Carribean Indian. African Black. Black

Transcription

1 White Black African Black Carribean Indian Pakistani Banglandeshi Black Other/Mixed Asian Other/Mixed Other/Mixed Unnknown/ Invalid Appendix A: Determination of Ethnic Status in HES Data As noted in the main text, patient ethnicity was derived from HES inpatient data. Since 2003/04 HES inpatient episodes have recorded ethnicity using the 16 ethnic groupings employed in the England and Wales sections of the 2001 UK Census. We have collapsed these into 9 groupings and Unknown/Invalid as indicated in the table below. Re-grouped Ethnicity Original HES Ethnicity (Ethnos) A = British (White) B = Irish (White) C = Any other White background D = White and Black Caribbean (Mixed) E = White and Black African (Mixed) F = White and Asian (Mixed) G = Any other Mixed background H = Indian (Asian or Asian British) J = Pakistani (Asian or Asian British) K = Bangladeshi (Asian or Asian British) L = Any other Asian background M = Caribbean (Black or Black British) N = African (Black or Black British) P = Any other Black background R = Chinese (other ethnic group) S = Any other ethnic group Z = Not stated = Unknown Where the individual had two or more different ethnicity codes recorded in their inpatient history, the number of episodes mapped in each of the redefined groups is summed. These patients are assigned to one of the other/mixed groups as follows: Patients with multiple ethnicity codes all with Black related original HES groupings (D, E, M, N, or P) or with any of these Black related original HES groupings and Any Other Mixed (G) or white related (A, B, or C) were assigned to the Black/Other Mixed. Patients with multiple ethnicity codes all with Asian related original HES groupings (F, H, J, K, or L) or with any of these Asian related original HES groupings and Any Other Mixed (G) or white related (A, B, or C) were assigned to the Asian/Other Mixed. Patients with multiple ethnicity codes across Black related original HES groupings and Asian related original HES groupings were assigned to Other/Mixed.

2 Appendix B: Individual Coefficients Used in Models Admissions Bed days Death in hospital Description Estimate Standard Error Pr > t Estimate Standard Error Pr > t Estimate Standard Error Pr > t Intercept < Age at death < < <.0001 Age at death < <.0001 Age at death < < <.0001 Age at death < < <.0001 Age at death Male < < <.0001 Female A00-A09 Intestinal infectious diseases < < <.0001 A15-A19 Tuberculosis < < <.0001 A20-A49 Certain bacterial diseases < < <.0001 A50-A64 Infections with predominantly sexual mode of transmission A65-A79 Other infectious and parasitic disorders A80-A89 Viral infections of the central nervous system < < <.0001 B00-B09 Viral infections characterized by skin & mucous mem. lesns < < <.0001 B15-B19 Viral hepatitis < < <.0001 B20-B24 Human imrnunodeficiency virus [HIV] disease B25-B34 Other viral diseases < < <.0001 B35-B49 Mycoses < < <.0001 B50-B64 Protozoal diseases < <.0001 B65-B83 Helminthiases B85-B99 Other infectious and parasitic diseases < < <.0001 C00-C14 Malignant neoplasm of liporal cavity and pharynx < < <.0001 C15-C26 Malignant neoplasm of digestive organs < < <.0001 C30-C39 Malignant neoplasms of respiratory & intrathoracic organs < < <.0001 C40-C41 Malignant neoplasm of bone and articular cartilage < < <.0001 C43-C44 Malignant neoplasms of skin < < <.0001

3 C45-C49 Malignant neoplasms of mesothelial and soft tissue < < <.0001 C50 Malignant neoplasm of breast < < <.0001 C51-C58 Malignant neoplasms of female genital organs < < <.0001 C60-C63 Malignant neoplasms of male genital organs < < <.0001 C64-C68 Malignant neoplasms of urinary tract < < <.0001 C69-C72 Malignant neoplasms of eye, brain & other parts of CNS < <.0001 C73-C80, C97 Malignant neoplsm. of thyroid and oth. endo. Glands etc < < <.0001 C81-C96 Malignant neoplasms of lymphoid, haematopoietic & rel. tiss < < <.0001 D00-D48 In situ & benign neoplasms and others of uncertainty < < <.0001 D50-D64 Anaemias < < <.0001 D65-D89 Diseases of the blood and blood-forming organs < < <.0001 E00-E07 Disorders of thyroid gland < < <.0001 E10-E14 Diabetes Mellitus < < <.0001 E15-E90 Endocrine nutritional and metabolic diseases < < <.0001 F00-F03 Dementia < < <.0001 F04-F09 Other organic including symptomatic mental disorders < < <.0001 F10-F19 Mental and behavioural disorders due to psychoactive subst < < <.0001 F20-F29 Schizophrenia, schizotypal and delusional disorders < < <.0001 F30-F39 Mood [affective] disorders < < <.0001 F40-F69 Neurotic, bahavioural & personality disorders < < <.0001 F70-F79 Mental retardation < < <.0001 F80-F99 Other mental and behavioural disorders < < <.0001 G00-G09 Inflammatory diseases of the central nervous system < < <.0001 G10-G13, G30-G32 Other degenerative diseases (incl. Alzheimer) < < <.0001 G20-G26 Extrapyramidal & movement disorders (incl. Parkinsonism) < < <.0001 G35-G37 Demyelinating diseases (incl Multiple Sclerosis) of the CNS < < <.0001 G40-G47 Epilepsymigraine & other episodic disorders < < <.0001 G50-G73 G90-G99 Other diseases & disorders of the nervous syst < < <.0001 G80-G83 Cerebral palsy & other paralytic syndromes < < <.0001 H00-H06, H15-H22, H30-H36, H43-H5 Other disorders of the eye etc < < <.0001 H10-H13 Disorders of conjunctiva (including conjunctivitis) H25-H28 Disorders of lens (including cataracts) < <.0001 H40-H42 Glaucoma < <.0001 H60-H95 Diseases of the ear and mastoid process < < <.0001

4 I00-I09 Rheumatic heart disease < < <.0001 I10-I15 Hypertensive diseases < < <.0001 I20-I25 Ischaemic heart diseases < < <.0001 I26-I28 Pulmonary heart disease & diseases of pulmonary circulation < < <.0001 I30-I52 Other forms of heart disease < < <.0001 I60-I69 Cerebrovascular diseases < < <.0001 I70-I79 Diseases of arteries, arterioles & capillaries < < <.0001 I80-I89 Diseases of veins & lymphatic system nec < < <.0001 I95-I99 Other & unspecified disorders of the circulatory system < < <.0001 J00-J06 Acute upper respiratory infections < < <.0001 J10-J18 Influenza & pneumonia < < <.0001 J20-J22 Other acute lower respiratory infections < < <.0001 J40-J47 Chronic lower respiratory diseases < < <.0001 J60-J70 Lung diseases due to external agents < < <.0001 J80-J99 Other diseases of the respiratory system < < <.0001 K00-K14 Diseases of oral cavity, salivary glands & jaws < < <.0001 K20-K31 Diseases of oesophagusstomach & duodenum < < <.0001 K35-K38 Diseases of appendix < < <.0001 K40-K46 Hernia < < <.0001 K50-K52 Noninfective enteritis & colitis < < <.0001 K55-K63 Other diseases of intestines < < <.0001 K65-K67 Diseases of peritoneum < < <.0001 K70-K77 Diseases of liver < < <.0001 K80-K87 Disorders of gall bladder, biliary tract & pancreas < < <.0001 K90-K93 Other diseases of the digestive system < < <.0001 L00-L14 L55-L99 Other infections and disorders of the skin < < <.0001 L20-L30 Dermatitis and eczema < < <.0001 L40-L45 Papulosquamous disorders (including Psoriasis) < < <.0001 L50-L54 Urticaria and erythems < < <.0001 M00-M25 Arthropathies < < <.0001 M30-M36 Systemic connective tissue disorders < < <.0001 M40-M54 Dorsopathies < < <.0001 M60-M79 Soft tissue disorders < < <.0001 M80-M94 Osteopathies and chondropathies < < <.0001

5 M95-M99 Other disorders of the musculoskeletal system & conn. tiss < < <.0001 N00-N08, N10-N16 Diseases of the kidney < < <.0001 N17-N19 Renal failure < < <.0001 N20-N23 Urolithiasis < < <.0001 N25-N29 Other disorders of kidney & ureter < < <.0001 N30-N39 Other diseases of the urinary system < < <.0001 N40-N51 Diseases of male genital organs < < <.0001 N60-N64 Disorders of breast < <.0001 N70-N77 Inflammatory diseases of female pelvic organs < < <.0001 N80-N98 Noninflammatory disorders of female genital tract < < <.0001 N99 Other disorders of the genitourinary system < < <.0001 O00-O08 Pregnancy with abortive outcome O10-O75, O85-O92, O95-O99 Complications of labour and delivery < <.0001 O80-O84 Delivery P05-P96 Other conditions originating in the perinatal period Q00-Q89 Congenital malformations < < <.0001 Q90-Q99 Chromosomal abnormalities nec < < R00-R09 Symptoms & signs inv. the circulatory/respiratory system < < <.0001 R10-R19 Symptoms & signs inv. the digestive system & abdomen < < <.0001 R20-R23 Symptoms & signs inv. the skin & subcutaneous tissue < < <.0001 R25-R29 Symptoms & signs inv. the nervous & musculoskeletal sys < < <.0001 R30-R39 Symptoms & signs involving the urinary system < < <.0001 R40-R46 Symptoms & signs inv. Cognition, perception etc < < <.0001 R47-R49 Symptoms & signs inv. speech & voice < < <.0001 R50-R68 General symptoms & signs < < <.0001 R69 Unknown & unspecified causes of morbidity < < <.0001 R70-R89 Abnormal findings of bodily fluids or samples without diag < < <.0001 R90-R94 Abnormal findings on diagnostic imaging/function studies < < <.0001 R95-R99 Ill-defined & unknown causes of mortality <.0001 S00-S09 Injuries to the head < < <.0001 S10-S19 Injuries to the neck < < <.0001 S20-S29 Injuries to the thorax < < <.0001 S30-S39 Injuries to abdomen, lower back, lumbar spine & pelvis < < <.0001 S40-S49 Injuries to the shoulder & upper arm < < <.0001

6 S50-S59 Injuries to the elbow & forearm < < <.0001 S60-S69 Injuries to the wrist & hand < < <.0001 S70-S79 Injuries to the hip & thigh < < <.0001 S80-S89 Injuries to the knee & lower leg < < <.0001 S90-S99 Injuries to the ankle & foot < < <.0001 T00-T07 Injuries involving multiple body regions < < <.0001 T08-T14 Injuries to unspecified part of trunk limb or body < < <.0001 T15-T19 Effects of foreign body entering through natural orifice < < <.0001 T20-T32 Burns and corrosions < < <.0001 T33-T35 Frostbite T36-T50 Poisonings by drugs medicaments & biological substances < < <.0001 T51-T65 Tox. effcts. of substnces. chiefly non-medicinal as to source < < <.0001 T66-T78 Other and unspecified effects of external causes < < <.0001 T79 Certain early complications of trauma < < <.0001 T80-T88 Complications of surgical & medical care nec < < <.0001 T90-T98 Sequelae of injuriesof poisoning & other consequences Z00-Z13 Examination and investigation < < <.0001 Z20-Z29 Potential health hazards related to communicable diseases < < <.0001 Z30-Z39 Health services in circumstances related to reproduction Z40-Z54 Persons encountering health services for specific care < < <.0001 Z55-Z65 Potential health hazards reltd. to socioeconomic & psychosoc.l Z70-Z76 Persons encountering health services in other circs < < <.0001 Z80-Z99 Persons with potential health hazards related to family < < < A00-A09 Intestinal infectious diseases A15-A19 Tuberculosis < < A20-A49 Certain bacterial diseases < <.0001 A50-A64 Infections with predominantly sexual mode of transmission A65-A79 Other infectious and parasitic disorders A80-A89 Viral infections of the central nervous system < <.0001 B00-B09 Viral infections characterized by skin & mucous mem. lesns < B15-B19 Viral hepatitis < B20-B24 Human imrnunodeficiency virus [HIV] disease < < <.0001 B25-B34 Other viral diseases

7 B35-B49 Mycoses B50-B64 Protozoal diseases < B65-B83 Helminthiases B85-B99 Other infectious and parasitic diseases < C00-C14 Malignant neoplasm of liporal cavity and pharynx < <.0001 C15-C26 Malignant neoplasm of digestive organs < <.0001 C30-C39 Malignant neoplasms of respiratory & intrathoracic organs < < <.0001 C40-C41 Malignant neoplasm of bone and articular cartilage < <.0001 C43-C44 Malignant neoplasms of skin < <.0001 C45-C49 Malignant neoplasms of mesothelial and soft tissue < <.0001 C50 Malignant neoplasm of breast < < <.0001 C51-C58 Malignant neoplasms of female genital organs < < <.0001 C60-C63 Malignant neoplasms of male genital organs < <.0001 C64-C68 Malignant neoplasms of urinary tract < < <.0001 C69-C72 Malignant neoplasms of eye, brain & other parts of CNS < <.0001 C73-C80, C97 Malignant neoplsm. of thyroid and oth. endo. Glands etc < < <.0001 C81-C96 Malignant neoplasms of lymphoid, haematopoietic & rel. tiss < < <.0001 D00-D48 In situ & benign neoplasms and others of uncertainty < < <.0001 D50-D64 Anaemias < <.0001 D65-D89 Diseases of the blood and blood-forming organs < E00-E07 Disorders of thyroid gland < < <.0001 E10-E14 Diabetes Mellitus < <.0001 E15-E90 Endocrine nutritional and metabolic diseases < <.0001 F00-F03 Dementia < < <.0001 F04-F09 Other organic including symptomatic mental disorders F10-F19 Mental and behavioural disorders due to psychoactive subst < < <.0001 F20-F29 Schizophrenia, schizotypal and delusional disorders <.0001 F30-F39 Mood [affective] disorders <.0001 F40-F69 Neurotic, bahavioural & personality disorders <.0001 F70-F79 Mental retardation F80-F99 Other mental and behavioural disorders <.0001 G00-G09 Inflammatory diseases of the central nervous system < G10-G13, G30-G32 Other degenerative diseases (incl. Alzheimer) < < <.0001 G20-G26 Extrapyramidal & movement disorders (incl. Parkinsonism) < < <.0001

8 G35-G37 Demyelinating diseases (incl Multiple Sclerosis) of the CNS < <.0001 G40-G47 Epilepsymigraine & other episodic disorders < < <.0001 G50-G73 G90-G99 Other diseases & disorders of the nervous syst < < <.0001 G80-G83 Cerebral palsy & other paralytic syndromes < <.0001 H00-H06, H15-H22, H30-H36, H43-H5 Other disorders of the eye etc H25-H28 Disorders of lens (including cataracts) H40-H42 Glaucoma H60-H95 Diseases of the ear and mastoid process I00-I09 Rheumatic heart disease < <.0001 I10-I15 Hypertensive diseases < < <.0001 I20-I25 Ischaemic heart diseases < < <.0001 I26-I28 Pulmonary heart disease & diseases of pulmonary circulation < < <.0001 I30-I52 Other forms of heart disease < < <.0001 I60-I69 Cerebrovascular diseases < < <.0001 I70-I79 Diseases of arteries, arterioles & capillaries < < <.0001 I80-I89 Diseases of veins & lymphatic system nec < < <.0001 I95-I99 Other & unspecified disorders of the circulatory system <.0001 J00-J06 Acute upper respiratory infections < J10-J18 Influenza & pneumonia < < <.0001 J20-J22 Other acute lower respiratory infections < <.0001 J40-J47 Chronic lower respiratory diseases < <.0001 J60-J70 Lung diseases due to external agents < J80-J99 Other diseases of the respiratory system < < <.0001 K00-K14 Diseases of oral cavity, salivary glands & jaws K20-K31 Diseases of oesophagusstomach & duodenum < < <.0001 K35-K38 Diseases of appendix < < K40-K46 Hernia < K50-K52 Noninfective enteritis & colitis < K55-K63 Other diseases of intestines < K65-K67 Diseases of peritoneum < K70-K77 Diseases of liver < <.0001 K80-K87 Disorders of gall bladder, biliary tract & pancreas < < <.0001 K90-K93 Other diseases of the digestive system < L00-L14 L55-L99 Other infections and disorders of the skin <

9 L20-L30 Dermatitis and eczema L40-L45 Papulosquamous disorders (including Psoriasis) L50-L54 Urticaria and erythems M00-M25 Arthropathies < < <.0001 M30-M36 Systemic connective tissue disorders <.0001 M40-M54 Dorsopathies M60-M79 Soft tissue disorders < <.0001 M80-M94 Osteopathies and chondropathies < M95-M99 Other disorders of the musculoskeletal system & conn. tiss N00-N08, N10-N16 Diseases of the kidney < <.0001 N17-N19 Renal failure < <.0001 N20-N23 Urolithiasis N25-N29 Other disorders of kidney & ureter < <.0001 N30-N39 Other diseases of the urinary system < N40-N51 Diseases of male genital organs < N60-N64 Disorders of breast N70-N77 Inflammatory diseases of female pelvic organs N80-N98 Noninflammatory disorders of female genital tract O00-O08 Pregnancy with abortive outcome O10-O75, O85-O92, O95-O99 Complications of labour and delivery < O80-O84 Delivery P05-P96 Other conditions originating in the perinatal period Q00-Q89 Congenital malformations < <.0001 Q90-Q99 Chromosomal abnormalities nec < < <.0001 R00-R09 Symptoms & signs inv. the circulatory/respiratory system < <.0001 R10-R19 Symptoms & signs inv. the digestive system & abdomen < R25-R29 Symptoms & signs inv. the nervous & musculoskeletal sys R30-R39 Symptoms & signs involving the urinary system R40-R46 Symptoms & signs inv. Cognition, perception etc R47-R49 Symptoms & signs inv. speech & voice R50-R68 General symptoms & signs < < <.0001 R70-R89 Abnormal findings of bodily fluids or samples without diag R90-R94 Abnormal findings on diagnostic imaging/function studies R95-R99 Ill-defined & unknown causes of mortality < < <.0001

10 T80-T88 Complications of surgical & medical care nec Z00-Z13 Examination and investigation < < <.0001 Z20-Z29 Potential health hazards related to communicable diseases < < <.0001 Z30-Z39 Health services in circumstances related to reproduction < < Z40-Z54 Persons encountering health services for specific care Number of LTCs = none < < Number of LTCs = < < Number of LTCs = < < Number of LTCs = < < Number of LTCs = < < Number of LTCs = < Number of LTCs = < Number of LTCs = < Number of LTCs = Number of LTCs = Number of LTCs = Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index < Charlson index <

11 Charlson index < Charlson index < Charlson index < Charlson index Asian Other ethnicity < <.0001 Bangladeshi ethnicity < Black African ethnicity Black Caribbean ethnicity < < Black Other ethnicity Indian ethnicity < <.0001 Other ethnicity Pakistani ethnicity < <.0001 Unknown ethnicity < < <.0001 White ethnicity IMD (excluding health domain) < < <.0001 Population density (gravity model) < < <.0001 Registered GP practice list size Registered GP practice FTE staff Nursing and care home bed density < < <.0001 Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust <

12 Predominant hospital, trust <.0001 Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust <.0001 Predominant hospital, trust < Predominant hospital, trust <.0001 Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust < <.0001 Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < <.0001 Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust

13 Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < <.0001 Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < < Predominant hospital, trust < <.0001 Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust <

14 Predominant hospital, trust < Predominant hospital, trust < <.0001 Predominant hospital, trust Predominant hospital, trust <.0001 Predominant hospital, trust <.0001 Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust <.0001 Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust

15 Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust

16 Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust <.0001 Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust

17 Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust < Predominant hospital, trust Predominant hospital, trust Predominant hospital, trust