Does improved survival lead to a more fragile population: time trends in second and third hospital admissions among men and women above the age of 60 in Sweden

Korinna Karampampa, Tomas Andersson, Sven Drefahl, Anders Ahlbom, Karin Modig, Korinna Karampampa, Tomas Andersson, Sven Drefahl, Anders Ahlbom, Karin Modig

Abstract

Background: Life expectancy and time to first hospitalization have been prolonged, indicating that people live longer without needing hospital care. Life expectancy increased partially due to improved survival from severe diseases, which, however, could lead to a more fragile population. If so, time to a subsequent hospitalization could decrease. Alternatively, the overall trend of improved health could continue after the first hospitalization, prolonging also the time to subsequent hospitalizations. This study analyzes trends in subsequent hospitalizations among Swedish men and women above the age of 60, relating them to first hospitalization. It also looks at trends in the proportion of never hospitalized.

Methods: Individuals were followed in national registers for hospital admissions and deaths between 1972 and 2010. The proportion of never hospitalized individuals at given ages and time points, and the annual change in the risks of first and subsequent hospitalizations, were calculated.

Findings: An increase in the proportion of never hospitalized was seen over time. The risks of first as well as subsequent hospitalizations were reduced by almost 10% per decade for both men and women. Improvements were observed mainly for individuals below the ages of 90 and up to the year 2000.

Conclusions: The reduction in annual risk of both first and subsequent hospitalizations up to 90 years of age speaks in favor of a postponement of the overall morbidity among the elderly and provides no support for the hypothesis that the population becomes more fragile due to increased survival from severe diseases.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Bronnum-Hansen H, Petersen I, Jeune B, Christensen K (2009) Lifetime according to health status among the oldest olds in Denmark. Age and ageing 38: 47–51.
    1. Vaupel JW, Zhang Z, van Raalte AA (2011) Life expectancy and disparity: an international comparison of life table data. BMJ open 1: e000128.
    1. Rasmussen LJ, Sander M, Wewer UM, Bohr VA (2011) Aging, longevity and health. Mechanisms of ageing and development 132: 522–532.
    1. Larsson K, Thorslund M (2006) Chapter 8: old people's health. Scandinavian journal of public health Supplement 67: 185–198.
    1. Cooper R, Cutler J, Desvigne-Nickens P, Fortmann SP, Friedman L, et al. (2000) Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation 102: 3137–3147.
    1. Kesteloot H, Sans S, Kromhout D (2006) Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. European heart journal 27: 107–113.
    1. Levi F, Chatenoud L, Bertuccio P, Lucchini F, Negri E, et al. (2009) Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update. European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 16: 333–350.
    1. Modig K, Andersson T, Drefahl S, Ahlbom A (2013) Age-specific trends in morbidity, mortality and case-fatality from cardiovascular disease, myocardial infarction and stroke in advanced age: evaluation in the Swedish population. PloS one 8: e64928.
    1. Karampampa K, Drefahl S, Andersson T, Ahlbom A, Modig K (2013) Trends in age at first hospital admission in relation to trends in life expectancy in Swedish men and women above the age of 60. BMJ open 3: e003447.
    1. Statistics Sweden [Statistika Centralbyrån] (2013) Total Population Register [Registret över totalbefolkningen (RTB)]. Available: . Accessed: 31 October, 2013.
    1. Statistics Sweden [Statistika Centralbyrån] (2013) Longitudinal integration database for health insurance and labour market studies (LISA by Swedish acronym). Available from: . Accessed: 31 October, 2013.
    1. National Board of Health and Welfare [Socialstyrelsen] (2013) Patient Register [Patientregistret]. Available: . Accessed: 31 October, 2013.
    1. National Board of Health and Welfare [Socialstyrelsen] (2013) Cause of Death Register [Dödsorsaksregistret]. Available: . Accessed: 31 October, 2013.
    1. Modig K, Drefahl S, Ahlbom A (2013) Limitless longevity: Comment on the Contribution of rectangularization to the secular increase of life expectancy. International journal of epidemiology.
    1. Socialstyrelsen [National Board of Health and Welfare] (2012) Patientregistret för 2010 ur ett DRG-perspektiv [National In-patient Care Register in 2010, from a DRG perspective]. Available: . Accessed: 16 Nov 2012.
    1. Drefahl S, Lundstrom H, Modig K, Ahlbom A (2012) The era of centenarians: mortality of the oldest old in Sweden. Journal of internal medicine 272: 100–102.
    1. Modig K, Drefahl S, Ahlbom A (2013) Limitless longevity: Comment on the Contribution of rectangularization to the secular increase of life expectancy. International journal of epidemiology 42: 914–916.
    1. Garellick G, Kärrholm J, Rogmark C, Rolfson O, Herberts P (2011) Swedish Hip Arthroplasty Register, Annual Report. Swedish Hip Arthroplasty Register.
    1. Holosko MJ, Holosko DA, Spencer K (2009) Social services in Sweden: an overview of policy issues, devolution, and collaboration. Social work in public health 24: 210–234.
    1. National Board of Health and Welfare [Socialstyrelsen] (2011) Inpatient diseases in Sweden 1987–2010 [Sjukdomar i sluten vård 1987–2010]. Available: . Accessed: 16 November, 2012.
    1. Bosetti C, Bertuccio P, Malvezzi M, Levi F, Chatenoud L, et al... (2013) Cancer mortality in Europe, 2005–2009, and an overview of trends since 1980. Annals of oncology: official journal of the European Society for Medical Oncology/ESMO.
    1. Karim-Kos HE, de Vries E, Soerjomataram I, Lemmens V, Siesling S, et al. (2008) Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. European journal of cancer 44: 1345–1389.
    1. Qiu C, von Strauss E, Backman L, Winblad B, Fratiglioni L (2013) Twenty-year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden. Neurology 80: 1888–1894.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅