Hospital Readmissions Among People Experiencing Homelessness: A Cohort Study of Linked Hospitalisation and Mortality Data in England for 3,222 Homeless Inpatients

ObjectivesThe present study analysed 4 years of a hospital register (2015–2018) to determine the risk of 30-day hospital readmission associated with the medical conditions and drug regimens of polymedicated, older inpatients discharged home.DesignRegistry-based cohort study.SettingValais Hospital—a public general hospital centre in the French-speaking part of Switzerland.ParticipantsWe explored the electronic records of 20 422 inpatient stays by polymedicated, home-dwelling older adults held in the hospital’s patient register. We identified 13 802 hospital readmissions involving 8878 separate patients over 64 years old.Outcome measuresSociodemographic characteristics, medical conditions and drug regimen data associated with risk of readmission within 30 days of discharge.ResultsThe overall 30-day hospital readmission rate was 7.8%. Adjusted multivariate analyses revealed increased risk of hospital readmission for patients with longer hospital length of stay (OR=1.014 per additional day; 95% CI 1.006 to 1.021), impaired mobility (OR=1.218; 95% CI 1.039 to 1.427), multimorbidity (OR=1.419 per additional International Classification of Diseases, 10th Revision condition; 95% CI 1.282 to 1.572), tumorous disease (OR=2.538; 95% CI 2.089 to 3.082), polypharmacy (OR=1.043 per additional drug prescribed; 95% CI 1.028 to 1.058), and certain specific drugs, including antiemetics and antinauseants (OR=3.216 per additional drug unit taken; 95% CI 1.842 to 5.617), antihypertensives (OR=1.771; 95% CI 1.287 to 2.438), drugs for functional gastrointestinal disorders (OR=1.424; 95% CI 1.166 to 1.739), systemic hormonal preparations (OR=1.207; 95% CI 1.052 to 1.385) and vitamins (OR=1.201; 95% CI 1.049 to 1.374), as well as concurrent use of beta-blocking agents and drugs for acid-related disorders (OR=1.367; 95% CI 1.046 to 1.788).ConclusionsThirty-day hospital readmission risk was associated with longer hospital length of stay, health disorders, polypharmacy and drug regimens. The drug regimen patterns increasing the risk of hospital readmission were very heterogeneous. Further research is needed to explore hospital readmissions caused solely by specific drugs and drug–drug interactions.

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Association between diabetes and subsequent Parkinson disease

Neurology ◽

10.1212/wnl.0000000000005771 ◽

2018 ◽

Vol 91 (2) ◽

pp. e139-e142 ◽

Cited By ~ 65

Author(s):

Eduardo De Pablo-Fernandez ◽

Raph Goldacre ◽

Julia Pakpoor ◽

Alastair J. Noyce ◽

Thomas T. Warner

Keyword(s):

Cohort Study ◽

Parkinson Disease ◽

Cox Regression ◽

Normal Pressure ◽

Relative Increase ◽

Mortality Data ◽

Drug Induced ◽

Therapeutic Implications ◽

Large Cohort Study ◽

Reference Cohort

ObjectiveTo investigate the association between type 2 diabetes mellitus (T2DM) and subsequent Parkinson disease (PD).MethodsLinked English national Hospital Episode Statistics and mortality data (1999–2011) were used to conduct a retrospective cohort study. A cohort of individuals admitted for hospital care with a coded diagnosis of T2DM was constructed, and compared to a reference cohort. Subsequent PD risk was estimated using Cox regression models. Individuals with a coded diagnosis of cerebrovascular disease, vascular parkinsonism, drug-induced parkinsonism, and normal pressure hydrocephalus were excluded from the analysis.ResultsA total of 2,017,115 individuals entered the T2DM cohort and 6,173,208 entered the reference cohort. There were significantly elevated rates of PD following T2DM (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.29–1.35; p < 0.001). The relative increase was greater in those with complicated T2DM (HR 1.49, 95% CI 1.42–1.56) and when comparing younger individuals (HR 3.81, 95% CI 2.84–5.11 in age group 25–44 years).ConclusionsWe report an increased rate of subsequent PD following T2DM in this large cohort study. These findings may reflect shared genetic predisposition and/or disrupted shared pathogenic pathways with potential clinical and therapeutic implications.

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Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures

BMJ Open ◽

10.1136/bmjopen-2018-026507 ◽

2019 ◽

Vol 9 (7) ◽

pp. e026507 ◽

Cited By ~ 2

Author(s):

Alexandra Jane Fogg ◽

Jennifer Welsh ◽

Emily Banks ◽

Walter Abhayaratna ◽

Rosemary J Korda

Keyword(s):

Sex Differences ◽

Cohort Study ◽

Cox Regression ◽

Artery Bypass ◽

Bypass Graft ◽

Primary Diagnosis ◽

Mortality Data ◽

Event Analysis ◽

Crude Rate ◽

Coronary Procedures

ObjectivesThe aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina.DesignThis is a prospective cohort study. Baseline questionnaire (January 2006–April 2009) data from the Sax Institute’s 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event.SettingThis was conducted in New South Wales, Australia.ParticipantsThe study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457).Outcome measuresThe outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics.ResultsAmong patients with AMI, 71.6% of men (crude rate 3.45/person-year) and 64.7% of women (2.62/person-year) received angiography; 57.8% of men (1.73/person-year) and 37.4% of women (0.77/person-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92–1.08) for angiography and 1.51 (1.38–1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36/person-year) and 54.9% of women (1.32/person-year) received angiography; 44.6% of men (0.90/person-year) and 19.5% of women (0.26/person-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14–1.34) and 2.44 (2.16–2.75), respectively.ConclusionsMen are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI.

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Validity of coronary heart diseases and heart failure based on hospital discharge and mortality data in the Netherlands using the cardiovascular registry Maastricht cohort study

European Journal of Epidemiology ◽

10.1007/s10654-009-9335-x ◽

2009 ◽

Vol 24 (5) ◽

pp. 237-247 ◽

Cited By ~ 94

Author(s):

Audrey H. H. Merry ◽

Jolanda M. A. Boer ◽

Leo J. Schouten ◽

Edith J. M. Feskens ◽

W. M. Monique Verschuren ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

The Netherlands ◽

Hospital Discharge ◽

Heart Diseases ◽

Mortality Data ◽

Coronary Heart Diseases

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Poisoning substances taken by young people: a population-based cohort study

British Journal of General Practice ◽

10.3399/bjgp18x698897 ◽

2018 ◽

Vol 68 (675) ◽

pp. e703-e710 ◽

Cited By ~ 6

Author(s):

Edward G Tyrrell ◽

Denise Kendrick ◽

Kapil Sayal ◽

Elizabeth Orton

Keyword(s):

Cohort Study ◽

Young People ◽

Population Based ◽

Incidence Rates ◽

Practice Research ◽

Mortality Data ◽

Clinical Practice Research Datalink ◽

Self Harm ◽

Harm Prevention ◽

Rate Ratios

BackgroundGlobally, poisonings account for most medically-attended self-harm. Recent data on poisoning substances are lacking, but are needed to inform self-harm prevention.AimTo assess poisoning substance patterns and trends among 10–24-year-olds across EnglandDesign and settingOpen cohort study of 1 736 527 young people, using linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics mortality data, from 1998 to 2014.MethodPoisoning substances were identified by ICD-10 or Read Codes. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substances by age, sex, index of multiple deprivation, and calendar year.ResultsIn total, 40 333 poisoning episodes were identified, with 57.8% specifying the substances involved. The most common substances were paracetamol (39.8%), alcohol (32.7%), non-steroidal anti-inflammatory drugs (NSAIDs) (11.6%), antidepressants (10.2%), and opioids (7.6%). Poisoning rates were highest at ages 16–18 years for females and 19–24 years for males. Opioid poisonings increased fivefold from 1998–2014 (females: aIRR 5.30, 95% confidence interval (CI) = 4.08 to 6.89; males: aIRR 5.11, 95% CI = 3.37 to 7.76), antidepressant poisonings three-to fourfold (females: aIRR 3.91, 95% CI = 3.18 to 4.80, males: aIRR 2.70, 95% CI = 2.04 to 3.58), aspirin/NSAID poisonings threefold (females: aIRR 2.84, 95% CI = 2.40 to 3.36, males: aIRR 2.76, 95% CI = 2.05 to 3.72) and paracetamol poisonings threefold in females (aIRR 2.87, 95% CI = 2.58 to 3.20). Across all substances poisoning incidence was higher in more disadvantaged groups, with the strongest gradient for opioid poisonings among males (aIRR 3.46, 95% CI = 2.24 to 5.36).ConclusionIt is important that GPs raise awareness with families of the substances young people use to self-harm, especially the common use of over-the-counter medications. Quantities of medication prescribed to young people at risk of self-harm and their families should be limited, particularly analgesics and antidepressants.

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Socioeconomic status (SES) and 30-day hospital readmissions for chronic obstructive pulmonary (COPD) disease: A population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0216741 ◽

2019 ◽

Vol 14 (5) ◽

pp. e0216741 ◽

Cited By ~ 2

Author(s):

Andrea S. Gershon ◽

Deva Thiruchelvam ◽

Shawn Aaron ◽

Matthew Stanbrook ◽

Nicholas Vozoris ◽

...

Keyword(s):

Socioeconomic Status ◽

Cohort Study ◽

Hospital Readmissions ◽

Population Based ◽

Chronic Obstructive ◽

Day Hospital

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Prognosis of schizophrenia in persons with and without a history of cannabis use

Psychological Medicine ◽

10.1017/s0033291714000191 ◽

2014 ◽

Vol 44 (12) ◽

pp. 2513-2521 ◽

Cited By ~ 38

Author(s):

E. Manrique-Garcia ◽

S. Zammit ◽

C. Dalman ◽

T. Hemmingsson ◽

S. Andreasson ◽

...

Keyword(s):

Cohort Study ◽

Patient Care ◽

Paranoid Schizophrenia ◽

Hospital Readmissions ◽

Cannabis Use ◽

Civil Status ◽

History Of ◽

Hospital Days ◽

Median Rate ◽

First Admission

BackgroundThe aim of the study was to determinate whether schizophrenia patients with a history of cannabis use have a different prognosis, with regards to readmission and hospital duration, compared with those without a history of cannabis use.MethodThe present investigation was a cohort study of 50 087 Swedish men with data on cannabis use at the ages of 18–20 years. A total of 357 cases of schizophrenia were identified from in-patient care and followed up from 1973 to 2007.ResultsSchizophrenia patients with a history of cannabis use had a higher median duration of first hospital episode (59 days v. 30 days). Patients with a history of cannabis use had a higher median rate of readmission (10 times v. four times). Also, total number of hospital days was higher in patients with a history of cannabis use compared with those without (547 days v. 184 days). Patients with a history of cannabis use had an increased odds of having more than 20 hospital readmissions compared with non-users [3.1, 95% confidence interval (CI) 1.3–7.3] as well as an increased odds of hospital admission lasting more than 2 years (2.4, 95% CI 1.1–7.4) after controlling for diagnosis of personality disorders, family socio-economic position, IQ score, civil status, place of residence, risky use of alcohol and use of other drugs. Patients with a history of cannabis use were less likely to have paranoid schizophrenia compared with never users (8% v. 17%) in the first admission.ConclusionsSchizophrenia patients with a history of cannabis use had a significantly higher burden of lifetime in-patient care than non-cannabis users. Not only does cannabis increase the risk of schizophrenia, but also our findings indicate that the course and prognosis of schizophrenia may be more severe than schizophrenia cases in general.

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Metabolic syndrome and the risk of cardiovascular and all-cause mortality: data of 14-year prospective cohort study in Siberia

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-3821 ◽

2020 ◽

Vol 25 (6) ◽

pp. 3821

Author(s):

G I Simonova ◽

S V Mustafina ◽

O D Rymar ◽

L V Scherbacova ◽

T I Nikitenko ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Cohort Study ◽

Prospective Cohort Study ◽

Cardiovascular Mortality ◽

Prospective Cohort ◽

Cardiovascular Death ◽

Mortality Data ◽

Risk Of Death ◽

All Cause Mortality

Aim. To study the risk of cardiovascular and all-cause mortality in patients with metabolic syndrome (MS) according to a 14-year prospective cohort study in Siberia.Material and methods. Based on the data from the Russian arm of the HAPIEE project, we assessed all-cause deaths occurred by 2017 in the population cohort examined at baseline in 2003-2005 (n=9273). The baseline examination included the assessment of blood pressure (BP), anthropometry, levels of fasting triglycerides, high density lipoprotein cholesterol (HDL-C), and blood glucose. The fatal cases in the studied cohort were identified from “Medical death certificates” for the period from February 1, 2003 to December 31, 2017, based on data from the Department of Civil Registration of Death Acts. Cardiovascular death was established using the International Classification of Diseases, the 10th revision (ICD-10): I (0-99).Results. The mortality rate in subjects with MS was 16,6% — 751 deaths (25,1% in men and 11,5% in women), and it was 20-30% higher than in those without MS. Cardiovascular mortality in subjects with MS was 12,6% — 572 deaths (20,5% in men and 8,9% in women), and it was nearly 30% higher than in those without MS. Multivariable Cox regression revealed that among the components of MS, the elevated BP level even with BP ≥135/80 mm Hg had the major impact on increasing the risk of all-cause mortality (HR=1,7 (1,4; 2,1) in men; HR=2,2 (1,7; 2,8) in women) and increasing the risk of cardiovascular mortality (HR=2,2 (1,5; 3,0) in men and HR=2,8 (1,8; 4.3) in women). Among men, already 1 component of MS increased the risk of cardiovascular and all-cause mortality by 2,0 or more times; among women, 2-4 components of MS increased the risk of death by 3 times, and 5 components — by 4.Conclusion. In the studied population sample, cardiovascular and all-cause mortality during the 14-year follow-up in individuals with MS was about 25-30% higher compared to those without MS. The risk of cardiovascular and all-cause deaths in subjects with MS is comparable to the risk in case of blood pressure ≥135/80 mm Hg. With an increase in the number of MS components from 1 to 5, the risk of all-cause and cardiovascular death increases.

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Mortality and major disease risk among migrants of the 1991–2001 Balkan wars to Sweden: A register-based cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003392 ◽

2020 ◽

Vol 17 (12) ◽

pp. e1003392

Author(s):

Edda Bjork Thordardottir ◽

Li Yin ◽

Arna Hauksdottir ◽

Ellenor Mittendorfer-Rutz ◽

Anna-Clara Hollander ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Psychiatric Disorders ◽

Disease Risk ◽

Mortality Data ◽

Post Traumatic Stress ◽

Individual Level ◽

Adverse Health Outcomes ◽

Balkan Wars ◽

National Patient

Background In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991–2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period. Methods and findings We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991–2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34–1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29–1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08–1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15–1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14–1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96–10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48–0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51–0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration. Conclusions Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.

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External validation of EPIC’s Risk of Unplanned Readmission model, the LACE+ index and SQLape as predictors of unplanned hospital readmissions: A monocentric, retrospective, diagnostic cohort study in Switzerland

PLoS ONE ◽

10.1371/journal.pone.0258338 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0258338

Author(s):

Aljoscha Benjamin Hwang ◽

Guido Schuepfer ◽

Mario Pietrini ◽

Stefan Boes

Keyword(s):

Cohort Study ◽

Quality Of Care ◽

Prediction Models ◽

Hospital Readmissions ◽

External Validation ◽

Superior Performance ◽

Study Endpoint ◽

Unplanned Readmission ◽

S Model

Introduction Readmissions after an acute care hospitalization are relatively common, costly to the health care system, and are associated with significant burden for patients. As one way to reduce costs and simultaneously improve quality of care, hospital readmissions receive increasing interest from policy makers. It is only relatively recently that strategies were developed with the specific aim of reducing unplanned readmissions using prediction models to identify patients at risk. EPIC’s Risk of Unplanned Readmission model promises superior performance. However, it has only been validated for the US setting. Therefore, the main objective of this study is to externally validate the EPIC’s Risk of Unplanned Readmission model and to compare it to the internationally, widely used LACE+ index, and the SQLAPE® tool, a Swiss national quality of care indicator. Methods A monocentric, retrospective, diagnostic cohort study was conducted. The study included inpatients, who were discharged between the 1st of January 2018 and the 31st of December 2019 from the Lucerne Cantonal Hospital, a tertiary-care provider in Central Switzerland. The study endpoint was an unplanned 30-day readmission. Models were replicated using the original intercept and beta coefficients as reported. Otherwise, score generator provided by the developers were used. For external validation, discrimination of the scores under investigation were assessed by calculating the area under the receiver operating characteristics curves (AUC). Calibration was assessed with the Hosmer-Lemeshow X2 goodness-of-fit test This report adheres to the TRIPOD statement for reporting of prediction models. Results At least 23,116 records were included. For discrimination, the EPIC´s prediction model, the LACE+ index and the SQLape® had AUCs of 0.692 (95% CI 0.676–0.708), 0.703 (95% CI 0.687–0.719) and 0.705 (95% CI 0.690–0.720). The Hosmer-Lemeshow X2 tests had values of p<0.001. Conclusion In summary, the EPIC´s model showed less favorable performance than its comparators. It may be assumed with caution that the EPIC´s model complexity has hampered its wide generalizability—model updating is warranted.

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