Temporal trends and risk factors for readmission for infections, gastrointestinal and immobility complications after an incident hospitalisation for stroke in Scotland between 1997 and 2005

Background: Improvements in stroke management have led to increases in the numbers of stroke survivors over the last decade and there has been a corresponding increase of hospital readmissions after an initial stroke hospitalisation. The aim of this study was to examine the one year risk of having a readmission due to infective, gastrointestinal or immobility (IGI) complications and to identify temporal trends and any risk factors.<p></p> Methods: Using a cohort of first hospitalised for stroke patients who were discharged alive, time to first event (readmission for IGI complications or death) within 1 year was analysed in a competing risks framework using cumulative incidence methods. Regression on the cumulative incidence function was used to model the risks of having an outcome using the covariates age, sex, socioeconomic status, comorbidity, discharge destination and length of hospital stay.<p></p> Results: There were a total of 51,182 patients discharged alive after an incident stroke hospitalisation in Scotland between 1997–2005, and 7,747 (15.1%) were readmitted for IGI complications within a year of the discharge. Comparing incident stroke hospitalisations in 2005 with 1997, the adjusted risk of IGI readmission did not increase (HR = 1.00 95% CI (0.90, 1.11). However, there was a higher risk of IGI readmission with increasing levels of deprivation (most deprived fifth vs. least deprived fifth HR = 1.16 (1.08, 1.26).<p></p> Conclusions: Approximately 15 in 100 patients discharged alive after an incident hospitalisation for stroke in Scotland between 1997 and 2005 went on to have an IGI readmission within one year. The proportion of readmissions did not change over the study period but those living in deprived areas had an increased risk

Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986–95: a retrospective cohort study

Background: Most deaths from coronary heart disease occur out of hospital. Hospital patients face social, age, and sex inequalities. Our aim was to examine inequalities and trends in out-of-hospital cardiac deaths. Methods: We used the Scottish record linked database to identify all deaths from acute myocardial infarction that occurred in Scotland (population 5·1 million), in 1986–95. We have compared population-based death rates for men and women across age and social groups. Findings: Between 1986 and 1995, 83·365 people died from acute myocardial infarction, out of hospital and without previous hospital admission (44·655 men, 38·710 women); and 117·749 were admitted with a first acute myocardial infarction, of whom 37·020 died within 1 year. Thus, out-of-hospital deaths accounted for 69·2% (95% CI 69·0–69·5) of all 120·385 deaths. Out-of-hospital deaths, measured as a proportion of all acute myocardial infarction events (deaths plus first hospital admissions), increased with age, from 20·1% (19·2–21·0) in people younger than 55 years, to 62·1% (61·3–62·9) in those older than 85 years. Population-based out-of-hospital mortality rates fell by a third in men and by a quarter in women. Mean yearly falls were larger in people aged 55–64 years (5·6% per year in men, 3·7% in women), than in those older than 85 years (2·5% in men and women). Mortality rates were substantially higher in deprived socioeconomic groups than in affluent groups, especially in people younger than 65 years. Interpretation: These inequalities in age, sex, and socioeconomic class should be actively addressed by prevention strategies for coronary heart disease