Abstract
BackgroundGranular data related to the likelihood of individuals of different ages accessing acute and critical care services over time is lacking.MethodsWe used population-based, administrative data from Ontario to identify residents of specific ages (20, 30, 40, etc. to 100) on January 1st every year from 1995–2019. We assessed rates of emergency department (ED) visits (2003–19), hospitalizations, intensive care unit (ICU) admissions (2003–19), and mechanical ventilation.FindingsOverall the 25-year study period, ED were the most common acute healthcare encounter with 100-year-olds having the lowest rate (138.7/1,000) and 90-year-olds the highest (378.5/1,000). Rates of hospitalization ranged from 24.2/1,000 for those age 20 up to 224.9/1,000 for those age 90. Rates of ICU admission and mechanical ventilation were lowest for those age 20 (1.0 and 0.4/1,000), more than tripled by age 50 (3.3 and 1.7/1,000) and peaked at age 80 (20.3 and 10.1/1,000). Over time rates of ED visits increased (164.3 /1,000 in 2003 vs 199.1 /1,000 in 2019) as did rates of invasive mechanical ventilation (2.0/1,000 in 1995 vs 2.9/1,000 in 2019), whereas rates of ICU admission remained stable (4.8/1,000 in 2003 vs 4.9/1,000 in 2019) and hospitalization declined (66.8/1,000 in 1995 vs 51.5/1,000 in 2019). Age stratified analysis demonstrated that rates of ED presentation increased for those age 70 and younger while hospitalization decreased for all age groups; ICU admission and mechanical ventilation rates changed variably by age, with increasing rates demonstrated primarily among people under the age of 50.InterpretationRates of hospitalizations have decreased over time across all age groups, whereas rates of ED presentation, ICU admissions, and mechanical ventilation have increased, primarily driven by younger adults. These findings suggest that although the delivery of healthcare may be moving away from inpatient medicine, there is a growing population of young adults requiring significant healthcare resources.
Highlights
Acute healthcare encounters vary by age, with older adults the highest users of most services [1, 2]
Despite the ongoing collection of administrative data, current population-level data on acute healthcare resource utilization are limited [4,5,6]. Specific organizations, such as the National Health Service (NHS), publish data related to hospital admissions, but considerable gaps exist in relation to temporal trends or utilization of critical care services [7]
Using comprehensive population-level healthcare data from Ontario, this study aimed to describe the overall patterns of resource utilization for major acute healthcare encounters, including emergency department (ED) presentations and hospitalizations, and critical care encounters, including intensive care unit (ICU) admissions and receipt of mechanical ventilation by age, and assess changes over time
Summary
Acute healthcare encounters vary by age, with older adults the highest users of most services [1, 2]. Despite the ongoing collection of administrative data, current population-level data on acute healthcare resource utilization are limited [4,5,6] Specific organizations, such as the National Health Service (NHS), publish data related to hospital admissions, but considerable gaps exist in relation to temporal trends or utilization of critical care services [7]. Population-level assessments of the impact of aging can be challenging as changes in outcomes at younger ages may mask opposing changes in event rates at older ages [8]. This phenomenon occurs when changes in event rates among the young have a greater impact on estimates of lifetime risk [8, 9]. Granular data related to the likelihood of individuals of different ages accessing acute and critical care services over time is lacking
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