North-South Disparity in Pneumonia Risks Laid Bare By New Report

Patients in the North West of England are more likely to die from pneumonia than those in the South, with almost one in six dying in hospital or within 30 days of discharge, according to a new report, Pneumonia: Closing the gap – A call to action.

Aqua, the NHS healthcare transformation and quality improvement agency which produced the report, highlight how hospital trusts in the region are working together to share data and improve the quality of care; but there is still work to be done.

The report identified that problems with diagnosis, a failure to prescribe the correct antibiotics quickly, and co-morbidities mediated by regional health inequalities, were key areas to address.

It also showed that as the NHS enters arguably the most challenging winter in its history, with record demand for respiratory care due to COVID-19, the UK has the highest age-adjusted death rate for pneumonia in Europe for women, and the third highest for men.

Aqua’s Advancing Quality (AQ) programme has developed a key set of metrics defining what good pneumonia care should entail, based on national guidance and supported by clinical advice. AQ’s data shows significant variation between North West trusts in timely prescription of antibiotics and use of x-rays.

Of the 42,000 who develop the condition, are treated in hospital and discharged, more than one in three are readmitted within the month as an emergency case.
The report comes on the back of Health Equity In England: The Marmot Review 10 Years On, published earlier this year; the follow-up to the seminal 2010 paper on health inequalities from Professor Marmot.

Aqua’s report finds that the entrenched socioeconomic factors identified by Marmot impact pneumonia prevalence.

The most deprived 10 per cent of the population account for more than a quarter of pneumonia admissions. People living in these communities also develop the condition eight years younger than those in more affluent areas.

Chronic co-morbidities also complicate the diagnosis and treatment of pneumonia; with many patients also suffering from atrial fibrillation (24%), chronic obstructive pulmonary disease (34%) and hypertension (38%). These illnesses are similarly more widespread in disadvantaged communities due to higher rates of lifestyle-mediated conditions.

Ruth Yates, associate director at aqua said: Deep-seated inequalities between North and South which have persisted for too long create a perfect storm for pneumonia to proliferate. COVID-19 has cruelly underlined the need to address this disparity, while also elevating interest in the way we diagnose and treat patients with respiratory disease to an all-time high.

“As a nation, we are now accustomed to tragic daily death numbers reported due to the virus. In the North West, more than 10,000 people have sadly died from coronavirus since the pandemic began. It has elicited a cohesive response from local and NHS leaders on an incredible scale. However, we shouldn’t forget about pneumonia, which was here before Covid: 6,700 people died in hospital from pneumonia in the North West in 2019.

“In the recovery from coronavirus we need decisive and effective action to support disadvantaged communities and reduce the underlying drivers for pneumonia. To improve the care patients receive once admitted, hospital trusts in the region must be backed with funding and resources equal to the challenge.

“Many trusts have been working together through aqua’s regional quality programmes and network to effect change. But our report outlines that in some trusts there is still too much unwarranted variation in the standard of pneumonia care which patients receive, both in terms of diagnosis, clinical coding, and appropriate, timely prescription of medication.

“All of these areas can be improved markedly through robust quality improvement processes. and learning from the best performing hospitals. Our report must serve as a call to action to properly prioritise pneumonia diagnosis and care.”

Dr Biswajit Chakrabarti, Consultant Respiratory Physician at Liverpool University Hospitals NHS Foundation Trust and Advancing Quality Clinical Lead for Pneumonia added: “Our data shows that patients admitted to hospital with a diagnosis of Community Acquired Pneumonia represent a group who are at significant risk for 30-day readmission following discharge.

“A diagnosis of Community Acquired Pneumonia should be regarded by healthcare professionals as more than just an acute respiratory illness but one that marks the need to identify and optimise comorbidity and frailty both during and beyond the hospital admission.

“It is therefore vital that we adopt a holistic approach to the management of Community Acquired Pneumonia if we are to maximise the benefit to our patients.”

Pneumonia: Closing the gap – A call to action was produced using Office for National Statistics (ONS) and NHS data.

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