The present study examines how trends in the prevalence of asthma during the past three decades associate with hospitalization and mortality during the same period.
Altogether 54?320 subjects aged 25-74 years were examined in seven independent cross-sectional population surveys repeated every five years between 1982 and 2012 in Finland. The study protocol included a standardized questionnaire on self-reported asthma, smoking habits and other risk factors, and clinical measurements at the study site. Data on hospitalizations were obtained from the Care Register for Health Care, and data on mortality from the National Causes of Death register.
During the study, the prevalence of asthma increased - especially in women. In asthmatic compared with non-asthmatic subjects, hospitalization was significantly higher for all causes, respiratory causes, cardiovascular causes and lung cancer. In addition, particularly in asthmatic subjects, mean yearly hospital days in the 5-year periods after each survey diminished. In asthmatic subjects, the decrease in yearly all-cause hospital days was from 4.45 (between 1982 and 1987) to 1.11 (between 2012 and 2015) and in subjects without asthma the corresponding decrease was from 1.77 to 0.60 (p?
A total of 3,727 in-patients with acute abdominal symptoms were identified during the first quarter of 1995 at the surgical clinics of the nine hospitals with emergency departments in the county of Stockholm. The diagnoses were: non-specific abdominal pain 24%; cholecystitis 9%; appendicitis 8%; bowel obstruction 7%; intra-abdominal malignancy, diseases of the urinary tract and peptic ulcer 6% each; gastrointestinal hemorrhage, diverticulitis of the colon and pancreatitis 5% each; other diseases as a cause of abdominal symptoms, 19%. 1,601 operations were performed of which 47% were endoscopic procedures. The mean duration of hospital stay was 4.8 days. The length of stay increased significantly with age. The age-related relative frequency of hospitalization due to acute abdominal pain was also dramatically higher in the elderly cohorts. These facts and the prognosis of an 18% increase of inhabitants 50 years of age or older until 2010 in Greater Stockholm signal an increased need of hospital resources for this large group of patients in the coming years.
Acute care hospital morbidity of the Blood Indian Band was compared with that of all Albertans between April 1, 1984 and March 31, 1987. The Blood Indians had over 2.5 times as many hospital separations and 2.2 times as many patient days as the Albertans. The highest separation rare ratios by ICD-9-CM chapter for both Blood males and females were for endocrine, metabolic and nutritional disorders. Blood females had higher rate ratios for hospitalizations for all chapters except neoplasms and Blood males had higher rate ratios for all except congenital anomalies and neoplasms. For individual conditions, Blood males had the highest separation rate ratios for alcohol dependence syndrome, gastritis/duodenitis and diabetes mellitus. Bronchitis/emphysema and diabetes mellitus had the highest rate ratios for Blood females. The results are consistent with those reported in other studies of North American Indians. Their health status is more consistent with a developing country than that expected in Canada and does not appear to be improving.
Acute hospital discharge delays are a pressing concern for many health care administrators. In Canada, a delayed discharge is defined by the alternate level of care (ALC) construct and has been the target of many provincial health care strategies. Little is known on the patient characteristics that influence acute ALC length of stay. This study examines which characteristics drive acute ALC length of stay for those awaiting nursing home admission.
Population-level administrative and assessment data were used to examine 17,111 acute hospital admissions designated as alternate level of care (ALC) from a large Canadian health region. Case level hospital records were linked to home care administrative and assessment records to identify and characterize those ALC patients that account for the greatest proportion of acute hospital ALC days.
ALC patients waiting for nursing home admission accounted for 41.5% of acute hospital ALC bed days while only accounting for 8.8% of acute hospital ALC patients. Characteristics that were significantly associated with greater ALC lengths of stay were morbid obesity (27?day mean deviation, 99% CI?=?±14.6), psychiatric diagnosis (13?day mean deviation, 99% CI?=?±6.2), abusive behaviours (12?day mean deviation, 99% CI?=?±10.7), and stroke (7?day mean deviation, 99% CI?=?±5.0). Overall, persons with morbid obesity, a psychiatric diagnosis, abusive behaviours, or stroke accounted for 4.3% of all ALC patients and 23% of all acute hospital ALC days between April 1st 2009 and April 1st, 2011. ALC patients with the identified characteristics had unique clinical profiles.
A small number of patients with non-medical days waiting for nursing home admission contribute to a substantial proportion of total non-medical days in acute hospitals. Increases in nursing home capacity or changes to existing funding arrangements should target the sub-populations identified in this investigation to maximize effectiveness. Specifically, incentives should be introduced to encourage nursing homes to accept acute patients with the least prospect for community-based living, while acute patients with the greatest prospect for community-based living are discharged to transitional care or directly to community-based care.
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Despite very little confirming evidence, one of the most pervasive beliefs about dying is that terminally ill people receive a great deal of health care in the last few days, weeks, or months of life. A secondary analysis of 1992/93 through 1996/97 Alberta inpatient hospital abstracts data was undertaken to explore and describe hospital use over the five years before death by all Albertans who died in acute care hospital beds during the 1996/97 year (n = 7,429). There were four key findings: (1) hospital use varied, but was most often low, (2) the last hospital stay was infrequently resource intensive, (3) age, gender, and illness did not distinguish use, and (4) most ultra-high users were rural residents, with the majority of care episodes taking place in small, rural hospitals.
This study aimed to investigate trends in first-time hospitalisations with chronic obstructive pulmonary disease (COPD) in a publicly financed healthcare system during the period from 2002 to 2008 with respect to incidence, outcome and characteristics of hospitalisations, departments, and patients.
Using health administrative data from national registers, all first-time hospitalisations with COPD in Denmark (population 5.4 million) were identified. Data based on the individual hospitalisations and patients were retrieved and analysed.
During the period 2002 to 2008 the total rate of COPD hospitalisations decreased from 460 to 410 per 100,000 person years. Among persons above 45 years of age, the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased by 8.2% (95% CI 5.0-11.2%). The inpatient mortality increased OR 1.16 (95% CI 1.01-1.34) and the one-year mortality increased OR 1.12 (95% CI 1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of outpatient clinics and encounters in general practice, while length of stay and number of receiving hospitals decreased.
Decreasing rate of first-time COPD hospitalisations combined with shorter lengths of stay and increasing severity of cases indicates that the use of hospital beds for COPD exacerbations has been gradually restricted. This may be causally related to both the centralisation into overcrowded departments and the improved outside hospital treatment of COPD, also demonstrated in this study.
OBJECTIVES: To examine the incidence and temporal trends of hospitalization during pregnancy, and provide additional information on maternal morbidity among Canadian women. METHODS: A population-based cohort study was conducted using the Canadian Institute for Health Information's Discharge Abstract Database between fiscal year 1991/92 and 2002/03. This database included antenatal hospitalizations for all hospital deliveries (N=3,103,365) in Canada except for those occurring in Manitoba and Quebec. Temporal trends, and variations in the non-delivery antenatal hospitalization ratio (per 100 deliveries) by maternal age and province or territory were quantified. Primary causes for antenatal hospitalization, the lengths of in-hospital stay, and changing pattern by maternal age and time period were compared. RESULTS: The overall antenatal hospitalization ratio declined by 43%, from 24.0 per 100 deliveries in 1991/92 to 13.6 in 2002/03. Younger women tended to be hospitalized more frequently than older women: 27.1 per 100 deliveries for women aged less than 20 years and 21.5 per 100 deliveries for 20-24 years, respectively, compared to 11.5 per 100 for women aged 35-39 years. The antenatal hospitalization ratio varied greatly by province/territory--from 12.2 per 100 deliveries in Ontario to 30.7 in the Yukon. Threatened preterm labour, antenatal hemorrhage, hypertensive disorders, severe vomiting and diabetes remained the five most common causes for antenatal hospitalization, although the trends for the first four declined dramatically from 1991/92 to 2002/03. Younger women were more likely to be admitted for threatened preterm labour and severe vomiting, while older women were more likely to be admitted for antenatal hemorrhage and hypertensive disorders. CONCLUSIONS: The decline in antenatal hospitalization may reflect changes in management of pregnancy complications, e.g., transition from in-hospital care to out-of-hospital care, and introduction of antepartum home care programs. Information on interprovincial/territorial variations in antenatal hospitalization may be helpful in directing future maternal health care.
Asthma has long been a major cause of illness and disability among young Canadians. From 1970-71 to 1987-88, hospital admissions for asthma increased significantly among Canadian children under the age of fourteen. Many hypotheses may explain this increase in asthma prevalence. There could be a true increase in the number of people developing symptoms of the disease or increased asthma rates could be an artifact due to changes in detection, diagnosis, treatment, or coding. This study reviews hypotheses put forward to explain the increase in asthma prevalence, and tests some of them in Manitoba for children aged 0-4. Physician claims data and hospital separation data were merged to create unique person oriented medical records. These records were used to estimate the number of children seeking medical services for asthma during a five-year period (1984-85 to 1988-89) and the change in rates over this time period. From 1984-85 to 1988-89, both prevalence and incidence rates for children less than five years of age increased. Prevalence rates showed strong seasonal peaks in the spring and the fall. There is no indication that asthma increased in severity. The hospitalization rate (the number visiting a hospital for asthma divided by the total number seeking medical care for asthma), the average number of hospital admissions per year, and the average number of days spent in a hospital per year did not increase. Levels of ozone (O3) and nitrogen dioxide (NO2) in downtown Winnipeg increased over the study period and asthma prevalence increased twice as fast in Winnipeg as in the rest of the province. For Manitoba, the increase in preschool-aged asthma does not appear to be due to increased use of medical services, a change in ICD coding, an increase in the severity of the cases, or a decrease in income levels. The increases appear to be at least partly due to changes in diagnostic practices. The relationship between asthma and air pollution needs more detailed study as pollution is likely to be an important factor, particularly during the spring. Other areas for further investigation are changes in allergy and virus precursors, maternal smoking, and increased levels of pollens, molds and dust mites.
Hospital records lack information about country of birth. This study describes a method for calculating hospitalization rates by the percentage of foreign-born in Census Dissemination Areas (DAs).
Data from the 2006 Census were used to classify DAs by the percentage of the foreign-born population who lived in them. Quintile and tercile thresholds were created to classify DAs as having low to high percentages of foreign-born residents. This information was appended to the 2005/2006 Hospital Morbidity Database via postal codes. Age-sex standardized hospitalization rates were calculated for low to high foreign-born concentration DAs, nationally and subnationally.
Nationally, quintile thresholds had better discriminatory power to detect variations in hospitalization rates by foreign-born concentration, but tercile thresholds produced reliable results at subnational levels. All-cause hospitalization rates were lowest among residents of the high foreign-born concentration terciles. Similar gradients emerged in hospitalization rates for heart disease, diseases of the circulatory system, and mental health conditions. The pattern varied more at the subnational level.
With this approach, administrative data can be used to calculate hospitalization rates by foreign-born concentration.