Department of Geography and Planning, University of Liverpool, Liverpool, UK.
School of Geography and the Environment, University of Oxford, Oxford, UK.
J Epidemiol Community Health. 2017 Nov;71(11):1068-1071. doi: 10.1136/jech-2017-209403. Epub 2017 Oct 2.
2015 saw the largest annual spike of mortality rates in England in almost 50 years. We examine whether these changes in mortality rates are associated with an indicator of poor functioning of health and social care: delay in hospital discharges.
Office for National Statistics monthly data of death counts and mortality rates for the period August 2010-March 2016 were compared with delays in discharges from National Health Service (NHS) England data on transfers of care for acute and non-acute patients in England. Autoregressive Integrated Moving Average regression models were used in the analysis.
We estimate that each additional day an acute admission was late being discharged was associated with an increase in 0.394 deaths (95% CIs 0.220 to 0.569). For each additional acute patient delayed being discharged, we found an increase of 7.322 deaths (95% CIs 1.754 to 12.890). Findings for non-acute admissions were mixed.
The increased prevalence of patients being delayed in discharge from hospital in 2015 was associated with increases in mortality, accounting for up to a fifth of mortality increases. Our study provides evidence that a lower quality of performance of the NHS and adult social care as a result of austerity may be having an adverse impact on population health.
2015 年是英国近 50 年来死亡率年度增幅最大的一年。我们研究了这些死亡率变化是否与卫生和社会保健功能不佳的一个指标有关：医院出院延迟。
我们将 2010 年 8 月至 2016 年 3 月期间的国家统计局月度死亡人数和死亡率数据与英格兰国民保健制度（NHS）关于急性和非急性患者转院的延迟数据进行了比较。分析中使用了自回归综合移动平均回归模型。
我们估计，急性入院每延迟一天出院，死亡人数就会增加 0.394 人（95%置信区间为 0.220 至 0.569）。对于每一个延迟出院的急性患者，我们发现死亡人数增加了 7.322 人（95%置信区间为 1.754 至 12.890）。非急性入院的结果则喜忧参半。
2015 年，越来越多的患者在出院时被延迟，这与死亡率的上升有关，死亡率上升的原因多达五分之一。我们的研究表明，由于紧缩政策，国民保健制度和成人社会保健服务质量下降，可能对人口健康产生不利影响。
