Background
Methods
Study design
Ethics statement
Inclusion and exclusion criteria
Mortality
Social deprivation
Risk factors
Patient demographics
Timing of admission
Hospital size
Patient comorbidities
Sample size calculations
Methods of analysis
Results
Mortality and social deprivation
Condition | Risk factor | Admissions (n) | 7 days mortality rate | 7 days OR (95 % CI)b | 30 days mortality rate | 30 days OR (95 % CI)b | 365 days mortality rate | 365 days OR (95 % CI)b |
---|---|---|---|---|---|---|---|---|
AMI
|
All cases
| 30,663 | 9.2 % | - | 14.3 % | - | 24.6 % | - |
Age
| ||||||||
< 65y | 9827 | 2.8 % | - | 4.0 % | - | 6.2 % | - | |
65–74y | 7088 | 7.4 % | - | 10.6 % | - | 17.2 % | - | |
75–84y | 8382 | 12.7 % | - | 19.6 % | - | 34.3 % | - | |
85y+ | 5366 | 17.7 % | - | 29.5 % | - | 52.8 % | - | |
Gender
| ||||||||
Male | 18,456 | 7.7 % | Ref | 11.9 % | Ref | 20.5 % | Ref | |
Female | 12,206 | 11.4 % |
1.09 (1.00, 1.18)
| 17.8 % | 1.07 (0.99, 1.15) | 30.8 % |
1.10 (1.03, 1.17)
| |
Social deprivation
| ||||||||
I (Least deprived) | 4776 | 8.9 % | Ref | 14.5 % | Ref | 25.3 % | Ref | |
II | 5527 | 8.7 % | 1.04 (0.90, 1.19) | 13.4 % | 0.97 (0.86, 1.09) | 23.6 % | 0.98 (0.89, 1.09) | |
III | 6579 | 9.1 % | 1.11 (0.97, 1.27) | 14.3 % | 1.07 (0.96, 1.20) | 25.4 % | 1.12 (1.01, 1.23) | |
IV | 6460 | 9.6 % |
1.23 (1.07, 1.40)
| 15.0 % |
1.17 (1.05, 1.31)
| 25.3 % |
1.13 (1.02, 1.24)
| |
V (Most deprived) | 6342 | 9.9 % |
1.34
a
(1.17, 1.53)
| 15.0 % |
1.25
a
(1.12, 1.40)
| 25.3 % |
1.20
a
(1.08, 1.32)
| |
Stroke
|
All cases
| 37,888 | 11.6 % | - | 21.4 % | - | 37.7 % | - |
Age
| ||||||||
< 65y | 6779 | 7.9 % | - | 10.9 % | - | 5.9 % | - | |
65–74y | 7989 | 9.4 % | - | 14.9 % | - | 25.1 % | - | |
75–84y | 13,171 | 11.7 % | - | 21.6 % | - | 39.6 % | - | |
85y+ | 9949 | 15.7 % | - | 33.4 % | - | 60.4 % | - | |
Gender
| ||||||||
Male | 17,936 | 9.8 % | Ref | 17.6 % | Ref | 32.1 % | Ref | |
Female | 19,952 | 13.1 % |
1.25
a
(1.16, 1.33)
| 24.7 % |
1.21
a
(1.15, 1.3)
| 42.8 % |
1.23
a
(1.17, 1.29)
| |
Social deprivation
| ||||||||
I (Least deprived) | 6390 | 11.3 % | Ref | 20.9 % | Ref | 37.2 % | Ref | |
II | 6803 | 11.3 % | 1.01 (0.91, 1.13) | 21.7 % |
1.09 (1.00, 1.19)
| 39.1 % |
1.13
a
(1.05, 1.22)
| |
III | 8078 | 12.2 % |
1.12 (1.01, 1.24)
| 22.2 % |
1.12 (1.04, 1.22)
| 38.7 % |
1.12 (1.04, 1.21)
| |
IV | 7817 | 11.3 % | 1.05 (0.95, 1.17) | 20.5 % | 1.06 (0.97, 1.15) | 37.5 % |
1.12 (1.04, 1.20)
| |
V (Most deprived) | 7886 | 11.9 % |
1.17 (1.05, 1.30)
| 22.0 % |
1.24
a
(1.14, 1.34)
| 37.9 % |
1.23
a
(1.15, 1.33)
| |
SAH
|
All cases
| 1753 | 26.9 % | - | 35.6 % | - | 40.4 % | - |
Age
| ||||||||
< 65y | 1043 | 22.5 % | - | 27.0 % | - | 28.9 % | - | |
65–74y | 317 | 29.7 % | - | 41.0 % | - | 47.3 % | - | |
75–84y | 266 | 34.6 % | - | 54.1 % | - | 62.4 % | - | |
85y+ | 127 | 40.2 % | - | 53.5 % | - | 70.5 % | - | |
Gender
| ||||||||
Male | 634 | 26.8 % | Ref | 35.6 % | Ref | 40.5 % | Ref | |
Female | 1119 | 27.0 % | 1.08 (0.85, 1.37) | 35.6 % | 1.03 (0.82, 1.29) | 40.3 % | 1.00 (0.80, 1.25) | |
Social deprivation
| ||||||||
I (Least deprived) | 291 | 28.2 % | Ref | 34.7 % | Ref | 40.0 % | Ref | |
II | 318 | 25.8 % | 0.91 (0.62, 1.34) | 35.5 % | 1.09 (0.75, 1.56) | 39.6 % | 1.02 (0.71, 1.47) | |
III | 366 | 26.0 % | 0.99 (0.69, 1.44) | 36.3 % | 1.24 (0.88, 1.76) | 41.5 % | 1.25 (0.88, 1.77) | |
IV | 355 | 27.0 % | 1.10 (0.76, 1.59) | 34.9 % | 1.19 (0.83, 1.69) | 39.4 % | 1.13 (0.80, 1.61) | |
V (Most deprived) | 369 | 27.4 % | 1.09 (0.75, 1.58) | 36.9 % | 1.32 (0.93, 1.87) | 42.5 % | 1.32 (0.93, 1.88) |
Risk factors | AMI | Stroke | SAH | |||
---|---|---|---|---|---|---|
Admissions, % 30 days mortality | Admissions, % 30 days mortality | Admissions, % 30 days mortality | ||||
I | V | I | V | I | V | |
Comorbidities | ||||||
Ischaemic heart disease (I20–I25) | 4776, 14.5 % | 6342, 15.0 % | 1873, 23.8 % | 2726, 23.3 % | 35, 45.7 % | 83, 45.8 % |
Other cardiovascular diseases (I00–I15, I26–I52) | 3702, 16.0 % | 4887, 16.3 % | 5088, 20.3 % | 6273, 21.8 % | 161, 39.1 % | 197, 41.1 % |
Cerebrovascular disease (I60–I69) | 521, 18.4 % | 733, 24.0 % | 6390, 20.9 % | 7886, 22.0 % | 291, 34.7 % | 369, 36.9 % |
Other circulatory diseases (I70–I99) | 1391, 15.0 % | 1827, 17.0 % | 2289, 18.0 % | 2780, 19.2 % | 69, 36.2 % | 88, 36.4 % |
Malignancies (C00–C97) | 634, 18.6 % | 661, 19.5 % | 986, 21.8 % | 998, 24.4 % | 22, 36.4 % | 21, 47.6 % |
Chronic obstructive pulmonary disease (J40–J44) | 511, 17.6 % | 1271, 18.7 % | 581, 22.2 % | 1433, 21.1 % | 20, 40.0 % | 43, 44.2 % |
Asthma (J45–J46), | 470, 12.3 % | 864, 13.5 % | 548, 17.9 % | 994, 18.2 % | 25, 44.0 % | 53, 30.2 % |
Diabetes (E10–E14) | 912, 16.1 % | 1492, 17.4 % | 1089, 22.4 % | 1857, 19.8 % | 17, 52.9 % | 35, 45.7 % |
Dementia (F00–F03, F05.1, G30) | 215, 29.8 % | 318, 28.6 % | 686, 25.1 % | 945, 25.9 % | 6, 66.7 % | 12, 33.3 % |
Liver disease (K70–K77) | 64, 10.9 % | 99, 22.2 % | 101, 20.8 % | 201, 23.4 % | 6, 50.0 % | 4, 50.0 % |
Renal failure (N17–N19) | 628, 25.2 % | 830, 25.8 % | 608, 27.3 % | 824, 25.6 % | 13, 61.5 % | 13, 69.2 % |
Age | ||||||
< 65y | 1324, 3.6 % | 2307, 4.9 % | 871, 11.1 % | 1791, 11.4 % | 166, 28.3 % | 228, 28.1 % |
65–74y | 1019, 10.2 % | 1465, 13.4 % | 1250, 12.8 % | 1800, 15.2 % | 52, 34.6 % | 65, 41.5 % |
75–84y | 1428, 17.6 % | 1576, 22.1 % | 2357, 19.9 % | 2587, 24.8 % | 54, 50.0 % | 45, 57.8 % |
85 + y | 1005, 28.9 % | 994, 29.8 % | 1912, 31.7 % | 1708, 36.1 % | 19, 47.4 % | 31, 61.3 % |
Gender | ||||||
Male | 2976, 12.3 % | 3680, 12.3 % | 2996, 18.1 % | 3761, 17.5 % | 100, 30.0 % | 131, 41.2 % |
Female | 1800, 18.2 % | 2662, 18.9 % | 3394, 23.4 % | 4125, 26.1 % | 191, 37.2 % | 238, 34.5 % |
Day type | ||||||
Weekdays (Mon–Fri) | 3493, 14.5 % | 4617, 15.4 % | 4829, 20.3 % | 5814, 21.7 % | 213, 33.8 % | 267, 33.3 % |
Weekends (Sat–Sun) | 1182, 13.8 % | 1600, 14.1 % | 1456, 22.7 % | 1913, 23.0 % | 74, 37.8 % | 98, 45.9 % |
Public holidays | 101, 22.8 % | 125, 14.4 % | 105, 21.0 % | 159, 22.0 % | 4, 25.0 % | 4, 50.0 % |
Season | ||||||
Winter | 1231, 15.5 % | 1673, 15.1 % | 1607, 23.1 % | 1967, 23.0 % | 77, 35.1 % | 83, 36.1 % |
Spring | 1293, 16.9 % | 1585, 15.0 % | 1601, 20.8 % | 2063, 22.4 % | 70, 37.1 % | 95, 31.6 % |
Summer | 1125, 13.1 % | 1530, 15.0 % | 1584, 19.3 % | 1974, 20.4 % | 70, 27.1 % | 100, 38.0 % |
Autumn | 1127, 12.2 % | 1554, 15.1 % | 1598, 20.3 % | 1882, 22.3 % | 74, 39.2 % | 91, 41.8 % |
Year group | ||||||
2004–2005 | 1382, 16.4 % | 1838, 16.9 % | 1562, 20.8 % | 2062, 23.3 % | 69, 40.6 % | 114, 33.3 % |
2006–2008 | 1798, 15.2 % | 2432, 15.1 % | 2353, 22.2 % | 3006, 22.6 % | 112, 29.5 % | 132, 45.5 % |
2009–2011 | 1596, 12.1 % | 2072, 13.4 % | 2475, 19.7 % | 2818, 20.5 % | 110, 36.4 % | 123, 30.9 % |
Hospital size | ||||||
Small (100–399 beds) | 277, 11.9 % | 853, 16.5 % | 288, 19.4 % | 859, 21.9 % | 10, 30.0 % | 27, 44.4 % |
Medium (400–599 beds) | 2133, 15.1 % | 3400, 14.3 % | 2961, 21.3 % | 4271, 22.9 % | 102, 39.2 % | 184, 38.6 % |
Large (600+ beds) | 2102, 14.4 % | 1867, 15.4 % | 2772, 21.7 % | 2335, 22.4 % | 173, 33.5 % | 147, 36.1 % |
Community hospitals | 264, 14.0 % | 222, 17.1 % | 369, 12.2 % | 421, 11.2 % | 6, 0.0 % | 11, 0.0 % |
Effect of risk factors on the relationship between mortality and social deprivation
Patient demographics
Risk factor | AMI | Stroke | SAH | ||||||
---|---|---|---|---|---|---|---|---|---|
Mortality rate (Quintile I) | Mortality rate (Quintile V) | 30 days mortality OR (95 % CI) b | Mortality rate (Quintile I) | Mortality rate (Quintile V) | 30 days mortality OR (95 % CI) b | Mortality rate (Quintile I) | Mortality rate (Quintile V) | 30 days mortality OR (95 % CI) b | |
Age
| |||||||||
< 65y | 3.6 % | 4.9 % | 1.35 (0.94, 1.94) | 11.1 % | 11.4 % | 1.14 (0.88, 1.49) | 28.3 % | 28.1 % | 1.20 (0.72, 2.02) |
65–74y | 10.2 % | 13.4 % | 1.28 (0.98, 1.67) | 12.8 % | 15.2 % | 1.22 (0.98, 1.51) | 34.6 % | 41.5 % | 2.03 (0.80, 5.13) |
75–84y | 17.6 % | 22.1 % |
1.32
a
(1.09, 1.59)
| 19.9 % | 24.8 % |
1.30
a
(1.13, 1.50)
| 50.0 % | 57.8 % | 1.33 (0.53, 3.38) |
85+ y | 28.9 % | 29.8 % | 1.06 (0.87, 1.29 | 31.7 % | 36.1 % |
1.19 (1.03, 1.37)
| 47.4 % | 61.3 % | 2.38 (0.51, 11.04) |
Gender
| |||||||||
Male | 12.3 % | 12.2 % |
1.21 (1.03, 1.42)
| 18.1 % | 17.5 % | 1.11 (0.97, 1.27) | 30.0 % | 41.2 % |
2.45 (1.21, 4.95)
|
Female | 18.2 % | 18.9 % |
1.26 (1.07, 1.49)
| 23.4 % | 26.1 % |
1.36
a
(1.21, 1.52)
| 37.2 % | 34.5 % | 1.04 (0.66, 1.65) |
Day of the week
| |||||||||
Weekdays (Mon–Fri) | 14.5 % | 15.4 % |
1.27
a
(1.11, 1.45)
| 20.3 % | 21.7 % |
1.27
a
(1.15, 1.40)
| 33.8 % | 33.3 % | 1.18 (0.77, 1.82) |
Weekends (Sat–Sun) | 13.8 % | 14.1 % | 1.21 (0.96, 1.54) | 22.7 % | 23.0 % | 1.16 (0.98, 1.38) | 37.8 % | 45.9 % | 1.96 (0.86, 4.51) |
Public holidays | 22.8 % | 14.4 % | 0.72 (0.32, 1.63) | 21.0 % | 22.0 % | 1.15 (0.59, 2.23) | 25.0 % | 50.0 % | NA |
Season of admission
| |||||||||
Winter | 15.5 % | 15.1 % | 1.09 (0.87, 1.36) | 23.1 % | 23.0 % | 1.10 (0.93, 1.30) | 35.1 % | 36.1 % | 0.98 (0.42, 2.28) |
Spring | 16.9 % | 15.0 % | 1.09 (0.87, 1.37) | 20.8 % | 22.4 % |
1.29 (1.09, 1.53)
| 37.1 % | 31.6 % | 0.99 (0.43, 2.29) |
Summer | 13.1 % | 15.0 % |
1.36 (1.07, 1.72)
| 19.3 % | 20.4 % |
1.27 (1.06, 1.51)
| 27.1 % | 38.0 % | 2.26 (0.97, 5.24) |
Autumn | 12.2 % | 15.1 % |
1.57
a
(1.23, 2.01)
| 20.3 % | 22.3 % |
1.36
a
(1.14, 1.62)
| 39.2 % | 41.8 % | 1.76 (0.75, 4.09) |
Year of admission
| |||||||||
2004–2005 | 16.4 % | 16.9 % |
1.25 (1.02, 1.53)
| 20.8 % | 23.3 % |
1.31
a
(1.10, 1.55)
| 40.6 % | 33.3 % | 0.67 (0.27, 1.65) |
2006–2008 | 15.2 % | 15.1 % | 1.16 (0.96, 1.39) | 22.2 % | 22.6 % |
1.23
a
(1.07, 1.41)
| 29.5 % | 45.5 % |
3.54
a
(1.77, 7.07)
|
2009–2011 | 12.1 % | 13.4 % |
1.32 (1.07, 1.63)
| 19.7 % | 20.5 % |
1.21 (1.05, 1.40)
| 36.4 % | 30.9 % | 0.75 (0.40, 1.43) |
Hospital size
| |||||||||
Small (100–399 beds) | 11.9 % | 16.5 % | 1.50 (0.96, 2.36) | 19.4 % | 21.9 % | 1.27 (0.89, 1.82) | 30.0 % | 44.4 % | NA |
Medium (400–599 beds) | 15.1 % | 14.3 % | 1.11 (0.94, 1.31) | 21.3 % | 22.9 % |
1.25
a
(1.11, 1.42)
| 39.2 % | 38.6 % | 1.28 (0.72, 2.29) |
Large (600+ beds) | 14.2 % | 15.4 % |
1.28 (1.06, 1.55)
| 21.7 % | 22.4 % |
1.20 (1.04, 1.39)
| 33.5 % | 36.1 % | 1.44 (0.84, 2.47) |
Community hospitals | 14.0 % | 17.1 % | 1.57 (0.92, 2.69) | 12.2 % | 11.2 % | 1.10 (0.69, 1.76) | 0.0 % | 0.0 % | NA |