Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.
Eur Geriatr Med. 2024 Feb;15(1):127-138. doi: 10.1007/s41999-023-00887-7. Epub 2023 Nov 28.
Examine preadmission diagnoses, medication use, and preadmission healthcare utilization among older adults prior to first potentially avoidable hospitalizations.
A nationwide population-based case-control study using Danish healthcare data. All Danish adults aged ≥ 65 years who had a first potentially avoidable hospitalization from January 1995 through March 2019 (n = 725,939) were defined as cases, and 1:1 age- and sex-matched general population controls (n = 725,939). Preadmission morbidity and healthcare utilization were assessed based on a complete hospital diagnosis history within 10 years prior, and all medication use and healthcare contacts 1 year prior. Using log-binomial regression, we calculated adjusted prevalence ratios (PR) with 95% confidence intervals (CI).
Included cases and controls had a median age of 78 years and 59% were female. The burden of preadmission morbidity was higher among cases than controls. The strongest associations were observed for preadmission chronic lung disease (PR 3.8, CI 3.7-3.8), alcohol-related disease (PR 3.1, CI 3.0-3.2), chronic kidney disease (PR 2.4, CI 2.4-2.5), psychiatric disease (PR 2.2, CI 2.2-2.3), heart failure (PR 2.2, CI 2.2-2.3), and previous hospital contacts with infections (PR 2.2, CI 2.2-2.3). A high and accelerating number of healthcare contacts was observed during the months preceding the potentially avoidable hospitalization (having over 5 GP contacts 1 month prior, PR 3.0, CI 3.0-3.0).
A high number of healthcare contacts and preadmission morbidity and medication use, especially chronic lung, heart, and kidney disease, alcohol-related or psychiatric disease including dementia, and previous infections are strongly associated with potentially avoidable hospitalizations.
研究老年人首次非必要住院前的入院诊断、用药情况和入院前医疗保健利用情况。
一项基于丹麦医疗保健数据的全国性人群病例对照研究。1995 年 1 月至 2019 年 3 月期间，所有年龄≥65 岁、首次非必要住院的丹麦成年人（n=725939）被定义为病例，且年龄和性别与病例匹配的普通人群对照（n=725939）。根据 10 年内完整的住院诊断史和 1 年前所有用药和医疗接触情况，评估入院前发病率和医疗保健利用情况。使用对数二项式回归，我们计算了调整后的比值比（PR）及其 95%置信区间（CI）。
纳入的病例和对照的中位年龄为 78 岁，59%为女性。病例的入院前发病率高于对照。观察到的最强关联是入院前慢性肺部疾病（PR 3.8，CI 3.7-3.8）、酒精相关疾病（PR 3.1，CI 3.0-3.2）、慢性肾脏病（PR 2.4，CI 2.4-2.5）、精神疾病（PR 2.2，CI 2.2-2.3）、心力衰竭（PR 2.2，CI 2.2-2.3）和以前因感染住院的接触（PR 2.2，CI 2.2-2.3）。在非必要住院前的几个月中，观察到医疗保健接触的次数很高且呈加速增加（在 1 个月前有超过 5 次全科医生接触，PR 3.0，CI 3.0-3.0）。
大量的医疗保健接触以及入院前发病率和用药情况，特别是慢性肺部、心脏和肾脏疾病、酒精相关或精神疾病（包括痴呆）以及以前的感染与非必要住院密切相关。
