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Atlases of hospital admission rates

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Work has been undertaken to produce atlases of hospital admission rates across England. This has been a joint project between the Unit of Health-Care Epidemiology, Oxford University, and the South East Public Health Observatory. We hope to continue updating the atlases in collaboration with Public Health England. Examples of the atlases are now available on this website. A particular feature of the atlases is that they include analyses of linked Hospital Episode Statistics. Thus the tables and maps include not only episode-based admission rates but also person-based admission rates (counting people who have several admissions as 'one person' in the person-based rates).

Geographical units of analysis. The production of rates at the level of local authority area is currently our main approach. However, we have built into our analytical methods the option also to produce tables and maps for strategic health authority areas (which, with the merger of strategic health authorities, we may modify to county level), and for Government Office regions. The choice of geographical units is likely to vary according to how common or rare the disease or operation is.

Episode-based and person-based rates. Counting episodes and people using national linked HES creates choices which include:

  • whether the episode-based rates should be based on finished consultant episodes (FCEs) or continuous inpatient spells (CIPS). Depending on the circumstances, each has its own strengths and weaknesses.
  • time-frames for counting 'people'. For example, whether to count each person once, and once only, if they are readmitted within a year; or whether to count people once, and once only over a longer period of time, e.g. five years. Again, there are some advantages and disadvantages of different ways of counting 'people'.
  • how to count people and reference them to a geographical area of residence if the person moves home. Shall we count them as one person, and one only, and assign them to the original area of residence? Or, if they move, shall we count them as a different 'person' from each of two different places of residence? Again, there are advantages and disadvantages of each method.

Principal diagnosis, or diagnoses in any position on the HES record. First operation or operations at any point on the record. We have built in the option to analyse any of these.

Source of admission. For some conditions, it can be useful to distinguish between admission rates for elective admissions, and those for emergency admissions. When appropriate, we will produce atlases for all admissions, elective admissions, and emergency admissions.


For simplicity, in our first presentations, we have chosen one set of selection criteria. We then propose that, for some conditions, we produce sets of atlases covering the different selection criteria for the condition.

These production runs of the atlases should be regarded as experimental and exploratory. For example, our selection of specialties (and ways of grouping them) and of diseases and operations (and ways of grouping them) can easily be changed. We have included some uncommon diseases, as well as common ones, to see what we find. We do not expect that every user will find every set of results equally interesting or important. We will learn as we go, and as we receive feedback, but the aim is to be reasonably comprehensive in a first round of analyses. We are currently consulting with colleagues in surgery to construct a full list of surgical operations to study.

The data are from national HES. Annual HES datasets have been kindly provided by the Health and Social Care Information Centre each year since 1998. At the time of writing in March 2014, the Information Centre has not yet been able to provide HES for 2012 and 2013. Neither we, nor we suspect any other people, are in a position to understand all the local quirks that may exist in the data for each and every location. We therefore invite users to be cautious in their interpretation of local values and to consider seeking advice from local experts on the likely reliability of, or known local quirks in, local HES data.

The Atlases are in PDF format which will require Adobe Reader to view.

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Unit of Health Care Epidemiology

Dept. of Public Health


The contents and analyses in this part of the website were designed by Michael Goldacre. The analyses were undertaken by David Yeates, Matt Davidson, Nick Hall, Hong Harper, Myfanwy Griffith, Leicester Gill.

The work was funded at various times by the Department of Health, the NHS National Co-ordinating Centre for Research Capacity Development, the Department of Health's National Institute for Health Research, the Department of Health's National Centre for Health Outcomes Development, and the Nuffield Department of Population Health.

© 2016 Unit of Health Care Epidemiology, Nuffield Department of Population Health, Oxford University, Old Road Campus, Headington, Oxford, OX3 7LF
Tel: +44 (0)1865 289288 Fax: +44 (0)1865 289287