Odd ratios of nursing home placement by primary diagnosis at admission in Singapore community hospitals from 1996 to 2005 (multivariate analyses).

*<p>P<0.05 (logistic regression adjusted for community hospital and year of admission).</p>†<p>0.05<u>≤</u>P<0.10 (logistic regression adjusted for community hospital and year of admission).</p

Descriptive table by primary diagnosis at admission to Singapore community hospitals from 1996 to 2005.

*<p>P<0.05;</p>†<p>0.05<u>≤</u>P<0.10.</p

Percentage variation explained by predictors in the overall model.

<p>Percentage variation explained by predictors in the overall model.</p

The Synergistic Effect of Functional Status and Comorbidity Burden on Mortality: A 16-Year Survival Analysis

<div><p>Objectives</p><p>The relationship between disability and comorbidity on mortality is widely perceived as additive in clinical models of frailty.</p><p>Design</p><p>National data were retrospectively extracted from medical records of community hospital.</p><p>Data Sources</p><p>There were of 12,804 acutely-disabled patients admitted for inpatient rehabilitation in Singapore rehabilitation community hospitals from 1996 through 2005 were followed up for death till 31 December 2011.</p><p>Outcome Measure</p><p>Cox proportional-hazards regression to assess the interaction of comorbidity and disability at discharge on all-cause mortality.</p><p>Results</p><p>During a median follow-up of 10.9 years, there were 8,565 deaths (66.9%). The mean age was 73.0 (standard deviation: 11.5) years. Independent risk factors of mortality were higher comorbidity (p<0.001), severity of disability at discharge (p<0.001), being widowed (adjusted hazard ratio [aHR]: 1.38, 95% confidence interval [CI]:1.25–1.53), low socioeconomic status (aHR:1.40, 95%CI:1.29–1.53), discharge to nursing home (aHR:1.14, 95%CI:1.05–1.22) and re-admission into acute care (aHR:1.54, 95%CI:1.45–1.65). In the main effects model, those with high comorbidity had an aHR = 2.41 (95%CI:2.13–2.72) whereas those with total disability had an aHR = 2.28 (95%CI:2.12–2.46). In the interaction model, synergistic interaction existed between comorbidity and disability (p<0.001) where those with high comorbidity and total disability had much higher aHR = 6.57 (95%CI:5.15–8.37).</p><p>Conclusions</p><p>Patients with greater comorbidity and disability at discharge, discharge to nursing home or re-admission into acute care, lower socioeconomic status and being widowed had higher mortality risk. Our results identified predictive variables of mortality that map well onto the frailty cascade model. Increasing comorbidity and disability interacted synergistically to increase mortality risk.</p></div

Multivariate model of all-cause mortality in patients admitted to Singapore community hospitals from 1996 to 2005.

a<p>Cox-proportional hazard model: stratified by age group (18–64, 65 and above), year of admission (1996 to 2005), gender (female, male), primary diagnosis at admission (stroke, fracture, amputation, lower limb arthroplasty, falls, others).</p><p>Multivariate model of all-cause mortality in patients admitted to Singapore community hospitals from 1996 to 2005.</p

Social demographics by death status at time of censoring and bivariate model of all-cause mortality for hazard ratio.

a<p>P-value: Cox-proportional hazard model: stratified by age group (18–64, 65 and above), year of admission, gender, primary diagnosis at admission (stroke, fracture, amputation, lower limb arthroplasty, falls, others).</p><p>Social demographics by death status at time of censoring and bivariate model of all-cause mortality for hazard ratio.</p

Kaplan-Meier survival curve by comorbidity burden, discharge disability and discharge destination.

<p>Kaplan-Meier survival curve by comorbidity burden, discharge disability and discharge destination.</p

Multiplicative interaction effect of comorbidity and disability in patients admitted to Singapore community hospitals from 1996 to 2005.

<p>Multiplicative interaction effect of comorbidity and disability in patients admitted to Singapore community hospitals from 1996 to 2005.</p

Social demographics by discharge disability.

a<p>P-value: Chi-square test for categorical variables and Kruskal-Wallis test for length of stay.</p><p>Social demographics by discharge disability.</p