Ontarians more likely to survive 1 year after hospitalization: study

Date: Sep-30-2013More people in Ontario are living longer after hospitalization than in 1994, with a 22% decrease in the risk of death after 1 year from admission, found an article in CMAJ (Canadian Medical Association Journal).

Hospitals deliver a substantial proportion of health care, from treating acute illness to performing surgery, offering specialist medicine and care for people from birth to death. They are large consumers of health care costs world-wide, and it is important to understand how they are performing as part of the health care system.

To understand whether outcomes for hospital patients are improving, Dr. Carl van Walraven, senior scientist with the Ottawa Hospital Research Institute and site director, ICES@uOttawa, looked at data on all patients hospitalized in Ontario in 4 years over a 15-year period from 1994 to 2009. The study of more than 2.5 million adults examined death from all causes within 1 year after admission to hospital.

The story is complicated by the fact that in 2009, when compared with 1994, patients admitted to hospital were much sicker, had increased comorbidities, were older (a median age of 58 years compared with 51) and were more likely to arrive by ambulance 25% compared with 16%). As a result of these changes, the unadjusted risk of death 1 year after hospitalization increased from 9.2% to 11.6%. But when correcting for factors such as those listed above, the likelihood of death declined overall for most age groups.

"After adjusting for changes in patient characteristics over the years studied, the 1-year risk of death decreased significantly between 1994 and 2004," says van Walraven. "Independent of patient age, sex and comorbidity, admission urgency and service, and ambulance status, the 1-year adjusted odds of death were 22% lower in 2009 than in 1994."

However, the risk of death in the general population also declined during the study period. For people under age 50, the annual risk of death, compared with the risk in 1994, declined 18%, 22% and 28% respectively in 1999, 2004 and 2009. Although previous studies have looked at survival rates for specific diseases, none has accounted for survival changes in the general population when measuring trends in patients' survival rates.

The improved trends in 1-year survival for hospitalized patients persisted after adjusting for both important covariates and improved survival in the general population. Compared with patients in 1994, those in 2009 were 19% less likely to die within a year after admission to hospital.

"Because admissions to hospital are so common, and the drop risk of death is so extensive, these changes translate into a meaningful decrease in life-years lost," van Walraven concludes.
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