The problems in determining international road mortality

We examined road traffic crash (RTC) fatality rate data for the year 2002 with the object of determining which data source offered the most reliable estimates for international comparison work. Data from the World Health Organisation (WHO) (supplied by national health authorities) and the International Road Federation (IRF) (supplied by national transport authorities) was compared. There were large discrepancies between the rates reported. Discrepancies may be partially explained by the under-reporting of fatalities and by different definitions of road fatality. Two methodologies to adjust for these factors in the IRF database were examined. Neither brought consensus with the WHO RTC fatality rate for all nations. While the WHO provide RTC fatality rates for a wider socio-economic and geographical range of nations than the IRF, the methodology used by the WHO to produce estimates for the least economically developed nations may lead to over-estimation of RTC fatality rate. WHO RTC fatality rates were more strongly associated with variables that are thought to explain RTC fatality rate. We suggest that WHO data may be more suitable than the IRF data for international comparison studies. However, it is advisable that data for the least developed nations be excluded from such work

Environmental factors and hospitalisation for COPD in a rural county of England

Background: Chronic obstructive pulmonary disease (COPD) is a major global cause of morbidity and mortality. Studies in urban areas have shown associations between air pollutants and hospital admissions for COPD. Whether temporal variations in air quality are associated with hospital admissions for COPD in a rural region with lower concentrations of air pollutants than previously studied was investigated. Methods: Daily COPD admissions were recorded for patients attending three hospitals in the county of Norfolk, UK, between January 2006 and February 2007. Records were combined with daily information on concentrations of six air pollutants (carbon monoxide, nitric oxide, nitrogen dioxide, oxides of nitrogen, ozone and fine particulates), airborne pollens, temperature and influenza incidence. A case–crossover analysis was used to examine the association between air pollution and daily admissions. Results: There were 1050 admissions for COPD over the study period. After adjustment for temperature, pollen and respiratory infections, each 10 µg/m3 increase in CO was associated with a 2% increase in the odds of admission. V3alues of 17%, 22% and 9% were observed for NO, NO2 and oxides of nitrogen respectively. No associations were observed with O3 or particulates. Conclusion: Among a population of a less urbanised area than previously investigated, this study found evidence that ambient pollutant concentrations were still associated with the risks of hospital admission for COPD

The effects of mobile speed camera introduction on road traffic crashes and casualties in a rural county of England

Problem This study assesses the impact of crash and casualty numbers in correspondence to the introduction of mobile speed cameras in the rural county of Norfolk, England. Method Road traffic accident casualty and crash data were collected for two years before the introduction of cameras and two years subsequently. The casualties and crashes occurring at 29 camera sites were identified and separated from those occurring in the rest of the county. Trends in crashes and casualties, and their severity, were examined graphically and comparisons were made between before and after periods. The regression to the mean effect at individual sites was estimated. Results After the introduction of cameras, overall crashes declined by 1% and crashes involving fatalities or serious injuries declined by 9% on the roads without cameras. At the camera sites, crashes decreased by 19% and fatal and serious crashes by 44%. The reduction in total crashes was significantly greater than that expected from the effect of regression to the mean in 12 out of 20 sites tested. Summary The introduction of cameras appears to have resulted in real and measurable reductions in crash risk in this rural county. Impact on industry Our results suggest the deployment of mobile speed cameras is an effective tool for organizations wishing to reduce road traffic casualties in areas where high crash rates have been associated with excessive vehicle speeds

Geographical access to healthcare in Northern England and post-mortem diagnosis of cancer

Background: There is some previous evidence that diagnosis of cancer at death, recorded as registry death certificate only records, is associated with problems of access to care. Methods Records from the Northern and Yorkshire Cancer Registry for patients registered with breast, colorectal, lung, ovarian or prostate cancer between 1994 and 2002 were supplemented with measures of travel time to general practitioner and hospital services, and social deprivation. Logistic regression was used to identify predictors of records where diagnosis was at death. Results There was no association between the odds diagnosis at death and access to primary care. For all sites except breast, the highest odds of being a cancer diagnosed at death fell among those living in the highest quartile of hospital travel time, although it was only statistically significant for colorectal and ovary tumours. Those in the most deprived and furthest travel time to hospital quartile were 2.6 times more likely to be a diagnosis at death case compared with those in the most affluent and proximal areas. Conclusions There is some evidence that poorer geographical access to tertiary care, in particular when coupled with social disadvantages, may be associated with increased odds of diagnosis at death

Social and geographical factors affecting access to treatment of lung cancer

Background:UK residents' healthcare is free of charge but uptake varies. Cancer survival is inferior to that of other Western European countries. We have used cancer registry data to assess factors associated with access to diagnosis and treatment of lung cancer in northern England.Method:We assigned 34 923 lung cancer patients diagnosed between 1994 and 2002 to quartiles for the deprivation score associated with their postcode and for the travel time to the relevant healthcare facility. Odds ratios, adjusted for age and sex, for undergoing interventions were calculated relative to the least deprived quartile living closest to the facility. The odds ratio for receiving chemotherapy for small-cell lung cancer (SCLC) was calculated according to the type of hospital where it was diagnosed.Results:The odds ratio for attainment of a histological diagnosis for the least deprived/furthest residence group was 0.83 (95% confidence 0.70-0.97) for the most deprived/nearest residence group was 0.74(0.62-0.87) and for the most deprived/furthest residence group it was 0.61 (0.49-0.75). The corresponding odds ratios for receipt of any active treatment were 0.93 (0.80-1.07), 0.74 (0.64-0.86), and 0.55 (0.46-0.67). The odds ratios for receipt of chemotherapy for SCLC were 1.27 (0.89-1.82), 1.21 (0.85-1.74) and 0.81 (0.52-1.28). Odds ratios for undergoing surgery for non-small cell lung cancer using (1) travel time to diagnosing hospital were 0.88 (0.70-1.11), 0.74 (0.59-0.94) and 0.60 (0.44-0.84). Using (2) travel time to a thoracic surgery facility they were 0.83 (0.65-1.06), 0.70 (0.55-0.89) and 0.55 (0.49-0.76).Conclusion:Living in a deprived locality reduces the likelihood of undergoing definitive management for lung cancer with the exception of chemotherapy for SCLC. This is amplified by travel time to services

Travel time to hospital and treatment for breast, colon, rectum, lung, ovary and prostate cancer

The aim was to examine the effect of geographical access to treatment services on cancer treatment patterns. Records for patients in northern England with breast, colon, rectal, lung, ovary and prostate tumours were augmented with estimates of travel time to the nearest hospital providing surgery, chemotherapy or radiotherapy. Using logistic regression to adjust for age, sex, tumour stage, selected tumour pathology characteristics and deprivation of place of residence, the likelihood of receiving radiotherapy was reduced for all sites studied with increasing travel time to the nearest radiotherapy hospital. Lung cancer patients living further from a thoracic surgery hospital were less likely to receive surgery, and both lung cancer and rectal cancer patients were less likely to receive chemotherapy if they lived distant from these services. Services provided in only a few specialised centres, involving longer than average patient journeys, all showed an inverse association between travel time and treatment take-up

Travel times to health care and survival from cancers in Northern England

The aim was to assess the effect of geographical accessibility on the stage of cancer at diagnosis and survival. Records of 117,097 cases of breast, colorectal, lung, ovary and prostate cancer diagnosed in Northern England between 1994 and 2002 were supplemented with estimates of travel times to the patients’ general practitioners (GPs) and hospitals attended, together with measures of access to public transport. Logistic regression and Cox proportional hazards models were used, adjusting for age, sex, whether the first hospital visited was a cancer centre and deprivation of area of residence. Late stage at diagnosis was associated with increasing travel time to GP for breast and colorectal cancers and risk of death was associated with travel time to GP for prostate cancer. Travel times to hospital and other accessibility measures showed no consistent associations with stage at diagnosis or survival, so travel to GP was the only influential factor