Death within 1 year among emergency medical admissions to Scottish hospitals: incident cohort study

Moore, E., Munoz-Arroyo, R., Schofield, L., Radley, A., Clark, D. and Isles, C. (2018) Death within 1 year among emergency medical admissions to Scottish hospitals: incident cohort study. BMJ Open, 8(6), e021432. (doi: 10.1136/bmjopen-2017-021432) (PMID:29961029) (PMCID:PMC6042622)

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Background: It is increasingly recognised that large numbers of hospital inpatients have entered the last year of their lives. Aim: To establish the likelihood of death within 12 months of admission to hospital; to examine the influence on survival of a cancer diagnosis made within the previous 5 years; to assess whether previous emergency admissions influenced mortality; and to compare mortality with that of the wider Scottish population. Design: Incident cohort study. Setting: 22 hospitals in Scotland. Participants: This study used routinely collected data from 10 477 inpatients admitted as an emergency to medicine in 22 Scottish hospitals between 18 and 31 March 2015. These data were linked to national death records and the Scottish Cancer Registry. Primary: outcome measures 1 year cohort mortality compared with that of the general Scottish population. Patient factors correlating with higher risk of mortality were identified using Cox regression. Results: There were 2346 (22.4%) deaths in the year following the census admission. Six hundred and ten patients died during that admission (5.8% of all admissions and 26% of all deaths) while 1736 died after the census admission (74% of all deaths). Malignant neoplasms (33.8%), circulatory diseases (22.5%) and respiratory disease (17.9%) accounted for almost three-quarters of all deaths. Mortality rose steeply with age and was five times higher at 1 year for patients aged 85 years and over compared with those who were under 60 years of age (41.9%vs7.9%) (p<0.001). Patients with cancer had a higher mortality rate than patients without a cancer diagnosis (55.6%vs16.6%) (p<0.001). Mortality was higher among patients with one or more emergency medical admissions in the previous year (30.1% v 15.1%) (p<0.001). Age/sex-standardised mortality was 110.4 (95% CI 104.4 to 116.5) for the cohort and 11.7 (95% CI 11.6 to 11.8) for the Scottish population, a 9.4-fold increase in risk. Conclusion: These data may help identify groups of patients admitted to hospital as medical emergencies who are at greatest risk of dying not only during admission but also in the following 12 months.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Clark, Professor David and Isles, Dr Christopher
Authors: Moore, E., Munoz-Arroyo, R., Schofield, L., Radley, A., Clark, D., and Isles, C.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
College of Social Sciences > School of Interdisciplinary Studies
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN (Online):2044-6055
Published Online:30 June 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in BMJ Open 8(6):e021432
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
645151Interventions at the end of life: social, historical and comparative analysis to promote global improvement.David ClarkWellcome Trust (WELLCOTR)103319/Z/13/ZIS - INTERDISCIPLINARY STUDIES