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Chronic conditions like asthma and
chronic obstructive pulmonary disease (COPD) are either preventable or manageable through
proper prevention or primary care interventions. Proper management of these chronic
conditions in primary care settings can reduce exacerbation and costly hospitalisation.
Hospital admission rates serve as a proxy for primary care quality, so high admission
rates may point to poor care co-ordination or care continuity. They may also indicate
structural constraints such as the supply of family physicians (AHRQ, 2009; Starfield
et al., 2005).
Asthma is a condition that affects the
airways that carry air in and out of the lungs. Asthma symptoms are usually intermittent
and treatment can be highly effective, even often reversing the effects of bronchial
irritation. COPD, on the other hand, is a progressive disease and people who have COPD
usually have a smoking history. Many people with COPD respond well to bronchodilators but
not to the same extent that asthmatics do.
Asthma is a very common chronic
condition affecting between 150 to 300 million people worldwide and causing some
250 000 deaths globally each year (WHO, 2011b). It is estimated that around 30 million
people have asthma in the European region (Masoli et al., 2004). COPD affects around 64 million worldwide and currently is the
fourth leading cause of death (WHO, 2011c). In Europe, COPD kills between 200 000 to
300 000 people each year and its economic burden is estimated to be EUR 102 billion per
year (European Lung Foundation, 2011).
Figure 5.1.1
and Figure 5.1.2 show an 11-fold difference in hospital
admission rates for asthma and a five-fold difference for COPD between the highest and
lowest country rates. For asthma, the Slovak Republic, the United States and Korea all
have rates that are around double the OECD average. Conversely, Portugal, Canada, Mexico,
Italy, Sweden and Germany have rates that are less than half the OECD average.
The high admission rates for the
United States and Korea have persisted over time. Both countries face similar problems in
terms of a less developed primary care system with deficits in the supply of family
physicians (American Academy of Family Physicians, 2009; Macinko et al., 2007; Kwon et al., 2010; Cho and
Rho, 2003).
Females have consistently higher rates
for asthma admissions compared to males. On average, the female admission rate is 85%
higher. Recent research shows that the incidence of asthma among women has increased and
"that asthmatic women have poorer quality of life and increased
utilisation of health care compared to males despite having similar medical treatment
and baseline pulmonary function" (Kynyk et al., 2011). The admission rate differences may therefore highlight the
need for more effective and targeted care in primary care settings.
The gender specific breakdown for COPD
is a mirror image of the asthma figure with males having consistently higher admission
rates than females (except for Denmark, Iceland, Norway and Sweden). On average, males
have an admission rate that is around 53% higher than females. This is partly due to
higher incidence and prevalence of COPD among men associated with higher smoking
rates.
Ireland, New Zealand, Australia and
Austria all have high admission rates for COPD relative to the OECD average. In Ireland,
this high admission rate is associated with high smoking prevalence, a major risk factor
for COPD. Portugal, France and Switzerland have rates that are less than half the OECD
average.
Definition and comparability
The asthma and COPD indicators are
defined as the number of hospital discharges of people aged 15 years and over per
100 000 population, adjusted to take account of the age and sex composition of each
country's population structure. Differences in diagnosis and coding between asthma and
COPD across countries may limit the precision of the specific disease rates.
Differences in disease classification systems, for example between ICD-9 CM and
ICD-10 AM, may also affect the comparability of the data.
Information on data for Israel:
http://dx.doi.org/10.1787/888932315602.
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| Indicator in PDF |
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| 5.1.1 Asthma hospital admission rates, population aged 15 and
over, 2009 (or nearest year) |
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| 5.1.2 COPD hospital admission rates, population aged 15 and
over, 2009 (or nearest year) |
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