• Emily Moore, Rosalia Munoz-Arroyo, Lauren Schofield, Alice Radley, David Clark, and Chris Isles.
• NHS National Services Scotland, Edinburgh, UK.
• BMJ Open. 2018 Jun 30; 8 (6): e021432.

BackgroundIt is increasingly recognised that large numbers of hospital inpatients have entered the last year of their lives.AimTo establish the likelihood of death within 12 months of admission to hospital; to examine the influence on survival of a cancer diagnosis made within the previous 5 years; to assess whether previous emergency admissions influenced mortality; and to compare mortality with that of the wider Scottish population.DesignIncident cohort study.Setting22 hospitals in Scotland.ParticipantsThis study used routinely collected data from 10 477 inpatients admitted as an emergency to medicine in 22 Scottish hospitals between 18 and 31 March 2015. These data were linked to national death records and the Scottish Cancer Registry.Primary Outcome Measures1 year cohort mortality compared with that of the general Scottish population. Patient factors correlating with higher risk of mortality were identified using Cox regression.ResultsThere were 2346 (22.4%) deaths in the year following the census admission. Six hundred and ten patients died during that admission (5.8% of all admissions and 26% of all deaths) while 1736 died after the census admission (74% of all deaths). Malignant neoplasms (33.8%), circulatory diseases (22.5%) and respiratory disease (17.9%) accounted for almost three-quarters of all deaths. Mortality rose steeply with age and was five times higher at 1 year for patients aged 85 years and over compared with those who were under 60 years of age (41.9%vs7.9%) (p<0.001). Patients with cancer had a higher mortality rate than patients without a cancer diagnosis (55.6%vs16.6%) (p<0.001). Mortality was higher among patients with one or more emergency medical admissions in the previous year (30.1% v 15.1%) (p<0.001). Age/sex-standardised mortality was 110.4 (95% CI 104.4 to 116.5) for the cohort and 11.7 (95% CI 11.6 to 11.8) for the Scottish population, a 9.4-fold increase in risk.ConclusionThese data may help identify groups of patients admitted to hospital as medical emergencies who are at greatest risk of dying not only during admission but also in the following 12 months.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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