• Kieran L Quinn, Nathan M Stall, Zhan Yao, Therese A Stukel, Peter Cram, Allan S Detsky, and Chaim M Bell.
• Department of Medicine (Quinn, Stall, Cram, Detsky, Bell), University of Toronto; ICES Central (Yao, Stukel); Institute of Health Policy, Management and Evaluation (Quinn, Stall, Stukel, Cram, Detsky, Bell), University of Toronto, Toronto, Ont.
• CMAJ. 2019 Dec 16; 191 (50): E1369-E1377.

BackgroundThe risk of death in people after their first admission to hospital or first presentation to the emergency department for any reason is not known. The objective of this study was to estimate the risk of death among older adults who had had no admissions to hospital or emergency department visits in the preceding 5 years.MethodsWe used administrative data from Ontario, Canada, from 2007 to 2017 to measure the 5-year risk of death in community-dwelling adults aged 66 years and older after their first planned or unplanned hospital admission or emergency department visit, and among those who were neither admitted to hospital nor presented to the emergency department. We describe how this risk varied by age.ResultsAmong 922 074 community-dwelling older adults, 12.7% died (116 940 deaths) over a follow-up of 3 112 528 person-years (standardized mortality rate 53.8 per 1000 person-years). After the first unplanned hospital admission, 39.7% died (59 234 deaths, standardized mortality rate 127.6 per 1000 person-years). After the first planned hospital admission, 13.0% died (10 775 deaths, standardized mortality rate 44.6 per 1000 person-years). After the first visit to the emergency department, 10.9% died (35 663 deaths, standardized mortality rate 36.2 per 1000 person-years). Among those with neither an emergency department visit nor hospital admission during follow-up, 3.1% died (11 268 deaths, standardized mortality rate 29.6 per 1000 person-years). Slightly more than half of all deaths were in those with first unplanned hospital admission (50.7%).InterpretationDeath within 5 years of first unplanned hospital admission for older adults is frequent and common. Knowledge of this risk may influence counselling and patient preferences and may be useful in research and analyses for health system planning.© 2019 Joule Inc. or its licensors.

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