Background
Methods
Study design, data sources and participants
Procedures
Main outcome and covariates
Statistical analysis
Non-cancer | Cancer | All | |
---|---|---|---|
Total number of patients | 73,024 | 3680 | 76,704 |
Mortality 365 days from admission | 18,840 (25.8%) | 2605 (70.8%) | 21,477 (28.0%) |
Days until death from admission | |||
0–28 nights | 3615 (19.2%) | 1433 (55.0%) | 5048 (23.5%) |
29–180 nights | 9587 (50.8%) | 964 (37.0%) | 10,551 (49.2%) |
181–365 nights | 5657 (30.0%) | 209 (8.0%) | 5866 (27.3%) |
Age (years) | |||
Mean (SD) | 76.8 (15.9) | 73.9 (12.8) | 76.7 (15.8) |
Median (IQR) | 81 (71–88) | 76 (67–83) | 81 (70–88) |
Age (years) | |||
18–39 | 3226 (4.4%) | 60 (1.6%) | 3286 (4.3%) |
40–64 | 9103 (12.5%) | 685 (18.6%) | 9788 (12.8%) |
65–74 | 10,927 (15.0%) | 976 (26.5%) | 11,903 (15.5%) |
75–84 | 21,848 (29.9%) | 1194 (32.5%) | 23,042 (30.0%) |
85–94 | 24,657 (33.8%) | 713 (19.4%) | 25,370 (33.1%) |
95+ | 3263 (4.5%) | 52 (1.4%) | 3315 (4.3%) |
Sex | |||
Female | 43,228 (59.2%) | 1932 (52.5%) | 45,100 (58.8%) |
Male | 29,793 (40.8%) | 1748 (47.5%) | 31,601 (41.2%) |
Ethnicity | |||
White | 69,892 (95.7%) | 3574 (97.1%) | 73,466 (95.8%) |
Black and ethnic minority | 1930 (2.6%) | 41 (1.1%) | 1971 (2.6%) |
Unknown | 1202 (1.7%) | 65 (1.8%) | 1267 (1.7%) |
Charlson comorbidity index | |||
Median (IQR) | 1 (0–3) | 8 (3–9) | 2 (0–3) |
Range | 0–18 | 2–17 | 0–18 |
Charlson comorbidity index | |||
0 | 20,155 (27.6%) | 0 (0.0%) | 20,155 (26.3%) |
1–2 | 28,386 (38.9%) | 713 (19.4%) | 29,099 (37.9%) |
3–4 | 15,275 (20.9%) | 667 (18.1%) | 15,942 (20.8%) |
≥ 5 | 9208 (12.6%) | 2300 (62.5%) | 11,508 (15.0%) |
Admission type | |||
Elective | 16,535 (22.7%) | 1257 (34.2%) | 17,828 (23.3%) |
Non-elective | 56,307 (77.3%) | 2418 (65.8%) | 58,689 (76.7%) |
Admitted from | |||
Hospital (ED or general hospital) | 33,553 (46.0%) | 1360 (37.0%) | 34,913 (45.5%) |
Home (personal dwelling/care home) | 36,585 (50.1%) | 2286 (62.1%) | 38,871 (50.7%) |
Other | 617 (0.8%) | 15 (0.4%) | 632 (0.8%) |
Unknown | 2269 (3.1%) | 19 (0.5%) | 2288 (3.0%) |
Length of stay in an intermediate care unit | |||
Median (IQR) | 17 (5–34) | 8 (5–34) | 17 (5–34) |
Range | 0–1073 | 0–190 | 0–1073 |
Length of stay in an intermediate care unit | |||
0–25 nights | 46,916 (64.6%) | 2961 (80.6%) | 49,877 (65.4%) |
26+ nights | 25,733 (35.4%) | 712 (19.4%) | 26,445 (34.7%) |
Research ethics statement
Results
Study population
Main outcome
Covariate [*denotes reference group] | 0 to 365 days | Hazard up to 28 daysa | Hazard 29 to 180 daysb | Hazard 181 to 365 daysc | |||
---|---|---|---|---|---|---|---|
n/N (%) | n/N (%) | Adjusted hazard ratio (95% CI) | n/N (%) | Adjusted hazard ratio (95% CI) | n/N (%) | Adjusted hazard ratio (95% CI) | |
Age (years) | |||||||
18–64 | 683/12,288 (6%) | 191/12,288 (2%) | 0.38 (0.32, 0.44) | 313/12,097 (3%) | 0.17 (0.15, 0.19) | 179/11,784 (2%) | 0.14 (0.12, 0.16) |
65–74 | 1885/10,894 (17%) | 407/10,894 (4%) | 0.58 (0.52, 0.65) | 906/10,487 (9%) | 0.41 (0.38, 0.44) | 572/9581 (6%) | 0.41 (0.38, 0.45) |
75–84 | 5731/21,796 (26%) | 1101/21,796 (5%) | 0.7 (0.65, 0.75) | 2852/20,695 (14%) | 0.6 (0.57, 0.62) | 1778/17,843 (10%) | 0.62 (0.59, 0.66) |
85–94* | 10,514/27,861 (38%) | 1911/27,861 (7%) | 1 | 5 00/25,950 (21%) | 1 | 3103/20,450 (15%) | 1 |
Sex | |||||||
Male* | 8779/29,759 (30%) | 1789/29,759 (6%) | 1 | 4476/27,970 (16%) | 1 | 2514/23,494 (11%) | 1 |
Female | 10,034/43,080 (23%) | 821/43,080 (4%) | 0.8 (0.75, 0.85) | 5095/41,259 (12%) | 0.76 (0.73, 0.80) | 3118/36,164 (9%) | 0.76 (0.72, 0.80) |
Charlson comorbidity index | |||||||
0 | 2172/20,088 (11%) | 341/20,088 (2%) | 0.59 (0.52, 0.67) | 1050/19,747 (5%) | 0.58 (0.54, 0.63) | 781/18,697 (4%) | 0.66 (0.60, 0.71) |
1–2* | 6702/28,320 (24%) | 1158/28,320 (4%) | 1 | 3398/27,162 (13%) | 1 | 2146/23,764 (9%) | 1 |
3–4 | 5290/15,249 (35%) | 990/15,249 (6%) | 1.39 (1.28, 1.52) | 2737/14,259 (19%) | 1.41 (1.34, 1.48) | 1563/11,522 (14%) | 1.36 (1.28, 1.45) |
5+ | 449/9182 (51%) | 1121/9182 (12%) | 2.57 (2.36, 2.79) | 2386/8061 (30%) | 2.31 (2.19, 2.44) | 1142/5675 (20%) | 2.06 (1.92, 2.22) |
Admission type | |||||||
Non-elective* | 16,646/56,270 (30%) | 3169/56,270 (6%) | 1 | 8490/53,101 (16%) | 1 | 4987/44,611 (11%) | 1 |
Elective | 2167/16,569 (13%) | 441/16,569 (3%) | 0.81 (0.73, 0.90) | 1081/16,128 (7%) | 0.72 (0.67, 0.77) | 645/15,047 (4%) | 0.67 (0.62, 0.73) |
Setting admitted from | |||||||
Home* (personal dwelling/care home) | 8005/36,442 (22%) | 1421/36,442 (4%) | 1 | 4233/35,021 (12%) | 1 | 2351/30,788 (8%) | 1 |
Hospital | 10,115/33,529 (30%) | 2092/33,529 (6%) | 1.26 (1.18, 1.35) | 4987/31,437 (16%) | 0.97 (0.93, 1.01) | 3036/26,450 (11%) | 1.07 (1.02, 1.13) |
Other and unknown | 693/2868 (24%) | 97/2868 (3%) | 0.74 (0.60, 0.91) | 351/2771 (13%) | 0.83 (0.75, 0.93) | 245/2420 (10%) | 1.02 (0.89, 1.16) |
Main diagnosis on admission (ICD-10 code) | |||||||
Musculoskeletal disorders* (M) | 855/9229 (9%) | 96/9229 (1%) | 1 | 450/9133 (5%) | 1 | 309/8683 (4%) | 1 |
Injury (S, T) | 2770/13,002 (21%) | 299/13,002 (2%) | 1.38 (1.09, 1.74) | 1495/12,703 (12%) | 1.4 (1.26, 1.56) | 976/11,208 (9%) | 1.35 (1.18, 1.53) |
Renal and genitourinary disease (N) | 1478/4820 (31%) | 257/4820 (5%) | 3.05 (2.41, 3.87) | 783/4563 (17%) | 2 (1.78, 2.25) | 438/3780 (12%) | 1.86 (1.60, 2.16) |
Cerebrovascular disease (I60–68) | 769/3067 (25%) | 191/3067 (6%) | 3.02 (2.35, 3.88) | 375/2876 (13%) | 1.36 (1.19, 1.57) | 203/2501 (8%) | 1.12 (0.94, 1.35) |
Digestive diseases (K) | 613/2828 (22%) | 133/2828 (5%) | 3.47 (2.67, 4.51) | 306/2695 (11%) | 1.77 (1.53, 2.05) | 174/2389 (7%) | 1.57 (1.31, 1.90) |
Pneumonia (J) | 1223/2821 (43%) | 341/2821 (12%) | 6.17 (4.90, 7.76) | 553/2480 (22%) | 2.31 (2.03, 2.62) | 329/1927 (17%) | 2.34 (2.00, 2.74) |
Chronic heart disease (I) | 823/1819 (45%) | 242/1819 (13%) | 6.14 (4.83, 7.81) | 399/1577 (25%) | 2.41 (2.10, 2.76) | 182/1178 (15%) | 1.89 (1.57, 2.28) |
Infections (A, B) | 485/1411 (34%) | 96/1411 (7%) | 3.69 (2.78, 4.91) | 274/1315 (21%) | 2.41 (2.07, 2.81) | 115/1041 (11%) | 1.67 (1.34, 2.07) |
COPD (J40–44) | 496/1125 (44%) | 105/1125 (9%) | 5.01 (3.78, 6.62) | 252/1020 (25%) | 2.86 (2.45, 3.34) | 139/768 (18%) | 2.76 (2.26, 3.39) |
Dementia (F00–03, G30–31) | 396/1046 (38%) | 92/1046 (9%) | 5.07 (3.80, 6.77) | 187/954 (20%) | 2.17 (1.82, 2.57) | 117/767 (15%) | 2.23 (1.80, 2.76) |
Acute heart disease (I) | 304/955 (32%) | 62/955 (6%) | 3.38 (2.45, 4.66) | 175/893 (20%) | 2.13 (1.78, 2.54) | 67/718 (9%) | 1.32 (1.01, 1.73) |
Blood diseases (D) | 223/574 (39%) | 45/574 (8%) | 4.47 (3.13, 6.38) | 118/529 (22%) | 2.66 (2.17, 3.26) | 60/411 (15%) | 2.49 (1.89, 3.29) |
Liver disease (B17–B18, C22, K70–75) | 88/178 (49%) | 32/178 (18%) | 9.75 (6.50, 14.6) | 40/146 (27%) | 4.06 (2.93, 5.62) | 16/106 (15%) | 3.23 (1.95, 5.36) |
Mental/behavioural disorders (F) | 240/2418 (10%) | 28/2418 (1%) | 1.37 (0.89, 2.09) | 124/2390 (5%) | 1.42 (1.16, 1.73) | 88/2266 (4%) | 1.51 (1.19, 1.92) |
Other | 8050/27,546 (29%) | 1591/27,546 (6%) | 3.6 (2.92, 4.43) | 4040/25,955 (16%) | 2.01 (1.82, 2.22) | 2419/21,915 (11%) | 1.88 (1.67, 2.12) |
0 to 365 days | Hazard up to 28 daysa | Hazard 29 to 365 daysb | |||
---|---|---|---|---|---|
Covariate reference group* | n/N (%) | n/N (%) | Adjusted hazard ratio (95% CI) | n/N (%) | Adjusted hazard ratio (95% CI) |
Age (years) | |||||
18–64 | 383/743 (52%) | 218/743 (29%) | 0.95 (0.79, 1.13) | 165/525 (31%) | 0.67 (0.55, 0.82) |
65–74 | 677/974 (70%) | 377/974 (39%) | 1.02 (0.88, 1.18) | 300/597 (50%) | 0.93 (0.79, 1.10) |
75–84 | 903/1194 (76%) | 495/1194 (41%) | 0.95 (0.83, 1.09) | 408/699 (58%) | 0.82 (0.71, 0.96) |
85–94* | 638/764 (84%) | 341/764 (45%) | 1 | 297/423 (70%) | 1 |
Sex | |||||
Male* | 1331/1746 (76%) | 763/1746 (44%) | 1 | 568/983 (58%) | 1 |
Female | 1270/1929 (66%) | 668/1929 (35%) | 0.94 (0.84–1.04) | 602/1261 (48%) | 1.14 (1.01–1.28) |
Charlson comorbidity index | |||||
0α | 0 | 0 | NA | 0 | NA |
1–2* | 277/713 (39%) | 118/713 (17%) | 1 | 159/595 (27%) | 1 |
3–4 | 392/665 (59%) | 181/665 (27%) | 1.35 (1.07, 1.71) | 211/484 (44%) | 1.23 (1.00, 1.52) |
5+ | 1932/2297 (84%) | 1132/2297 (49%) | 2.59 (2.13, 3.15) | 800/1165 (69%) | 2.09 (1.75, 2.50) |
Admission type | |||||
Non-Elective* | 2095/2418 (87%) | 1168/2418 (48%) | 1 | 927/1250 (74%) | 1 |
Elective | 506/1257 (40%) | 263/1257 (21%) | 0.58 (0.50–0.68) | 243/994 (24%) | 0.42 (0.36–0.50) |
Admitted from | |||||
Home* | 1452/2282 (64%) | 831/2282 (36%) | 1 | 621/1451 (43%) | 1 |
Hospital | 1121/1359 (82%) | 588/1359 (43%) | 0.85 (0.77–0.95) | 533/771 (69%) | 0.86 (0.76–0.98) |
Other and unknown | 28/34 (82%) | 12/34 (35%) | 0.95 (0.54–1.68) | 16/22 (73%) | 1.91 (1.16–3.16) |
Cancer site | |||||
Breast (C50) | 120/534 (22%) | 60/534 (11%) | 0.34 (0.26, 0.45) | 60/474 (13%) | 0.23 (0.17, 0.31) |
Digestive organs (C15–26) | 708/867 (82%) | 399/867 (46%) | 1.11 (0.98, 1.26) | 309/468 (66%) | 0.98 (0.85, 1.13) |
Lung (C30–32, 34, 37, 38) | 458/489 (94%) | 265/489 (54%) | 1.20 (1.04, 1.39) | 193/224 (86%) | 1.44 (1.22, 1.70) |
Urinary tract (C64–68) | 139/314 (44%) | 71/314 (23%) | 0.7 (0.55, 0.90) | 68/243 (28%) | 0.6 (0.46, 0.78) |
Other | 1176/1471 (80%) | 636/1471 (43%) | 1 | 540/835 (65%) | 1 |