Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA.
STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA.
J Epidemiol Community Health. 2019 Jun;73(6):537-543. doi: 10.1136/jech-2018-210783. Epub 2019 Feb 6.
The world's population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (60 years) compared with non-older population, as well as the epidemiology of these hospital admissions.
Using the Brazilian Unified Health System (known as 'Sistema Único de Saúde' (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation.
A total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%.
These findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.
世界人口正逐渐老龄化，这给社会和政府带来了诸多挑战。本研究旨在调查与非老年人群相比，老年（60 岁及以上）人群住院所产生的负担，以及这些住院患者的流行病学特征。
利用巴西统一卫生系统（简称 SUS），对 2009 年至 2015 年期间 SUS 所有成年患者的住院情况进行了分析。使用的指标包括住院率、重症监护病房（ICU）入住率、平均住院和 ICU 住院时间、住院死亡率和平均住院费用。
7 年间共分析了 61958959 例住院病例，其中包括 17893392 例（28.9%）老年患者。老年人占巴西成年人口的 15%（n=21294950），但占住院患者的 29%（n=17893392）、占 ICU 入住患者的 52%（n=1731299）和住院死亡率的 66%（n=1885291）。在成年人中，老年人占总住院费用的 39%。2009 年至 2015 年期间，老年人口增加了 27%，而 ICU 入住率增加了 20%；2015 年 ICU 平均住院时间比 2009 年（5.8 天）长 12%（6.5 天）；住院死亡率从 9.8%上升到 11.2%。
这些发现说明了巴西公立卫生系统中老年人住院负担的现状，并证明了流行病学的转变正在巩固，即巴西老年人住院的主要原因正由传染病向非传染性疾病转变。
