Gallstones--an increasing problem: a study of hospital admissions in England between 1989/1990 and 1999/2000

BACKGROUND: The number of operations for cholelithiasis increased from the 1950s to the 1990s. AIMS: To determine the time trends in cholelithiasis for hospital admissions, operations and in-hospital case fatalities in England between 1989/1990 and 1999/2000, and population mortality rates between 1979 and 1999. METHODS: Hospital Episode Statistics for admissions were obtained from the Department of Health and mortality data were obtained from the Office for National Statistics. RESULTS: Between 1989/1990 and 1999/2000, age-standardized hospital admission rates for cholelithiasis increased by 30% for males and 64% for females. The proportions of admissions undergoing an operation declined progressively over the study period. In 1999/2000, the frequency of operation was approximately 50-60% for most age groups, but decreased progressively with advancing age at > or = 65 years. The proportions of admissions undergoing therapeutic endoscopy increased several-fold, especially amongst older individuals. Case fatality rates declined. Mortality rates declined from 1979 to 1988, but showed no further change from 1989 to 1999. CONCLUSIONS: There has been a steady increase in admission rates for cholelithiasis over the study period. Whilst the frequency of operation has declined, the proportion of patients undergoing therapeutic endoscopy has increased.     

Diverticular disease of the colon--on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000

BACKGROUND: Diverticular disease emerged as a common problem in Western countries over the course of the 20th century. AIMS: To determine the time trends in diverticular disease for hospital admissions in England between 1989/1990 and 1999/2000 and population mortality rates from 1979 to 1999. METHODS: Hospital Episode Statistics were obtained from the Department of Health and mortality data from the Office for National Statistics. RESULTS: Between 1989/1990 and 1999/2000, annual age-standardized hospital admission rates for diverticular disease increased by 16% for males (from 20.1 to 23.2 per 100,000) and 12% for females (from 28.6 to 31.9 per 100,000). Female rates were significantly higher than male rates throughout the study period. The proportions of admissions with an operation increased by 16% for males (from 22.9% to 24.1%) and 14% for females (from 19.7% to 22.3%). Older patients were less likely to undergo operation than younger patients. In-patient case fatality rates and population mortality rates remained unchanged. CONCLUSIONS: Admission rates for diverticular disease increased over the study period. The proportion of patients who underwent operation increased, but in-patient and population mortality rates remained unchanged. With an ageing population, diverticular disease will become an increasingly important clinical problem in England.     

The increasing hospital disease burden of haemochromatosis in England

Background Hereditary haemochromatosis is a preventable cause of liver disease with an increasing disease burden. Aims To investigate time trends for hospital admission ascribed to haemochromatosis in England during the period from 1989/1990 to 2002/2003 and mortality from 1979 to 2005. Methods Hospital admission data, relating to both in‐patients and day‐cases, were obtained from the Hospital Episodes Statistics service. Mortality rates for England and Wales were provided by the Office for National Statistics. Results Haemochromatosis is an uncommon cause for hospital admission. Age‐standardized in‐patient admission rates increased over the study period by 269% in men and by 290% in women: (from 0.64 to 2.36 and from 0.21 to 0.81 per year per 100 000). The increase in age‐standardized day‐case admission rates was even higher (men: from 2.78 to 34.9 per year per 100 000, 1155%; women: from 0.58 to 11.67 per year per 100 000, 1924%). Haemochromatosis was recorded as an uncommon cause of death. Conclusions Hospital in‐patient and day case admissions for haemochromatosis increased markedly over the study period while mortality remained low. Both admission rates and mortality were higher in men than in women. The increase in admission rate may reflect improved recognition and diagnosis of iron overload disorders following identification of the HFE gene. Aliment Pharmacol Ther 31 , 247–252     

Recent trends in hospital admissions and mortality rates for peptic ulcer in Scotland 1982-2002

BACKGROUND: While overall hospital admission rates for peptic ulcer declined in England in the 1990 s, they increased among the elderly, especially for complicated ulcer. However, peptic ulcer admissions fell for all age groups in the United States. AIM: To examine time trends in the incidence of hospital admissions, mortality and operations because of peptic ulcer in Scotland from 1982 to 2002, and the use of various drugs relevant to the aetiology and treatment of peptic ulcer from 1992 to 2002. RESULTS: There was a general decrease in admission rates, especially for younger individuals. For individuals aged above 74 years, admission rates actually increased for gastric ulcer with haemorrhage among men, and for duodenal ulcer haemorrhage between both sexes. The number of operations fell dramatically, especially for younger patients. Mortality rates generally declined. Case fatality rates were greater for women than men, and declined over the study period for gastric ulcer, but increased for duodenal ulcer. The use of low-dose aspirin, oral anticoagulants, selective serotonin reuptake inhibitors and proton-pump inhibitors increased while those of non-steroidal anti-inflammatory drugs and histamine-2 antagonists declined. CONCLUSIONS: Admission rates for peptic ulcer generally fell for younger individuals, but increased for older people with haemorrhage.     

Declining incidence of peptic ulcer but not of its complications: a nation-wide study in The Netherlands

BACKGROUND: Despite reports of decreasing hospitalizations and mortality due to peptic ulcer, it is unclear whether the incidence has truly declined over time. AIM: To investigate time trends in the incidence of and in hospital admission rates for peptic ulcer in the Netherlands. METHODS: The nationwide registry of pathology reports (PALGA) and the national registry of hospital admissions (Landelijke Medische Registratie) were used. Standardized morbidity ratios were calculated to assess the magnitude of the changes. RESULTS: The age-adjusted incidence of gastric ulcer halved for both men (standardized morbidity ratio 0.48; CI 0.46-0.49) and women (standardized morbidity ratio 0.49; CI 0.47-0.51). Although the number of gastric biopsies obtained at endoscopy increased, the proportion with a diagnosis of peptic ulcer decreased by more than 50% (standardized morbidity ratio 0.47; CI 0.46-0.49). The admission rate for peptic ulcer more than halved between 1980 and 2003. In contrast, admission rates for complicated ulcers barely changed and slightly increased among women. CONCLUSIONS: The incidence of histopathologically confirmed gastric ulcer halved between 1992 and 2003 in the Netherlands. As the number of gastric biopsies increased in this period, a true decrease is likely. Hospital admissions for peptic ulcer declined dramatically between 1980 and 2003, but remained unchanged or slightly increased for complicated ulcers.     

Descriptive epidemiology of hospitalisation for psoriasis

ABSTRACT

Background: The epidemiology and outcome of people hospitalised with a primary diagnosis of psoriasis has never been characterised previously in the United Kingdom. The aim of the study was to characterise the epidemiology of people admitted to hospital with a primary diagnosis of psoriasis.

Methods: Routine hospital data from a large urban area of South Wales, UK (with a population of approximately 435 000) were record-linked using probability matching algorithms to mortality data from the Office of National Statistics (1991–2005). Relative survival was compared using Cox proportional hazards models. Patients were selected with a primary diagnosis of psoriasis. Admission rates were calculated as a proportion (%) of admissions and a crude population rate.

Results: It was possible to identify 1935 hospital admissions from 1038 subjects; 49% male. The mean age at first admission was 44 years (SD 20). The minimum, crude prevalence of people hospitalised with psoriasis at some time was 0.23%. These admissions represented 0.13% of all hospital admissions. The crude admission rate with a primary diagnosis of psoriasis was 2.9 per 10 000 population per year. The proportion of subjects who had only one admission ranged between 65% and 77%. The median time between the first admission and the second admission was 1.4 years (IQR 0.5–3.1). The mean length of hospital stay was 16.8 days (median 15; IQR 8–23). There were 55 deaths in total in this group. Ten year survival was 92.7%. Following standardisation, people admitted more than once had increased risk of all cause mortality (hazard ratio 2.71; 95% CI 1.39–5.31).

Conclusion: This study provides useful background intelligence on the most severe psoriasis patients identified by their admission to hospital with the condition. The proportion of psoriasis patients admitted was estimated to be about one in six people. Those with more than one admission with psoriasis – greater psoriasis severity – were associated with increased risk of all-cause mortality.     

Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study

Aliment Pharmacol Ther 2011; 33: 64–76

Summary

Background Upper gastrointestinal (GI) bleeding is the most common emergency managed by gastroenterologists. Aim To establish the hospitalized incidence and case fatality for upper GI bleeding, and to determine how they are associated with factors including day of admission, hospital size, social deprivation and distance from hospital. Methods Systematic record linkage of hospital in‐patient and mortality data for 24 421 admissions for upper GI bleeding among 22 299 people in Wales from 1999 to 2007. Results The hospitalized incidence of upper GI bleeding was 134 per 100 000. Case fatality was 10.0%. Incidence was stable from 1999 to 2007; case fatality fell from 11.4% in 1999–2000 to 8.6% in 2006–7. Incidence was associated significantly with social deprivation. Compared with weekday admissions, case fatality was 13% higher for weekend admissions and 41% higher for admissions on public holidays. There was little variation in case fatality according to social deprivation, hospital size or distance from hospital. Conclusions Incidence, but not case fatality, was associated significantly with social deprivation. The higher mortality for weekend and public holiday admissions could not be explained by measures of case mix and may indicate a possible impact of reduced staffing levels and delays to endoscopy at weekends in some hospitals.     

Trends in hospital admission related to poisoning by,narcotics and psychodysleptics and poisoning by antiepileptic,sedative-hypnotic,and antiparkinsonism drugs in England and Wales between April 1999 and April 2020: An ecological study

BackgroundThis study aimed to investigate the trend of hospital admissions related to poisoning by narcotics and psychodysleptics and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales between April 1999 and April 2020.MethodsAn observational ecological study were conducted using data from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. The rate of hospital admissions with 95% confidence intervals (CIs) was calculated by dividing the number of episodes of poisoning by narcotics and psychodysleptics related admission and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs-related admission by the mid-year population from the Office for National Statistics. All analyses were conducted using SPSS version 27.ResultsThe total annual number of hospital admissions for narcotics and psychodysfunctionals poisonings increased by 1.40-fold [from 15.70 (95% CI 15.36–16.04) in 1999 to 37.64 (95% CI 37.15–38.13) in 2020 per 100,000 people, p < 0.01]. However, the overall annual number of poisonings by antiepileptic, sedative-hypnotic and antiparkinsonism drugs hospital admissions for various reasons decreased by 12.8% [from 33.55 (95% CI 33.05–34.04) in 1999 to 29.26 (95% CI 28.82–29.69) in 2020 per 100,000 persons, p < 0.05]. Poisoning by other opioids (53.2%), heroin (15.1%), and other synthetic narcotics (13.3%) were the most common reasons for narcotic and psychodysfunctional poisoning. While poisoning by benzodiazepines (54.2%) and poisoning: other antiepileptic and sedative-hypnotic drugs (30.7%) were the most common hospital admission reasons for poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism.ConclusionPoisoning by narcotics have increased in England and Wales over the study period, however, poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales were relatively stable during the same period. Future initiatives and awareness programs to prevent harmful use and drug poisoning by narcotics, sedative-hypnotic and other medications are needed.     

Hospial admission among Pacific children Auckland 1992-97

AIMS: To describe the reasons for, and rates of, hospital admissions for Pacific children, compared with Maori and 'Other' (non Maori, non Pacific) children in Auckland over the six year period 1992 to 1997. METHOD: Analysis was carried out of the New Zealand National Health Information Service database for Auckland domiciled children to show diagnostic codes and hospital admission rates for 0-14 year old children, using the 1996 Census population as the denominator population. Age standardised rates were calculated using the 'Other' group of children as the standard population. RESULTS: All-cause admission rates were higher among Pacific Children, compared with Maori and 'Other' children. Pacific Children were over-represented in admissions for acute respiratory infections, pneumonia and asthma/chronic obstructive pulmonary diseases, compared with both Maori and 'Other' children. CONCLUSION: Pacific children had the highest hospital admission rates, the main reason being preventable respiratory tract conditions. These findings suggest that Pacific children should be a priority group for intervention at various levels. Improvements in socio-economic circumstances, access to early primary health care and community education supported by comprehensive ambulatory paediatric services (particularly with respect to respiratory conditions) need to be implemented urgently. Qualitative research is needed to determine why ethnic differences exist and to identify effective interventions for Pacific children.     

Changing patterns of hospital admissions for patients with rheumatic diseases

AIMS: To audit trends in hospital admission of patients with rheumatic diseases to a rheumatology unit. METHODS: Numbers of admissions for 1990-1999 were reviewed. Notes of patients admitted in 1993, 5, 7 and 9 were reviewed for principal diagnosis and other data. RESULTS: There was a 75% decline in admissions during the study period. There was a significant fall in admissions for control of active rheumatoid arthritis which declined from 53% to 21% of total admissions (p=0.004). CONCLUSIONS: In the last decade in Otago there has been a substantial decrease in patient admissions for treatment. This was mainly due to decreased admissions for treatment of flares of rheumatoid arthritis and its complications. Determining if this was due merely to more rigorous admission criteria or improved effectiveness of treatment of rheumatoid arthritis will be important for guiding decisions on healthcare services for patients with rheumatic diseases.     

1999年～2001年上海47家医院用药状况及趋势分析

目的 :了解上海地区医院用药趋势。方法 :对上海47家医院提供的1999年～2001年用药资料进行分析。结果 :购药总金额呈增长趋势 ;购药金额的结构百分比 ,进口药逐年下降 ,合资药趋于稳定 ,国产药由逐年升高至渐趋稳定 ;购药金额领先的前100个品种和前15个品种所占总金额百分比一改逐年下降趋势 ,至2001年有回升和略有回升 ;各大类药排序2001年较2000年变化不大。结论 :用药情况与“医保”改革有关 ,总体上的用药增长趋势未变     

Admission of geriatric patients to hospital on Niue Island 1977-1982

This report analyses the admission to hospital of people aged 65 years or more on Niue Island in the years 1977-1982. Geriatric admissions, of which 59% were female, comprised 8% of all admissions, equalling the proportion of old people in the community. There were no significant differences by age and or sex for admission rates, reasons for admission, length of stay or disposition. Acute illnesses, particularly respiratory problems, accounted for the majority of geriatric admissions although chronic degenerative disorders, usually cardio-vascular in nature, also played a role. The median hospital stay was 10.5 days, with 81% of all geriatric patients being discharged within one month. The majority (79%) of patients are discharged back into the community. Longest hospital stays resulted from potentially preventable accidents and injury, which constitute a leading cause of death for elderly men, from infectious/parasitic diseases, and from nonspecific nursing care admissions.     

Morbidity and mortality of adult patients with HIV/AIDS at Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia

A one year (January 1-December 31, 2000) prospective study of consecutive HIV seropositive patients admitted to the medical wards to Tikur Anbessa Teaching Hospital was made to determine the morbidity, mortality, and spectrum of HIV-associated disease among medical inpatients. During the study period, there were 1813 medical admissions and 568 hospital deaths. Of the medical inpatients, 566 were tested for HIV-1 antibody because of clinical suspicion and for treatment decision. Of these, 237(42%) patients tested positive and this accounted for 13% of the annual medical admission. The male to female ratio was 1.4:1. The mean age +/- SD was 32.8 +/- 8.9 years with a range of 17-70 years. The mean length of hospital stay was 27.5 days (range: 0.5-103 days). Ninety two percent (218/237) of the patients were in WHO clinical stage IV at the time of hospital admission. Thirty one percent(73/237) of the patients died in hospital during the study period, accounting for 13%(73/568) of the annual hospital deaths among medical inpatients. Tuberculosis, central nervous system mass lesion suggestive of CNS toxoplasmosis, and sepsis were the three most common disease complexes among admissions and deaths. It is, therefore, recommended that similar studies estimating disease burden at different levels of health care system be made so as to assess the overall morbidity and mortality associated with HIV/AIDS in the country.     

Population impact of regulatory activity restricting prescribing of COX-2 inhibitors: ecological study

AIMS

To investigate impacts of withdrawal and regulatory advice regarding cyclooxygenase-2 (COX-2) inhibitors on UK population rates of gastrointestinal haemorrhage and acute myocardial infarction (MI).

METHODS

Ecological time series study of prescribing, mortality and hospital admission trends in people aged ≥55 years.

RESULTS

Withdrawal and regulatory advice limiting COX-2 inhibitor availability from 2004 were temporally associated with reversal of previously unfavourable trends in emergency MI admissions among people aged ≥65 years. Annual admission rate trends changed from +4.6% to −3.1% (P < 0.001) among women and from +2.1% to −3.8% (P= 0.003) among men. Absolute changes in average annual trend in the number of individuals aged ≥65 years admitted following MI were from +981 (1999–2004) to −819 (2004–2006) per year for women and from +713 to −995 for men. No change in trend was apparent among people aged 55–64 years, or in MI mortality trends. There was some suggestion of an unfavourable change in admission trends for gastrointestinal haemorrhage among 55−64-year-olds, although this appeared to occur prior to COX-2 inhibitor withdrawal/regulation by up to 2 years. These trends were not apparent in older people, or in gastrointestinal haemorrhage mortality rates.

CONCLUSIONS

Withdrawal/regulation of COX-2 inhibitors was temporally associated with a favourable reversal of population-level hospital admission trends in MI among people aged ≥65 years. Unfavourable reversal of previous declines in gastrointestinal haemorrhage admissions probably occurred before changes in COX-2 inhibitor availability. Withdrawal/ regulation of COX-2 inhibitors did not appear to have any adverse impact on population health and may have been beneficial.     

Admission patterns for childhood acute asthma: Christchurch 1974-89.

OBJECT: to examine trends in hospital admission for acute childhood asthma in Christchurch over the period 1974-89. METHODS: trends in the estimated annual rates of admission and readmission for asthma were compared between boys and girls in each of three age groups: 0-4 years, 5-9 years, 10-13 years. RESULTS: for both sexes there was a 4.5-5 fold increase in overall rates of admission during the survey period. Boys on average had higher admission rates than girls with this effect being most marked in the preschool age group. Since the mid 1980s there has been a changing pattern of admissions with a downward trend in admission rates for school aged children and a continuing upward trend in the preschool age group. An alarming new trend is a rise in the numbers of preschool girls admitted with acute asthma: admission rates for this group have shown a three-fold increase since 1983. CONCLUSIONS: possible reasons for the changing pattern of admissions are discussed, with emphasis on the possible role of the increased use of cromoglycate and inhaled steroid in older children. Further research is needed to determine whether the trends in these data are reflected throughout the country.