Clark David, Armstrong Matthew, Allan Ananda, Graham Fiona, Carnon Andrew, Isles Christopher
1 School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK.
2 Healthcare Information Group, Information Services Division, NHS National Services Scotland, Edinburgh, UK.
Palliat Med. 2014 Jun;28(6):474-479. doi: 10.1177/0269216314526443.
There is a dearth of evidence on the proportion of the hospital population at any one time, that is in the last year of life, and therefore on how hospital policies and services can be oriented to their needs.
To establish the likelihood of death within 12 months of a cohort of hospital inpatients on a given census date.
Prevalent cohort study.
In total, 10,743 inpatients in 25 Scottish teaching and general hospitals on 31 March 2010.
In all, 3098 (28.8%) patients died during follow-up: 2.9% by 7 days, 8.9% by 30 days, 16.0% by 3 months, 21.2% by 6 months, 25.5% by 9 months and 28.8% by 12 months. Deaths during the index admission accounted for 32.3% of all deaths during the follow-up year. Mortality rose steeply with age and was three times higher at 1 year for patients aged 85 years and over compared to those who were under 60 years (45.6% vs 13.1%; p < 0.001). In multivariate analyses, men were more likely to die than women (odds ratio: 1.18, 95% confidence interval: 0.95-1.47) as were older patients (odds ratio: 4.99, 95% confidence interval: 3.94-6.33 for those who were 85 years and over compared to those who were under 60 years), deprived patients (odds ratio: 1.17, 95% confidence interval: 1.01-1.35 for most deprived compared to least deprived quintile) and those admitted to a medical specialty (odds ratio: 3.13, 95% confidence interval: 2.48-4.00 compared to surgical patients).
Large numbers of hospital inpatients have entered the last year of their lives. Such data could assist in advocacy for these patients and should influence end-of-life care strategies in hospital.
目前缺乏关于在任何一个时间点，即在生命最后一年的住院患者比例的证据，因此也缺乏关于医院政策和服务如何根据他们的需求进行调整的证据。
确定在给定普查日期住院的一组患者在12个月内死亡的可能性。
现患队列研究。
2010年3月31日，苏格兰25家教学医院和综合医院的10743名住院患者。
共有3098名（28.8%）患者在随访期间死亡：7天内死亡2.9%，30天内死亡8.9%，3个月内死亡16.0%，6个月内死亡21.2%，9个月内死亡25.5%，12个月内死亡28.8%。首次住院期间的死亡占随访年度所有死亡的32.3%。死亡率随年龄急剧上升，85岁及以上患者1年时的死亡率是60岁以下患者的三倍（45.6%对13.1%；p<0.001）。在多变量分析中，男性比女性更易死亡（比值比：1.18，95%置信区间：0.95-1.47），老年患者也是如此（85岁及以上患者与60岁以下患者相比，比值比：4.99，95%置信区间：3.94-6.33），贫困患者（最贫困五分位数与最不贫困五分位数相比，比值比：1.17，95%置信区间：1.01-1.35）以及入住内科专科的患者（与外科患者相比，比值比：3.13，95%置信区间：2.48-4.00）。
大量住院患者已进入生命的最后一年。这些数据有助于为这些患者进行宣传，并应影响医院的临终关怀策略。
