Ann Geriatr Med Res.  2019 Sep;23(3):133-140. 10.4235/agmr.19.0029.

Risk Factors and Causes of Short-Term Mortality after Emergency Department Discharge in Older Patients: Using Nationwide Health Insurance Claims Data

• Na S
• Cho Y
• Lim TH
• Kang H
• Oh J
• Ko BS

• KMID: 2464502
• DOI: http://doi.org/10.4235/agmr.19.0029

Abstract

BACKGROUND
The purpose of this study was to identify the risk factors and causes of short-term mortality after emergency department (ED) discharge in older patients.
METHODS
This population-based cohort study used nationwide health insurance claims data in Korea from 2008 to 2014. The causes of death and diagnoses of patients who died within 1 week after discharge from EDs (1-week ED death) were obtained. The risk factors for 1-week ED death were calculated using Cox proportional hazard regression analyses.
RESULTS
The rate of 1-week ED death was 0.5% among 133,251 individuals aged ≥65 years discharged from EDs. In multivariate analysis, the top five ED discharge diagnoses associated with an increased risk of 1-week ED death were hypotension and vascular disease (adjusted hazard ratio [aHR]=5.11; 95% confidence interval [CI], 3.03-8.63), neoplasm (aHR=4.89; 95% CI, 3.77-6.35), coronary artery disease (aHR=3.83; 95% CI, 2.73-5.39), dyspnea (aHR=3.41; 95% CI, 2.48-4.68), and respiratory disease (aHR=2.25; 95% CI, 1.73-2.92). The most common causes of 1-week ED death were neoplasm (14.8%), senility (13.8%), and cerebrovascular disease (11.7%).
CONCLUSION
Neoplasm, coronary artery disease, and respiratory disease were the discharge diagnoses associated with an increased risk of short-term mortality after ED discharge. Neoplasm was the leading cause of short-term mortality after ED discharge in older patients.

Keyword

Aged; Mortality; Emergency departments; Risk factors

MeSH Terms

Cause of Death
Cerebrovascular Disorders
Cohort Studies
Coronary Artery Disease
Diagnosis
Dyspnea
Emergencies*
Emergency Service, Hospital*
Humans
Hypotension
Insurance, Health*
Korea
Mortality*
Multivariate Analysis
Risk Factors*
Vascular Diseases