Key Health Data for the West Midlands 2001
Chapter 3: Winter Health
List
of Tables
List
of Figures
Main Body
1: West Midlands Geography
2: Our Healthier Nation
3: Winter Health
4: Accident and Emergency
5: Environment and Health
6: Mental Health
7: Communicable Disease
8: Perinatal Mortality
9: Crime
10: Sports Facilities
11: Housing Quality
12: Inequalities, Focusing on the early years
3.1 Introduction
Demand for health services, particularly in the acute sector, rises significantly in the Winter period. The reasons for this are well known and well understood, being mainly related to increased incidence of respiratory illnesses. With high bed occupancy throughout the year, this peak in demand frequently exceeds supply and serious service pressures result. Whilst this is problem occurs across the country, it has been observed that the peaks are highly variable from area to area (King's Fund 2001) The aim of this chapter is to illustrate some of the epidemiological factors underlying these peaks, and show how some of them impact upon service use in the West Midlands
The dramatic impact of respiratory illness can be seen in Figure.3.1. These are not the only pressures on services at this time of year. Peaks have also been reported in accidents and emergencies amongst the elderly. Regular monitoring of A&E attendances in the West Midlands, highlighted a December / January peak in this age group (Figure. 3.2).
A significant increase in strokes and a lesser peak in myocardial infarctions have also been noted. In 1999 / 2000 monthly stroke deaths the West Midlands peaked in January at 543 (Figure. 3.3). Admissions for acute myocardial infarction also peak in the winter months although to a lesser extent. In 1999/2000 the peak monthly total occurred in December, at 732 admissions up from a monthly mean of approximately 635 (Figure. 3.4). The relationship between season and cardiovascular and cerebro-vascular events is less well understood, although exposure to cold is considered to be a possible contributory factor (West Midlands Health Technology Assessment Group, 2001).
Whilst we have considered the impact of seasonal illness upon acute providers, much of the burden of respiratory illness falls upon primary care services. A simple analysis of consultation rates in central England and Wales illustrates the increased activity associated with these conditions particularly in the first quarter (January to March) and the fourth quarter (October to December) of the year.
The selected conditions are:
- flu and flu-like illnesses, (Figure. 3.5),
- pneumonia, (Figure. 3.6),
- common cold (Figure 3.7)
- and acute bronchitis (Figure. 3.8).
3.2 Data sources
A & E attendances were derived from data collected by the West midlands Accident and Emergency Surveillance Centre, The University of Birmingham, www.bham.ac.uk/publichealth/accidentandemergencycentre
Admissions for respiratory diseases were derived from Hospital Episode Statistics (HES), using ICD10 diagnostic coding to obtain target data. Data were grouped to obtain number of individual spells rather than finished consultant episodes.
GP consultation rates were obtained from the Birmingham Research Unit of the Royal College of General Practitioners weekly returns service. The data is collected across 3 supra regional groups. Data presented in this report are from the 'Central' group, 24 practices in Central England and Wales. Populations used for the consultation rates are Office of National Statistics (ONS) estimates for 1999.
Deaths were obtained from ONS mortality data
for the calendar year 2000.
References
King's Fund, 2001, Short Paper, Winter pressures
and the NHS, King's Fund London, www.kingsfund.org.uk/eKingsfund/assets/applets/winter.pdf.
West Midlands Health Technology Assessment Group, 2001, A systematic review
of the biological and health effects of exposure to cold temperature in
healthy and diseased adults including the elderly, The University of Birmingham.
For more information please
contact Carol Richards on
0121 414 3368
© Department of Public Health
and Epidemiology, University of Birmingham