Determinants of inter-practice variation in childhood asthma and respiratory infections: cross-sectional study of a national sentinel network

BMJ Open. 2019 Jan 24;9(1):e024372. doi: 10.1136/bmjopen-2018-024372.


Objectives: Respiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study the effect of practice-level factors on these variations.

Design: Cross-sectional study.

Setting: We analysed data from 164 general practices in the Royal College of General PractitionersResearch and Surveillance Centresentinel network in England.

Participants: Children 5-12 years.

Interventions: None. In this observational study, we used regression analysis to explore the impact of practice-level determinants on the number of respiratory infections in children with asthma.

Primary and secondary outcome measures: We describe the distribution of childhood asthma and the determinants of upper/lower respiratory tract infections in these children.

Results: 83.5% (137/164) practices were in urban locations; the mean number of general practitioners per practice was 7; and the mean duration since qualification 19.7 years. We found almost 10-fold difference in the rate of asthma (1.5-11.8 per 100 children) and 50-fold variation in respiratory infection rates between practices. Larger practices with larger lists of asthmatic children had greater rates of respiratory infections among these children.

Conclusion: We showed that structural/environmental variables are consistent predictors of a range of respiratory infections among children with asthma. However, contradictory results between measures of practice clinical care show that a purely structural explanation for variability in respiratory infections is limited. Further research is needed to understand how the practice factors influence individual risk behaviours relevant to respiratory infections.

Keywords: asthma; clinical practice variations; computerized; general practice; medical record systems.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma / epidemiology*
  • Bronchiolitis / epidemiology
  • Bronchitis / epidemiology
  • Child
  • Child, Preschool
  • Common Cold / epidemiology
  • Cross-Sectional Studies
  • England / epidemiology
  • Female
  • General Practice*
  • Humans
  • Male
  • Pharyngitis / epidemiology
  • Pneumonia / epidemiology
  • Respiratory Tract Infections / epidemiology*
  • Scarlet Fever / epidemiology
  • Streptococcal Infections / epidemiology
  • Urban Population / statistics & numerical data