Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study
Summary: Background: It is unclear what effect the pattern of health-care use before admission to hospital with COVID-19 (index admission) has on the long-term outcomes for patients. We sought to describe mortality and emergency readmission to hospital after discharge following the index admission...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-07-01
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| Series: | The Lancet: Digital Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589750023000511 |
| _version_ | 1827913090049507328 |
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| author | Annemarie B Docherty, PhD James Farrell, PhD Mathew Thorpe, MSc Conor Egan, MSc Sarah Dunn, MSc Lisa Norman, PhD Catherine A Shaw, PhD Andrew Law, PhD Gary Leeming, BA Lucy Norris, MSc Andrew Brooks, MSc Bianca Prodan, BSc Hons Ruairidh MacLeod, MSci Robert Baxter, PhD Carole Morris, BSc Diane Rennie, BA Wilna Oosthuyzen, PhD Malcolm G Semple, ProfPhD J Kenneth Baillie, ProfPhD Riinu Pius, PhD Sohan Seth, PhD Ewen M Harrison, ProfPhD Nazir I Lone, PhD |
| author_facet | Annemarie B Docherty, PhD James Farrell, PhD Mathew Thorpe, MSc Conor Egan, MSc Sarah Dunn, MSc Lisa Norman, PhD Catherine A Shaw, PhD Andrew Law, PhD Gary Leeming, BA Lucy Norris, MSc Andrew Brooks, MSc Bianca Prodan, BSc Hons Ruairidh MacLeod, MSci Robert Baxter, PhD Carole Morris, BSc Diane Rennie, BA Wilna Oosthuyzen, PhD Malcolm G Semple, ProfPhD J Kenneth Baillie, ProfPhD Riinu Pius, PhD Sohan Seth, PhD Ewen M Harrison, ProfPhD Nazir I Lone, PhD |
| author_sort | Annemarie B Docherty, PhD |
| collection | DOAJ |
| description | Summary: Background: It is unclear what effect the pattern of health-care use before admission to hospital with COVID-19 (index admission) has on the long-term outcomes for patients. We sought to describe mortality and emergency readmission to hospital after discharge following the index admission (index discharge), and to assess associations between these outcomes and patterns of health-care use before such admissions. Methods: We did a national, retrospective, complete cohort study by extracting data from several national databases and linking the databases for all adult patients admitted to hospital in Scotland with COVID-19. We used latent class trajectory modelling to identify distinct clusters of patients on the basis of their emergency admissions to hospital in the 2 years before the index admission. The primary outcomes were mortality and emergency readmission up to 1 year after index admission. We used multivariable regression models to explore associations between these outcomes and patient demographics, vaccination status, level of care received in hospital, and previous emergency hospital use. Findings: Between March 1, 2020, and Oct 25, 2021, 33 580 patients were admitted to hospital with COVID-19 in Scotland. Overall, the Kaplan-Meier estimate of mortality within 1 year of index admission was 29·6% (95% CI 29·1–30·2). The cumulative incidence of emergency hospital readmission within 30 days of index discharge was 14·4% (95% CI 14·0–14·8), with the number increasing to 35·6% (34·9–36·3) patients at 1 year. Among the 33 580 patients, we identified four distinct patterns of previous emergency hospital use: no admissions (n=18 772 [55·9%]); minimal admissions (n=12 057 [35·9%]); recently high admissions (n=1931 [5·8%]), and persistently high admissions (n=820 [2·4%]). Patients with recently or persistently high admissions were older, more multimorbid, and more likely to have hospital-acquired COVID-19 than patients with no or minimal admissions. People in the minimal, recently high, and persistently high admissions groups had an increased risk of mortality and hospital readmission compared with those in the no admissions group. Compared with the no admissions group, mortality was highest in the recently high admissions group (post-hospital mortality HR 2·70 [95% CI 2·35–2·81]; p<0·0001) and the risk of readmission was highest in the persistently high admissions group (3·23 [2·89–3·61]; p<0·0001). Interpretation: Long-term mortality and readmission rates for patients hospitalised with COVID-19 were high; within 1 year, one in three patients had died and a third had been readmitted as an emergency. Patterns of hospital use before index admission were strongly predictive of mortality and readmission risk, independent of age, pre-existing comorbidities, and COVID-19 vaccination status. This increasingly precise identification of individuals at high risk of poor outcomes from COVID-19 will enable targeted support. Funding: Chief Scientist Office Scotland, UK National Institute for Health Research, and UK Research and Innovation. |
| first_indexed | 2024-03-13T02:25:27Z |
| format | Article |
| id | doaj.art-bf21f5321c63465b8b823ca2609b4a95 |
| institution | Directory Open Access Journal |
| issn | 2589-7500 |
| language | English |
| last_indexed | 2024-03-13T02:25:27Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet: Digital Health |
| spelling | doaj.art-bf21f5321c63465b8b823ca2609b4a952023-06-30T04:22:40ZengElsevierThe Lancet: Digital Health2589-75002023-07-0157e446e457Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort studyAnnemarie B Docherty, PhD0James Farrell, PhD1Mathew Thorpe, MSc2Conor Egan, MSc3Sarah Dunn, MSc4Lisa Norman, PhD5Catherine A Shaw, PhD6Andrew Law, PhD7Gary Leeming, BA8Lucy Norris, MSc9Andrew Brooks, MSc10Bianca Prodan, BSc Hons11Ruairidh MacLeod, MSci12Robert Baxter, PhD13Carole Morris, BSc14Diane Rennie, BA15Wilna Oosthuyzen, PhD16Malcolm G Semple, ProfPhD17J Kenneth Baillie, ProfPhD18Riinu Pius, PhD19Sohan Seth, PhD20Ewen M Harrison, ProfPhD21Nazir I Lone, PhD22Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK; Correspondence to: Dr Annemarie Docherty, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh EH16 4SB, UKCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKRoslin Institute, University of Edinburgh, Edinburgh, UKDepartment of Biostatistics, University of Liverpool, Liverpool, UKBayes Centre, University of Edinburgh, Edinburgh, UKBayes Centre, University of Edinburgh, Edinburgh, UKBayes Centre, University of Edinburgh, Edinburgh, UKBayes Centre, University of Edinburgh, Edinburgh, UKBayes Centre, University of Edinburgh, Edinburgh, UKPublic Health Scotland, Edinburgh, UKPublic Health Scotland, Edinburgh, UKRoslin Institute, University of Edinburgh, Edinburgh, UKNIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UKRoslin Institute, University of Edinburgh, Edinburgh, UKCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKSchool of Informatics, University of Edinburgh, Edinburgh, UKCentre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UKCentre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UKSummary: Background: It is unclear what effect the pattern of health-care use before admission to hospital with COVID-19 (index admission) has on the long-term outcomes for patients. We sought to describe mortality and emergency readmission to hospital after discharge following the index admission (index discharge), and to assess associations between these outcomes and patterns of health-care use before such admissions. Methods: We did a national, retrospective, complete cohort study by extracting data from several national databases and linking the databases for all adult patients admitted to hospital in Scotland with COVID-19. We used latent class trajectory modelling to identify distinct clusters of patients on the basis of their emergency admissions to hospital in the 2 years before the index admission. The primary outcomes were mortality and emergency readmission up to 1 year after index admission. We used multivariable regression models to explore associations between these outcomes and patient demographics, vaccination status, level of care received in hospital, and previous emergency hospital use. Findings: Between March 1, 2020, and Oct 25, 2021, 33 580 patients were admitted to hospital with COVID-19 in Scotland. Overall, the Kaplan-Meier estimate of mortality within 1 year of index admission was 29·6% (95% CI 29·1–30·2). The cumulative incidence of emergency hospital readmission within 30 days of index discharge was 14·4% (95% CI 14·0–14·8), with the number increasing to 35·6% (34·9–36·3) patients at 1 year. Among the 33 580 patients, we identified four distinct patterns of previous emergency hospital use: no admissions (n=18 772 [55·9%]); minimal admissions (n=12 057 [35·9%]); recently high admissions (n=1931 [5·8%]), and persistently high admissions (n=820 [2·4%]). Patients with recently or persistently high admissions were older, more multimorbid, and more likely to have hospital-acquired COVID-19 than patients with no or minimal admissions. People in the minimal, recently high, and persistently high admissions groups had an increased risk of mortality and hospital readmission compared with those in the no admissions group. Compared with the no admissions group, mortality was highest in the recently high admissions group (post-hospital mortality HR 2·70 [95% CI 2·35–2·81]; p<0·0001) and the risk of readmission was highest in the persistently high admissions group (3·23 [2·89–3·61]; p<0·0001). Interpretation: Long-term mortality and readmission rates for patients hospitalised with COVID-19 were high; within 1 year, one in three patients had died and a third had been readmitted as an emergency. Patterns of hospital use before index admission were strongly predictive of mortality and readmission risk, independent of age, pre-existing comorbidities, and COVID-19 vaccination status. This increasingly precise identification of individuals at high risk of poor outcomes from COVID-19 will enable targeted support. Funding: Chief Scientist Office Scotland, UK National Institute for Health Research, and UK Research and Innovation.http://www.sciencedirect.com/science/article/pii/S2589750023000511 |
| spellingShingle | Annemarie B Docherty, PhD James Farrell, PhD Mathew Thorpe, MSc Conor Egan, MSc Sarah Dunn, MSc Lisa Norman, PhD Catherine A Shaw, PhD Andrew Law, PhD Gary Leeming, BA Lucy Norris, MSc Andrew Brooks, MSc Bianca Prodan, BSc Hons Ruairidh MacLeod, MSci Robert Baxter, PhD Carole Morris, BSc Diane Rennie, BA Wilna Oosthuyzen, PhD Malcolm G Semple, ProfPhD J Kenneth Baillie, ProfPhD Riinu Pius, PhD Sohan Seth, PhD Ewen M Harrison, ProfPhD Nazir I Lone, PhD Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study The Lancet: Digital Health |
| title | Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study |
| title_full | Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study |
| title_fullStr | Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study |
| title_full_unstemmed | Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study |
| title_short | Patient emergency health-care use before hospital admission for COVID-19 and long-term outcomes in Scotland: a national cohort study |
| title_sort | patient emergency health care use before hospital admission for covid 19 and long term outcomes in scotland a national cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S2589750023000511 |
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