Age and the Risk of In-Hospital Death: Insights from a Multihospital Study of Intensive Care Patients

OBJECTIVES: To determine independent relationships between age and the risk of in‐hospital death. DESIGN: Retrospective cohort study. SETTING: Thirty‐eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region. PARTICIPANTS: One hundred fifty‐six thousand, one hundred th...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Journal of the American Geriatrics Society (JAGS) 2002-07, Vol.50 (7), p.1205-1212
Hauptverfasser: Rosenthal, Gary E., Kaboli, Peter J., Barnett, Mitchell J., Sirio, Carl A.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1212
container_issue 7
container_start_page 1205
container_title Journal of the American Geriatrics Society (JAGS)
container_volume 50
creator Rosenthal, Gary E.
Kaboli, Peter J.
Barnett, Mitchell J.
Sirio, Carl A.
description OBJECTIVES: To determine independent relationships between age and the risk of in‐hospital death. DESIGN: Retrospective cohort study. SETTING: Thirty‐eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region. PARTICIPANTS: One hundred fifty‐six thousand, one hundred thirty‐six consecutive admissions to medical, surgical, neurological, and mixed medical/surgical ICUs between March 1, 1991, and March 31, 1997. MEASUREMENTS: In‐hospital death rates were compared at successive 5‐year age intervals, adjusting for gender, diagnosis, admission source, comorbidity, and acute physiology scores. Acute physiology scores were determined using a validated methodology based on abnormalities in 17 physiological measures collected during the first 24 hours of ICU admission. RESULTS: The adjusted odds of death increased with each 5‐year age increment. For example, relative to patients younger than 35, adjusted odds of death in patients aged 40 to 44, 50 to 54, 60 to 64, 70 to 74, 80 to 84, and 90 and older were 1.51, 1.73, 2.38, 2.98, 3.86, and 4.74, respectively. In stratified analyses, age‐related increases in the odds of death were somewhat higher in surgical than medical patients or patients with lower severity of illness at admission. Although acute physiology scores had excellent discrimination in all age groups, discrimination decreased with age (e.g., c‐statistics of 0.928 and 0.835 in patients younger than 45 and 85 and older, respectively). CONCLUSION: Our findings demonstrate incremental increases in the risk of hospital death associated with age that was independent of severity of illness and other prognostic factors. Although the current results may be less biased by differences in treatment goals than studies of general hospitalized patients, the lower discrimination of physiology scores in older patients suggests that unmeasured factors (e.g., functional status, patient preferences for care, differences in physician practices) may be of greater prognostic importance in older than in younger patients.
doi_str_mv 10.1046/j.1532-5415.2002.50306.x
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_71936251</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>57731789</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4626-dfec8c504d19b381881831cb921c3d215e38870775dfaf290ac59bd97e3a64103</originalsourceid><addsrcrecordid>eNqNkdFu0zAUhi0EYmXwCsjigrtkPnYcO1wgTR3rNm2A2IBLy01O1nRpUmyHtW-Pu5QhcQOSJVs-3_mOrZ8QCiwFluVHyxSk4InMQKacMZ5KJliebp6QyWPhKZmwWEp0DtkBeeH9kjHgTOvn5AA4CMEgmxA8vkVqu4qGBdIvjb-jfU3Pu-Ss9-sm2JaeoA2Ld_HKN7eL4Gnt-hW19GpoQ7P4DV2HodqOnQEj-RPp1Dqkn21osAv-JXlW29bjq_1-SL6efriZniWXn2bn0-PLpMxynidVjaUuJcsqKOZCg45LQDkvOJSi4iBRaK2YUrKqbc0LZktZzKtCobB5Bkwckrejd-36HwP6YFaNL7FtbYf94I2CQuRcwj9BqZQApYsIvvkLXPaD6-InDI8DtYgvipAeodL13juszdo1K-u2BpjZBWaWZpeL2eVidoGZh8DMJra-3vuH-QqrP437hCLwfgTumxa3_y02F7Prh2MUJKOg8QE3jwLr7kyuhJLm-8eZuZrenDL17cJw8Qt1V7EQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>210383388</pqid></control><display><type>article</type><title>Age and the Risk of In-Hospital Death: Insights from a Multihospital Study of Intensive Care Patients</title><source>Applied Social Sciences Index &amp; Abstracts (ASSIA)</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Rosenthal, Gary E. ; Kaboli, Peter J. ; Barnett, Mitchell J. ; Sirio, Carl A.</creator><creatorcontrib>Rosenthal, Gary E. ; Kaboli, Peter J. ; Barnett, Mitchell J. ; Sirio, Carl A.</creatorcontrib><description>OBJECTIVES: To determine independent relationships between age and the risk of in‐hospital death. DESIGN: Retrospective cohort study. SETTING: Thirty‐eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region. PARTICIPANTS: One hundred fifty‐six thousand, one hundred thirty‐six consecutive admissions to medical, surgical, neurological, and mixed medical/surgical ICUs between March 1, 1991, and March 31, 1997. MEASUREMENTS: In‐hospital death rates were compared at successive 5‐year age intervals, adjusting for gender, diagnosis, admission source, comorbidity, and acute physiology scores. Acute physiology scores were determined using a validated methodology based on abnormalities in 17 physiological measures collected during the first 24 hours of ICU admission. RESULTS: The adjusted odds of death increased with each 5‐year age increment. For example, relative to patients younger than 35, adjusted odds of death in patients aged 40 to 44, 50 to 54, 60 to 64, 70 to 74, 80 to 84, and 90 and older were 1.51, 1.73, 2.38, 2.98, 3.86, and 4.74, respectively. In stratified analyses, age‐related increases in the odds of death were somewhat higher in surgical than medical patients or patients with lower severity of illness at admission. Although acute physiology scores had excellent discrimination in all age groups, discrimination decreased with age (e.g., c‐statistics of 0.928 and 0.835 in patients younger than 45 and 85 and older, respectively). CONCLUSION: Our findings demonstrate incremental increases in the risk of hospital death associated with age that was independent of severity of illness and other prognostic factors. Although the current results may be less biased by differences in treatment goals than studies of general hospitalized patients, the lower discrimination of physiology scores in older patients suggests that unmeasured factors (e.g., functional status, patient preferences for care, differences in physician practices) may be of greater prognostic importance in older than in younger patients.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1046/j.1532-5415.2002.50306.x</identifier><identifier>PMID: 12133014</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Boston, MA, USA: Blackwell Science Inc</publisher><subject>Adult ; Age ; Age Factors ; Age patterns ; Aged ; Aged, 80 and over ; APACHE ; Critical care ; Death ; Elderly people ; Female ; Health Services Research ; Hospital Mortality ; Hospitalization ; Hospitals ; Humans ; intensive care units ; Intensive Care Units - statistics &amp; numerical data ; Male ; Middle Aged ; Mortality ; Ohio - epidemiology ; outcome assessment ; Outcome Assessment (Health Care) ; Retrospective Studies ; Risk Factors ; severity of illness ; USA</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2002-07, Vol.50 (7), p.1205-1212</ispartof><rights>Copyright Lippincott Williams &amp; Wilkins Jul 2002</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4626-dfec8c504d19b381881831cb921c3d215e38870775dfaf290ac59bd97e3a64103</citedby><cites>FETCH-LOGICAL-c4626-dfec8c504d19b381881831cb921c3d215e38870775dfaf290ac59bd97e3a64103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1532-5415.2002.50306.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1532-5415.2002.50306.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,30977,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12133014$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rosenthal, Gary E.</creatorcontrib><creatorcontrib>Kaboli, Peter J.</creatorcontrib><creatorcontrib>Barnett, Mitchell J.</creatorcontrib><creatorcontrib>Sirio, Carl A.</creatorcontrib><title>Age and the Risk of In-Hospital Death: Insights from a Multihospital Study of Intensive Care Patients</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>Journal of the American Geriatrics Society</addtitle><description>OBJECTIVES: To determine independent relationships between age and the risk of in‐hospital death. DESIGN: Retrospective cohort study. SETTING: Thirty‐eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region. PARTICIPANTS: One hundred fifty‐six thousand, one hundred thirty‐six consecutive admissions to medical, surgical, neurological, and mixed medical/surgical ICUs between March 1, 1991, and March 31, 1997. MEASUREMENTS: In‐hospital death rates were compared at successive 5‐year age intervals, adjusting for gender, diagnosis, admission source, comorbidity, and acute physiology scores. Acute physiology scores were determined using a validated methodology based on abnormalities in 17 physiological measures collected during the first 24 hours of ICU admission. RESULTS: The adjusted odds of death increased with each 5‐year age increment. For example, relative to patients younger than 35, adjusted odds of death in patients aged 40 to 44, 50 to 54, 60 to 64, 70 to 74, 80 to 84, and 90 and older were 1.51, 1.73, 2.38, 2.98, 3.86, and 4.74, respectively. In stratified analyses, age‐related increases in the odds of death were somewhat higher in surgical than medical patients or patients with lower severity of illness at admission. Although acute physiology scores had excellent discrimination in all age groups, discrimination decreased with age (e.g., c‐statistics of 0.928 and 0.835 in patients younger than 45 and 85 and older, respectively). CONCLUSION: Our findings demonstrate incremental increases in the risk of hospital death associated with age that was independent of severity of illness and other prognostic factors. Although the current results may be less biased by differences in treatment goals than studies of general hospitalized patients, the lower discrimination of physiology scores in older patients suggests that unmeasured factors (e.g., functional status, patient preferences for care, differences in physician practices) may be of greater prognostic importance in older than in younger patients.</description><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Age patterns</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>APACHE</subject><subject>Critical care</subject><subject>Death</subject><subject>Elderly people</subject><subject>Female</subject><subject>Health Services Research</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>intensive care units</subject><subject>Intensive Care Units - statistics &amp; numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Ohio - epidemiology</subject><subject>outcome assessment</subject><subject>Outcome Assessment (Health Care)</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>severity of illness</subject><subject>USA</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkdFu0zAUhi0EYmXwCsjigrtkPnYcO1wgTR3rNm2A2IBLy01O1nRpUmyHtW-Pu5QhcQOSJVs-3_mOrZ8QCiwFluVHyxSk4InMQKacMZ5KJliebp6QyWPhKZmwWEp0DtkBeeH9kjHgTOvn5AA4CMEgmxA8vkVqu4qGBdIvjb-jfU3Pu-Ss9-sm2JaeoA2Ld_HKN7eL4Gnt-hW19GpoQ7P4DV2HodqOnQEj-RPp1Dqkn21osAv-JXlW29bjq_1-SL6efriZniWXn2bn0-PLpMxynidVjaUuJcsqKOZCg45LQDkvOJSi4iBRaK2YUrKqbc0LZktZzKtCobB5Bkwckrejd-36HwP6YFaNL7FtbYf94I2CQuRcwj9BqZQApYsIvvkLXPaD6-InDI8DtYgvipAeodL13juszdo1K-u2BpjZBWaWZpeL2eVidoGZh8DMJra-3vuH-QqrP437hCLwfgTumxa3_y02F7Prh2MUJKOg8QE3jwLr7kyuhJLm-8eZuZrenDL17cJw8Qt1V7EQ</recordid><startdate>200207</startdate><enddate>200207</enddate><creator>Rosenthal, Gary E.</creator><creator>Kaboli, Peter J.</creator><creator>Barnett, Mitchell J.</creator><creator>Sirio, Carl A.</creator><general>Blackwell Science Inc</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>200207</creationdate><title>Age and the Risk of In-Hospital Death: Insights from a Multihospital Study of Intensive Care Patients</title><author>Rosenthal, Gary E. ; Kaboli, Peter J. ; Barnett, Mitchell J. ; Sirio, Carl A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4626-dfec8c504d19b381881831cb921c3d215e38870775dfaf290ac59bd97e3a64103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Adult</topic><topic>Age</topic><topic>Age Factors</topic><topic>Age patterns</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>APACHE</topic><topic>Critical care</topic><topic>Death</topic><topic>Elderly people</topic><topic>Female</topic><topic>Health Services Research</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>intensive care units</topic><topic>Intensive Care Units - statistics &amp; numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Ohio - epidemiology</topic><topic>outcome assessment</topic><topic>Outcome Assessment (Health Care)</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>severity of illness</topic><topic>USA</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rosenthal, Gary E.</creatorcontrib><creatorcontrib>Kaboli, Peter J.</creatorcontrib><creatorcontrib>Barnett, Mitchell J.</creatorcontrib><creatorcontrib>Sirio, Carl A.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Applied Social Sciences Index &amp; Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rosenthal, Gary E.</au><au>Kaboli, Peter J.</au><au>Barnett, Mitchell J.</au><au>Sirio, Carl A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Age and the Risk of In-Hospital Death: Insights from a Multihospital Study of Intensive Care Patients</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>Journal of the American Geriatrics Society</addtitle><date>2002-07</date><risdate>2002</risdate><volume>50</volume><issue>7</issue><spage>1205</spage><epage>1212</epage><pages>1205-1212</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>OBJECTIVES: To determine independent relationships between age and the risk of in‐hospital death. DESIGN: Retrospective cohort study. SETTING: Thirty‐eight intensive care units (ICUs) in 28 hospitals in a large Midwest metropolitan region. PARTICIPANTS: One hundred fifty‐six thousand, one hundred thirty‐six consecutive admissions to medical, surgical, neurological, and mixed medical/surgical ICUs between March 1, 1991, and March 31, 1997. MEASUREMENTS: In‐hospital death rates were compared at successive 5‐year age intervals, adjusting for gender, diagnosis, admission source, comorbidity, and acute physiology scores. Acute physiology scores were determined using a validated methodology based on abnormalities in 17 physiological measures collected during the first 24 hours of ICU admission. RESULTS: The adjusted odds of death increased with each 5‐year age increment. For example, relative to patients younger than 35, adjusted odds of death in patients aged 40 to 44, 50 to 54, 60 to 64, 70 to 74, 80 to 84, and 90 and older were 1.51, 1.73, 2.38, 2.98, 3.86, and 4.74, respectively. In stratified analyses, age‐related increases in the odds of death were somewhat higher in surgical than medical patients or patients with lower severity of illness at admission. Although acute physiology scores had excellent discrimination in all age groups, discrimination decreased with age (e.g., c‐statistics of 0.928 and 0.835 in patients younger than 45 and 85 and older, respectively). CONCLUSION: Our findings demonstrate incremental increases in the risk of hospital death associated with age that was independent of severity of illness and other prognostic factors. Although the current results may be less biased by differences in treatment goals than studies of general hospitalized patients, the lower discrimination of physiology scores in older patients suggests that unmeasured factors (e.g., functional status, patient preferences for care, differences in physician practices) may be of greater prognostic importance in older than in younger patients.</abstract><cop>Boston, MA, USA</cop><pub>Blackwell Science Inc</pub><pmid>12133014</pmid><doi>10.1046/j.1532-5415.2002.50306.x</doi><tpages>8</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0002-8614
ispartof Journal of the American Geriatrics Society (JAGS), 2002-07, Vol.50 (7), p.1205-1212
issn 0002-8614
1532-5415
language eng
recordid cdi_proquest_miscellaneous_71936251
source Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; Wiley Online Library Journals Frontfile Complete
subjects Adult
Age
Age Factors
Age patterns
Aged
Aged, 80 and over
APACHE
Critical care
Death
Elderly people
Female
Health Services Research
Hospital Mortality
Hospitalization
Hospitals
Humans
intensive care units
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Mortality
Ohio - epidemiology
outcome assessment
Outcome Assessment (Health Care)
Retrospective Studies
Risk Factors
severity of illness
USA
title Age and the Risk of In-Hospital Death: Insights from a Multihospital Study of Intensive Care Patients
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T10%3A28%3A47IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Age%20and%20the%20Risk%20of%20In-Hospital%20Death:%20Insights%20from%20a%20Multihospital%20Study%20of%20Intensive%20Care%20Patients&rft.jtitle=Journal%20of%20the%20American%20Geriatrics%20Society%20(JAGS)&rft.au=Rosenthal,%20Gary%20E.&rft.date=2002-07&rft.volume=50&rft.issue=7&rft.spage=1205&rft.epage=1212&rft.pages=1205-1212&rft.issn=0002-8614&rft.eissn=1532-5415&rft.coden=JAGSAF&rft_id=info:doi/10.1046/j.1532-5415.2002.50306.x&rft_dat=%3Cproquest_cross%3E57731789%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=210383388&rft_id=info:pmid/12133014&rfr_iscdi=true