Abstract

Past and recent trends in medical and other admissions in England are examined to determine if the increasing elderly population is the sole source for pressures in the NHS arising from large increases in medical admissions. Unusual step-like events appear to lie behind the unexplained growth in medical admissions. Age banded trends since 2012/13 show evidence for age-specific patterns of growth which are similar to patterns in immunity arising from antigenic original sin, i.e. repeated priming of the immune system and consequent antibody landscapes arising from lifetime exposure to different strains of the same agent. Contrary to common belief, age-standardised growth in medical group (general and elderly medicine, etc.) admissions is highest in the younger age bands, except for children. As opposed to the medical group, age standardised growth in the oncology (oncology, radiotherapy) group occurs to the greatest extent in the youngest and oldest. Periods of unexplained higher deaths which accompany these events have been overlooked by traditional disease surveillance methods, and hidden patterns in deaths can be revealed by the use of cumulative sum of deviations from the mean (CUSUM), and running 12 month total analysis. Interactions between a suspected infectious agent and influenza appear likely. Changes in the gender ratio at birth around the time of the 1918 ‘Spanish flu’ epidemic suggest the potential involvement of a second agent. The pattern of conditions most affected shows some evidence for common immune function aetiology, and the immune modifying virus cytomegalovirus may be in some way involved in these events either as cause or via opportunistic reactivation.

Keywords: Disease surveillance; Age-standardized growth; Demography; Cytomegalovirus; Influenza; Gender ratio at birth