Incidence of hospital admission does not equal incidence of disease
| Autor: | Pobereskin Lh, Sneyd |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Pediatrics
medicine.medical_specialty education.field_of_study Subarachnoid hemorrhage Inequality Referral business.industry media_common.quotation_subject Incidence (epidemiology) Population General Medicine Disease medicine.disease Cohort medicine First-degree relatives business education media_common |
| Zdroj: | BMJ. 320:1277-1277 |
| ISSN: | 0959-8138 |
| DOI: | 10.1136/bmj.320.7244.1277 |
| Popis: | Editor—We are concerned about Gaist and colleagues' methods and feel that the conclusions they draw from their data are incorrect.1 The diagnosis of subarachnoid haemorrhage was validated in a sample from only one county. Is Funen County representative of Denmark, and how was it selected? Hospitals with 10 or fewer registered patients in the study period were excluded. Why was it appropriate to exclude the smaller hospitals when they may be a source of patients with particularly low predictive value for a registered diagnosis of subarachnoid haemorrhage? The cohort of first degree relatives was overwhelmingly made up of children, and they were the only group in table 2 for whom the incidence rate ratios were significantly different from 1. The main problem with the study is one that plagues much of the literature on subarachnoid haemorrhage—it was hospital based. The strongest predictor of survival in subarachnoid haemorrhage is age. This is just as true when considering who will survive to reach medical attention. In a recent population based review of 824 cases of subarachnoid haemorrhage in Devon and Cornwall, the proportion of patients dying outside hospital was 7% and 17% for those of less than and more than 45 years of age respectively. It is therefore not surprising that, as has been shown in this study, a group aged 33 years is more likely to be admitted to hospital after a subarachnoid haemorrhage than a group aged 53. In addition, these first degree relatives were generally patients who had a parent who had experienced subarachnoid haemorrhage in the past few years. They and their own families would therefore be highly aware of this condition and its serious consequences and be more likely than the general population to refer themselves for investigation and to press for referral to a specialist centre. This study suggests that first degree relatives are more likely than the general population to be admitted to hospital following a subarachnoid haemorrhage. If the differences in age and awareness between index cases and relatives are considered, however, it would seem to go beyond the data to conclude that first degree relatives are more likely to have a subarachnoid haemorrhage. |
| Databáze: | OpenAIRE |
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