1994-2009 年安大略省住院患者 1 年存活率趋势。
Trends in 1-year survival of people admitted to hospital in Ontario, 1994-2009.
出版信息
CMAJ. 2013 Nov 5;185(16):E755-62. doi: 10.1503/cmaj.130875. Epub 2013 Sep 30.
BACKGROUND
Changes in the long-term survival of people admitted to hospital is unknown. This study examined trends in 1-year survival of patients admitted to hospital adjusted for improved survival in the general population.
METHODS
One-year survival after admission to hospital was determined for all adults admitted to hospital in Ontario in 1994, 1999, 2004, or 2009 by linking to vital statistics datasets. Annual survival in the general population was determined from life tables for Ontario.
RESULTS
Between 1994 and 2009, hospital use decreased (from 8.8% to 6.3% of the general adult population per year), whereas crude 1-year mortality among people with hospital admissions increased (from 9.2% to 11.6%). During this time, patients in hospital became significantly older (median age increased from 51 to 58 yr) and sicker (the proportion with a Charlson comorbidity index score of 0 decreased from 68.2% to 60.0%), and were more acutely ill on admission (elective admissions decreased from 47.4% to 42.0%; proportion brought to hospital by ambulance increased from 16.1% to 24.8%). Compared with 1994, the adjusted odds ratio (OR) for death at 1 year in 2009 was 0.78 (95% confidence interval [CI] 0.77-0.79). However, 1-year risk of death in the general population decreased by 24% during the same time. After adjusting for improved survival in the general population, risk of death at 1 year for people admitted to hospital remained significantly lower in 2009 than in 1994 (adjusted relative excess risk 0.81, 95% CI 0.80-0.82).
INTERPRETATION
After accounting for both the increased burden of patient sickness and improved survival in the general population, 1-year survival for people admitted to hospital increased significantly from 1994 to 2009. The reasons for this improvement cannot be determined from these data.
背景
住院患者长期生存率的变化尚不清楚。本研究通过链接生命统计数据集，调查了调整一般人群生存率改善后住院患者 1 年生存率的变化趋势。
方法
通过链接生命统计数据集，确定了 1994 年、1999 年、2004 年和 2009 年所有在安大略省住院的成年人住院后的 1 年生存率。安大略省的一般人群年度生存率从生命表中确定。
结果
1994 年至 2009 年期间，医院就诊人数减少（每年占一般成年人口的比例从 8.8%降至 6.3%），而住院患者的粗 1 年死亡率上升（从 9.2%升至 11.6%）。在此期间，住院患者年龄明显增大（中位数年龄从 51 岁增加到 58 岁），病情恶化（Charlson 合并症指数评分为 0 的比例从 68.2%降至 60.0%），入院时病情更为急性（择期入院从 47.4%降至 42.0%；通过救护车入院的比例从 16.1%增至 24.8%）。与 1994 年相比，2009 年 1 年死亡的调整后比值比（OR）为 0.78（95%置信区间 [CI] 0.77-0.79）。然而，同一时期一般人群 1 年死亡风险下降了 24%。在调整一般人群生存率改善后，2009 年住院患者 1 年死亡风险仍显著低于 1994 年（调整后的相对超额风险为 0.81，95%CI 0.80-0.82）。
解释
在考虑患者疾病负担增加和一般人群生存率改善的情况下，1994 年至 2009 年住院患者 1 年生存率显著提高。从这些数据中无法确定这种改善的原因。
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