COPD-PPH conditions in Spain have undergone a strong decline and a reduction in geographical variation in the last 12 years, suggesting a general improvement in health policies and health care over time. Variability among areas still remains, with a substantial room for improvement.
authors: Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Catalunya Av. 21, 46020, Valencia, Spain. librero_jul@gva.es.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain. librero_jul@gva.es.
authors: Julián
authors: J
authors: Librero
authors: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.|NavarraBiomed - Fundación Miguel Servet, Pamplona, Spain.
authors: Berta
authors: B
authors: Ibañez-Beroiz
authors: Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Catalunya Av. 21, 46020, Valencia, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
authors: Salvador
authors: 0000-0002-3902-569X
authors: S
authors: Peiró
authors: Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Catalunya Av. 21, 46020, Valencia, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.|Instituto Aragonés de Ciencias de la Salud. IIS Aragón, Zaragoza, Spain.
authors: M
authors: M
authors: Ridao-López
authors: Centro Superior de Investigación en Salud Pública (CSISP-FISABIO), Catalunya Av. 21, 46020, Valencia, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
authors: Clara L
authors: CL
authors: Rodríguez-Bernal
authors: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.|Instituto Aragonés de Ciencias de la Salud. IIS Aragón, Zaragoza, Spain.
authors: Francisco J
authors: FJ
authors: Gómez-Romero
authors: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.|Instituto Aragonés de Ciencias de la Salud. IIS Aragón, Zaragoza, Spain.
authors: Enrique
authors: E
authors: Bernal-Delgado
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D001499:Bayes Theorem; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D013030:Spain
keywords: Chronic obstructive pulmonary disease; Hospitalization; Potentially preventable hospitalizations; Small area variation analysis