Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): a significant decline and convergence between areas

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Chronic obstructive pulmonary disease; Hospitalization; Potentially preventable hospitalizations; Small area variation analysis.

Fig. 1

Distribution of COPD-PPH standardized rates among Hospital Service Areas for the overall population, men and women (Spanish NHS, 2002–2013). Foot: COPD-PPH: Chronic Obstructive Pulmonary Disease for Potentially Preventable Hospitalizations; NHS: National Health System. Gray lines represent deciles and coloured lines the median (red) and the mean (blue)

Fig. 2

Age-sex adjusted relative risk of being hospitalized for a COPD-PPH condition for the overall population, men and women (Spanish NHS, 2002–2013). Foot: COPD-PPH: Chronic Obstructive Pulmonary Disease for Potentially Preventable Hospitalizations; NHS: National Health System

Fig. 3

Evolution of COPD-PPH standardized rates by Autonomous Communities (Spanish NHS, 2002–2013). Foot: COPD-PPH: Chronic Obstructive Pulmonary Disease for Potentially Preventable Hospitalizations; NHS: National Health System

Fig. 4

Spatial patterns in standardized rates of COPD-PPH by Health Service Areas for the entire population, men and women (Spanish NHS, 2002–2013). Foot: COPD-PPH: Chronic Obstructive Pulmonary Disease for Potentially Preventable Hospitalizations; NHS: National Health System. The left-hand maps show the COPD-PPH admission spatial risk associated to each Health Service Areas to be constant along the period. The right-hand map shows the posterior probability that this spatial risk will be higher than 1 (probabilities above 0.8 indicate high-risk areas)