Healthcare use and costs in the last year of life: a national population data linkage study

BackgroundPeople who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain.ObjectivesTo describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life.MethodsRetrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048).ResultsSecondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation.ConclusionsHospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

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Healthcare use and cost trajectories during the last year of life: A national population administrative secondary care data linkage study

10.1101/2020.09.29.20203794 ◽

2020 ◽

Author(s):

Katharina Diernberger ◽

Xhyljeta Luta ◽

Joanna Bowden ◽

Marie Fallon ◽

Joanne Droney ◽

...

Keyword(s):

End Of Life ◽

Secondary Care ◽

Urban Areas ◽

Data Linkage ◽

Hospital Admissions ◽

Community Support ◽

Linkage Study ◽

Healthcare Use ◽

Admission Rates ◽

Mean Cost

Abstract Background: People who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain. Objectives: To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life. Methods: Retrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274,048). Results: Secondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last three months. The mean cost was 10,000 pound. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation. Conclusions: Hospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end of life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

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Patterns and costs of hospital-based cancer care in the last year of life: A national data linkage study in Scotland.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18732 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18732-e18732

Author(s):

Katharina Diernberger ◽

Joanna Bowden ◽

Marie T. Fallon ◽

Xhyljeta Luta ◽

Joanne Droney ◽

...

Keyword(s):

Cause Of Death ◽

Advanced Cancer ◽

Linear Models ◽

Data Linkage ◽

Hospital Admissions ◽

Linkage Study ◽

Healthcare Use ◽

Day Case ◽

Admission Rates ◽

One Year

e18732 Background: Approximately thirty thousand people in Scotland are diagnosed with cancer each year, of whom 10,000 live less than one year. Hospital is the most common place of death for people with cancer, despite most expressing a preference for community-based care. There is inadequate understanding of the nature and value of hospital-based care for people with advanced cancer. This study aimed to describe patterns of hospital-based healthcare use and associated costs for cancer decedents in their last year of life. Methods: A population-wide administrative data linkage study of hospital-based healthcare use for cancer decedents aged 60+ at death who died between 2012 and 2017 was conducted in Scotland. Linkage was established between the Scottish Morbidity Record, Scottish Cancer Registry and the National Records of Scotland. Hospital admissions, length of stay (LoS), number and nature of outpatient and day case appointments were extracted. Associated costs were estimated using generalised linear models, adjusted for age, gender, primary cause of death, socioeconomic deprivation status, rural-urban (RU) status and comorbidity. Results: The study population included 85,732 decedents with a cancer diagnosis, for whom 64,553 (75.3%) cancer was the underlying cause of death. Mean age at death was 84 years. The mean number of inpatient stays in the last year of life was 5.88 (SD 5.68), with a mean LoS of 7 days. Mean total 1-year inpatient, outpatient and day-case costs per patient were £10,261, £1,275 and £977 respectively. People who died of haematological cancers had the most hospital admissions (mean 11.8). Admission rates rose sharply in the last month of life and were most common in those who died of haematological and lung cancers. One year adjusted and unadjusted costs decreased with increasing age. Unadjusted costs for the youngest group (60-64) were £15,895, double the cost for those aged 90+. People dying of haematological cancers had the highest hospital-based costs (mean £24,772) followed by those with ovarian cancer (mean £17,556). The largest single contributor to hospital-based costs in the last year of life was unscheduled admissions. Conclusions: People in Scotland in their last year of life with cancer use substantial hospital-based care. Unscheduled admission rates are high, particularly in the last month of life when the value of acute intervention may be uncertain. Further research is needed to examine triggers for hospitalisation and to assess the value of hospital-based care to people living with advanced cancer.

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Interpregnancy Intervals and Child Development at Age Five: A Population Data Linkage Study

SSRN Electronic Journal ◽

10.2139/ssrn.3682095 ◽

2020 ◽

Author(s):

Gursimran Dhamrait ◽

Catherine Taylor ◽

Gavin Pereira

Keyword(s):

Child Development ◽

Data Linkage ◽

Population Data ◽

Linkage Study ◽

Interpregnancy Intervals

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Area Deprivation, Urbanicity and Severe Mental Illness – A Population-Based Linkage Study Using Routinely Collected Primary and Secondary Care Data

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1201 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Sze Chim Lee ◽

Marcos Delpozo-Banos ◽

Keith Lloyd ◽

Ian Jones ◽

James TR Walters ◽

...

Keyword(s):

Bipolar Disorder ◽

Secondary Care ◽

Urban Areas ◽

Lower Layer ◽

Population Based ◽

Linkage Study ◽

Mental Illnesses ◽

Area Deprivation ◽

Small Area Statistics ◽

Urban Rural

Background There is a long-standing debate regarding the associations between area deprivation, urbanicity and elevated risk of severe mental illnesses (SMIs). Main Aim We investigated the associations between area deprivation, urbanicity and risk of SMIs in a population cohorts in Wales. Methods/Approach We extracted primary and secondary care electronic health records from 2004 to 2015 from Wales’s population. We identified prevalent and incident individuals with SMIs (schizophrenia related disorders and bipolar disorder) and their level of deprivation and urbanicity. We used the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator to measure the level of area deprivation and urbanicity respectively for all lower layer super output areas, the geographic units used in the reporting of small area statistics comprised of approximately 1,500 individuals. Results Prevalence and incidence of SMIs is not evenly distributed in Wales. Increased prevalence and incidence of SMIs occur in more deprived and urban areas. Such associations occur for both schizophrenia related disorders and bipolar disorder and in both the primary and secondary care cohorts. Conclusion These findings have implications for resource allocation, service configuration and access to services in deprived communities, as well as, for broader public health interventions addressing poverty, and social and environmental contexts.

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Indigenous and non‐Indigenous Australian children hospitalised for burn injuries: a population data linkage study

The Medical Journal of Australia ◽

10.5694/mja16.00213 ◽

2017 ◽

Vol 206 (9) ◽

pp. 392-397 ◽

Cited By ~ 4

Author(s):

Holger Möller ◽

Lara Harvey ◽

Kathleen Falster ◽

Rebecca Ivers ◽

Kathleen F Clapham ◽

...

Keyword(s):

Data Linkage ◽

Population Data ◽

Linkage Study ◽

Burn Injuries ◽

Indigenous Australian

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838Thriving in adversity: positive child development despite early disadvantage in a whole-of-population data linkage study

International Journal of Epidemiology ◽

10.1093/ije/dyab168.129 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Catherine Chittleborough ◽

Thomas Brown ◽

Helena Schuch ◽

Anna Kalamkarian ◽

Rhiannon Pilkington ◽

...

Keyword(s):

Child Development ◽

Child Protection ◽

Latent Class ◽

Data Linkage ◽

Population Data ◽

Linkage Study ◽

First Year ◽

Early Adversity ◽

Negative Effects ◽

Latent Class Analyses

Abstract Background Experiencing socioeconomic disadvantage, poor health, or child maltreatment in early life has negative effects on child development. However, we know little about children who have good developmental outcomes despite experiencing adversity. Methods This study used de-identified, linked government administrative data from the South Australian Early Childhood Data Project: specifically Australian Early Development Census (AEDC) data for all South Australian born children in their first year of school in 2009, 2012 and 2015 (n = 47,179) and their corresponding birth, perinatal, school enrolment, hospital admission, emergency department presentation, public housing and child protection data. Latent class analyses constructed multidimensional measures of socioeconomic, health, and maltreatment adversities experienced from birth to age 5. Results Overall, 49.8% (95% CI 49.2-50.4) of children were on track on all five AEDC domains, but this ranged from 53.7% among children who did not experience high levels of adversity to 13.5% among children with high levels of all three adversities. Conclusions Among children who experienced high levels of two or three early adversity types, approximately 1 in 5 were developmentally on track. Understanding characteristics of these children who thrive, against the odds, will help identify intervention opportunities to improve child development. Key messages Compared with children who did not experience high levels of adversity, each additional adversity reduced the likelihood of being developmentally on track by approximately 10% to 15%. Children experiencing socioeconomic or maltreatment adversity were less likely to be developmentally on track than children experiencing health adversity.

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