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Use of linked data to assess the impact of including out-of-hospital deaths on 30-day in-hospital mortality indicators: a retrospective cohort study

Ania Syrowatka, Mingyang Li, Jing Gu, Ling Yin, Danielle Rice and Yana Gurevich
October 11, 2022 10 (4) E882-E888; DOI: https://doi.org/10.9778/cmajo.20210264
Ania Syrowatka
Canadian Institute for Health Information (Syrowatka, Li, Gu, Yin, Rice, Gurevich), Ottawa/Toronto, Ont.; Division of General Internal Medicine (Syrowatka), Brigham and Women’s Hospital, Boston, Mass.; Harvard Medical School (Syrowatka), Boston, Mass.; Department of Psychology (Rice), McGill University, Montreal, Que.
PhD
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Mingyang Li
Canadian Institute for Health Information (Syrowatka, Li, Gu, Yin, Rice, Gurevich), Ottawa/Toronto, Ont.; Division of General Internal Medicine (Syrowatka), Brigham and Women’s Hospital, Boston, Mass.; Harvard Medical School (Syrowatka), Boston, Mass.; Department of Psychology (Rice), McGill University, Montreal, Que.
MD PhD
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Jing Gu
Canadian Institute for Health Information (Syrowatka, Li, Gu, Yin, Rice, Gurevich), Ottawa/Toronto, Ont.; Division of General Internal Medicine (Syrowatka), Brigham and Women’s Hospital, Boston, Mass.; Harvard Medical School (Syrowatka), Boston, Mass.; Department of Psychology (Rice), McGill University, Montreal, Que.
MD PhD
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Ling Yin
Canadian Institute for Health Information (Syrowatka, Li, Gu, Yin, Rice, Gurevich), Ottawa/Toronto, Ont.; Division of General Internal Medicine (Syrowatka), Brigham and Women’s Hospital, Boston, Mass.; Harvard Medical School (Syrowatka), Boston, Mass.; Department of Psychology (Rice), McGill University, Montreal, Que.
MD MSc
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Danielle Rice
Canadian Institute for Health Information (Syrowatka, Li, Gu, Yin, Rice, Gurevich), Ottawa/Toronto, Ont.; Division of General Internal Medicine (Syrowatka), Brigham and Women’s Hospital, Boston, Mass.; Harvard Medical School (Syrowatka), Boston, Mass.; Department of Psychology (Rice), McGill University, Montreal, Que.
MSc
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Yana Gurevich
Canadian Institute for Health Information (Syrowatka, Li, Gu, Yin, Rice, Gurevich), Ottawa/Toronto, Ont.; Division of General Internal Medicine (Syrowatka), Brigham and Women’s Hospital, Boston, Mass.; Harvard Medical School (Syrowatka), Boston, Mass.; Department of Psychology (Rice), McGill University, Montreal, Que.
MD MPH
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    Figure 1:

    Proportions of deaths that occurred during the index hospital stay, upon readmission and outside of the hospital over the 30-day follow-up period for each indicator, by fiscal year: acute myocardial infarction in (A) 2011/12 and (B) 2016/17; stroke in (C) 2011/12 and (D) 2016/17; and major surgery in (E) 2011/12 and (F) 2016/17.

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    Table 1:

    Sociodemographic characteristics of cohorts of acute myocardial infarction, stroke and major surgery patients for 2 fiscal years (2011/12 and 2016/17)

    CharacteristicNo. (%)* of patients
    AMIStrokeMajor surgery
    2011/12
    n = 37 255
    2016/17
    n = 40 680
    2011/12
    n = 23 680
    2016/17
    n = 27 330
    2011/12
    n = 272 705
    2016/17
    n = 304 515
    Age, yr, mean ± SD68 ± 1468 ± 1472 ± 1472 ± 1462 ± 1663 ± 16
    Sex, female12 435 (33.4)13 245 (32.6)11 640 (49.2)12 965 (47.4)153 480 (56.3)169 360 (55.6)
    Rural or remote residence8830 (23.7)9395 (23.1)4595 (19.4)5210 (19.1)57 025 (20.9)62 030 (20.4)
    Province of service†
     Alberta4645 (12.5)4990 (12.3)2835 (12.0)3335 (12.2)37 565 (13.8)42 885 (14.1)
     British Columbia5920 (15.9)6750 (16.6)4420 (18.7)5130 (18.8)46 860 (17.2)52 560 (17.3)
     Manitoba2050 (5.5)1995 (4.9)1070 (4.5)1065 (3.9)13 430 (4.9)13 890 (4.5)
     New Brunswick1585 (4.3)1835 (4.5)805 (3.4)905 (3.3)9730 (3.6)10 805 (3.6)
     Newfoundland1135 (3.0)1360 (3.3)560 (2.4)650 (2.4)6275 (2.3)6985 (2.3)
     Nova Scotia2000 (5.4)2180 (5.4)955 (4.0)1065 (3.9)11 925 (4.3)12 825 (4.2)
     Ontario18 050 (48.4)19 725 (48.5)11 865 (50.1)13 860 (50.7)133 840 (49.1)150 270 (49.3)
     Prince Edward Island270 (0.7)225 (0.5)140 (0.6)210 (0.8)1120 (0.4)1250 (0.4)
     Saskatchewan1600 (4.3)1620 (4.0)1030 (4.3)1110 (4.0)11 960 (4.4)13 045 (4.3)
    • Note: AMI = acute myocardial infarction, SD = standard deviation.

    • ↵* Unless specified otherwise.

    • ↵† We did not include data from Quebec, Northwest Territories, Nunavut and Yukon.

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    Table 2:

    Absolute numbers and relative proportions of in- and out-of-hospital deaths and associated 30-day mortality rates for 2 fiscal years (2011/12 and 2016/17)

    OutcomeMortality indicator
    AMIStrokeMajor surgery
    2011/12
    n = 37 255
    2016/17
    n = 40 680
    2011/12
    n = 23 680
    2016/17
    n = 27 330
    2011/12
    n = 272 705
    2016/17
    n = 304 515
    Absolute no. of deaths
     In-hospital deaths254023153320327543954700
     Out-of-hospital deaths300325455545660820
     All deaths*284026403775382050555520
    Relative proportion of all deaths, %
     In-hospital deaths89.487.787.985.786.985.1
     Out-of-hospital deaths10.612.312.114.313.114.9
    30-day mortality rate, %
     In-hospital deaths6.85.714.012.01.61.5
     Out-of-hospital deaths0.80.81.92.00.20.3
     All deaths7.66.515.914.01.91.8
    • Note: AMI = acute myocardial infarction.

    • ↵* All deaths include in- and out-of-hospital deaths.

    • View popup
    Table 3:

    Acute care hospital admissions from the Discharge Abstract Database with a documented in-hospital death that were matched with a Canadian Vital Statistics Death Database record

    OutcomeMortality indicator
    AMIStrokeMajor surgery
    2011/12
    n = 2540
    2016/17
    n = 2315
    2011/12
    n = 3320
    2016/17
    n = 3275
    2011/12
    n = 4395
    2016/17
    n = 4700
    Absolute no. of in-hospital deaths
     Matched to a CVSD death record243022103180313042204550
     Not matched to a CVSD death record110105140145175150
    Relative proportion of in-hospital deaths, %
     Matched to a CVSD death record95.795.595.895.696.096.8
     Not matched to a CVSD death record4.34.54.24.44.03.2
    • Note: AMI = acute myocardial infarction, CVSD = Canadian Vital Statistics Death Database.

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CMAJ Open: 10 (4)
Vol. 10, Issue 4
1 Oct 2022
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Use of linked data to assess the impact of including out-of-hospital deaths on 30-day in-hospital mortality indicators: a retrospective cohort study
Ania Syrowatka, Mingyang Li, Jing Gu, Ling Yin, Danielle Rice, Yana Gurevich
Sep 2022, 10 (4) E882-E888; DOI: 10.9778/cmajo.20210264

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Use of linked data to assess the impact of including out-of-hospital deaths on 30-day in-hospital mortality indicators: a retrospective cohort study
Ania Syrowatka, Mingyang Li, Jing Gu, Ling Yin, Danielle Rice, Yana Gurevich
Sep 2022, 10 (4) E882-E888; DOI: 10.9778/cmajo.20210264
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