Hospital Admissions In England Research Articles

EGS SO02 - The undifferentiated general surgical take over 10 years: Admissions

Abstract Background Hospital admissions in England and Wales have been increasing over time. This increase has occurred across many specialties, including across the surgical specialties. The aim of this study is to review the undifferentiated emergency general surgical take, with regards to admissions in July 2013 and July 2023, at a District General Hospital to understand the specific pressures on the department and to identify areas in which we could adapt to facilitate these demands. Method Retrospective data regarding admission and re-admission on all patients treated by the emergency general surgical team in July 2013 and July 2023 was collected from electronic notes. If insufficient information was available, patients were excluded from analysis. Results Patient numbers increased by 50% from 2013 to 2023, from 395 to 594. Average length of stay in 2013 was 3.26 days (+/-0.2, p = 0.03), reducing to 2.58 days (+/-0.2, p = 0.03) in 2023. Number of patients admitted overnight has decreased from 74% (n=291/395) in 2013, to 54% (n=324/594) in 2023. Proportion of referrals from ED increased from 48% in 2013, to 69% in 2023. Planned reviews and patients ambulated for surgery the following day has increased from 4% of all patients seen in 2013, to 16% in 2023. Conclusion Volume of patients has increased significantly over this 10-year period. Simultaneously, duration and number of overnight admissions have decreased, alongside increasing use of ambulatory services. This reflects the aims of the Government, and the Royal College of Surgeons, with increasing investment in day-case and ambulatory services. However, without an increase in hospital bed numbers, the rising volume of patients may become difficult to manage.

Differences in health visiting contacts for children of mothers with and without a history of adversity-related hospital admissions in England (2018/19 to 2019/20): an analysis of novel linked community health and hospital data.

ObjectiveExplore differences in children’s contact with health visiting (HV) services by pre-birth exposure to maternal adversity. ApproachFor the first time, we linked the Community Services Dataset (CSDS), which records HV contacts for children in England from 1 April 2018 to 31 March 2020, to Hospital Episode Statistics (HES) which contains births and mothers’ hospital admissions in the preceding 3 years. We used admissions that included ICD-10 codes related to mental health, substance use and violence to identify children born to mothers with a history of adversity. We compared characteristics of children’s HV contacts (i.e. number, mode, location, duration) stratified by maternal adversity. ResultsOverall, 85.2% of 626,478 children in CSDS linked to a birth record in HES. Among children receiving HV contacts, 11.7% were exposed to maternal adversity: 11.1% mental health, 1.3% substance use, 0.4% violence. Children with maternal adversity had more HV contacts than other children (mean = 3.8 vs 2.7, p<0.001). There were no differences in contact mode (i.e. face-to-face or phone) for children with maternal adversity compared to others, but their contacts were longer (44.5% lasting >30 minutes vs 35.1%, p<0.001) and more likely to be at home (56.3% vs 47.8%, p<0.001). ConclusionsHV services respond in different ways to children with and without pre-birth exposure to serious maternal adversity, reflecting the “proportionate universalism” that underpins HV services in England. ImplicationsThe differential service response for vulnerable children may require additional resources (e.g. staff, training) which should be considered when designing and funding HV services.

Risk of unintended consequences from lower antibiotic prescribing for respiratory tract infections in primary care

About 60% of antibiotic prescribing in primary care is for respiratory tract infections (RTIs), some of which is likely unnecessary. There is limited evidence on the association between reduced antibiotic prescribing and adverse events. We aimed to identify associations between practice-level prescribing rates for RTIs in general practice, and patient-level adverse outcomes. We included 1471 English General Practitioner (GP) practices, linked to hospital admissions in England, from the Clinical Practice Research Datalink for 2005 to 2019. Outcomes were hospitalisations, RTI-related re-consultations and additional antibiotic prescriptions, adjusted for practice level case-mix prescribing. Prescribing rates for practices falling within the lowest and highest prescribing quintiles were 52 and 139 prescriptions per 1000 RTI-related consultations. Patients from practices in the lowest prescribing quintile did not have significantly higher risk of hospitalisation, adjusted odds ratio 0·99 (95% CI 0·96 to 1·02). Re-consultations within 30 days were significantly higher for the lowest prescribing practices, adjusted odds ratio 1·209 (1·206 to 1·212). Additional antibiotic prescriptionsand subsequent prescriptions upon re-consultationwere significantly lower for the lowest prescribing practices, adjusted odds ratio 0·317 (0·314 to 0·321) and 0·706 (0·699 to 0·712), respectively. Our results contribute to evidence on the safety of reduced antibiotic prescribing for RTIs in primary care. Results suggest that for the majority of practices, further reductions in RTI-related antibiotic prescribing should be possible without an increase in hospitalisation for pneumonia.

The impact of COVID-19 vaccine spring boosters on COVID-19 hospital admissions in England 2022/23

In the spring of 2022 and 2023 COVID-19 vaccine boosters were recommended for those aged ≥75 years in England as well as those in an immunosuppression risk group. The aim was to reduce severe COVID-19 disease in these groups. The large difference in coverage between those above and below age 75 years was the basis for applying an age-discontinuity approach for measuring the impact of vaccination on COVID-19 hospitalisations in both spring 2022 and 2023. Hospitalisations in individuals positive by PCR for COVID-19 were obtained from the national secondary user service hospital dataset. The ratio of hospital counts by each year of age in 8-week periods after compared to before the roll out was modelled using negative binomial regression to estimate the discontinuity at age 75 years. A clear discontinuity was seen at age 75 years of 17.0% (95% CI: 6.1%-26.6%) in 2022 and 18.0% (3.3%-30.4%) in 2023. If applied to those aged ≥75 years this translates to 1302 and 418 averted hospitalisations in the 8-week period in 2022 and 2023, respectively. This study shows a clear impact of vaccination on preventing COVID-19 hospitalisations and compliments other epidemiological methods assessing the impact of COVID-19 vaccines. One way to see if the booster vaccines doses given to protect against COVID-19 disease are working is to compare hospital admissions in groups of people who were and were not eligible for the dose. In England the spring booster doses were recommended for those aged 75 years and above. We could therefore compare hospitalisations in those above this age to those just below (aged 65-74) and see if there is a step change in rates from age 74 to 75 in the time after the vaccine was given. The results showed hospitalisations were about 18% lower in the group that were eligible, which is evidence that the vaccine is protecting against severe COVID-19.

Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis

IntroductionTooth extraction due to dental caries is associated with socioeconomic deprivation and is a major reason for elective childhood hospital admissions in England. Consumption of sugar-sweetened beverages is a risk...

School building energy efficiency and health: Modelling childhood asthma and hospital admissions in England and Wales

School building energy efficiency and health: Modelling childhood asthma and hospital admissions in England and Wales

Adhesive small bowel obstruction: a clinical review

Each year, acute bowel obstruction accounts for 22 000 hospital admissions in England and Wales. Surgery is sometimes required to treat this condition, which increases the risk of death. To prevent complications, timely intervention is essential. This review will discuss the different types of bowel obstruction, with a focus on adhesive small bowel obstruction, the investigations that lead to a diagnosis and the treatment and management of this condition.

Water fluoridation: what, why, where and when

Dental UpdateVol. 50, No. 6 Guest EditorialWater fluoridation: what, why, where and whenBarry Cockcroft, Simon HearnshawBarry CockcroftChair of the British Fluoridation SocietySearch for more papers by this author, Simon Hearnshawemail: E-mail Address: [email protected]Training Programme Director Health Education England, Coordinator National Community Water Fluoridation NetworkSearch for more papers by this authorBarry Cockcroft; Simon HearnshawPublished Online:13 Jun 2023https://doi.org/10.12968/denu.2023.50.6.475AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Mullen J; European Association for Paediatric Dentistry. History of water fluoridation. Br Dent J 2005 Oct 8; 199(7 Suppl): 1–4. doi: https://doi.org/10.1038/sj.bdj.4812863. PMID: 16215546. Medline, Google ScholarFrom the Centers for Disease Control and Prevention. 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Available at: www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document (accessed May 2023). Google ScholarNHS England. Core20PLUS5 (adults) – an approach to reducing healthcare inequalities. Available at: www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/ (accessed May 2023). Google ScholarAustralian Government, National Health and Medical Research Council. Information Paper. Water fluoridation: dental and other human health outcomes. 2017. Available at: www.nhmrc.gov.au/sites/default/files/documents/reports/fluoridation-info-paper.pdf (accessed May 2023. Google ScholarNew Zealand Ministry of Health. Review of the benefits and costs of water fluoridation in New Zealand. 2016. Available at: www.health.govt.nz/publication/review-benefits-and-costs-water-fluoridation-new-zealand (accessed June 2023). Google ScholarGovernment of Canada. The state of community water fluoridation across Canada. 2022. Available at: www.canada.ca/en/public-health/services/publications/healthy-living/community-water-fluoridation-across-canada.html (accessed June 2023). Google ScholarOffice for Health Improvement and Disparities. Water fluoridation health monitoring report for England 2022. 2022. Available at: www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2022 (accessed May 2023). Google ScholarPublic Health England. Water fluoridation. Health monitoring report for England 2018. Executive summary. 2018. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/692756/EXECUTIVE_SUMMARY_Water_Fluoridation_Health_monitoring_report_for_England_2018_DR.pdf (accessed May 2023). Google ScholarPublic Health England. Return on investment of oral health improvement programmes for 0–5 year olds. 2016. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/560973/ROI_oral_health_interventions.pdf (accessed May 2023). Google ScholarDuane B, Lyne A, Parle R, Ashley P. The environmental impact of community caries prevention – part 3: water fluoridation. Br Dent J 2022; 233: 303–307. https://doi.org/10.1038/s41415-022-4251-5 Medline, Google ScholarLevine RS. Childhood caries and hospital admissions in England: a reflection on preventive strategies. Br Dent J 2021; 230: 611–616. https://doi.org/10.1038/s41415-021-2945-8 Medline, Google ScholarNHS England. What are integrated care systems. Available at: www.england.nhs.uk/integratedcare/what-is-integrated-care/ (accessed May 2023). Google ScholarAssociation of Directors of Public Health. ADPH lead consensus on oral health. 2023 Available at: www.adph.org.uk/2023/03/adph-leads-consensus-on-child-oral-health/ (accessed May 2023). Google ScholarGodlee F, Smith J, Marcovitch H. Wakefield's article linking MMR vaccine and autism was fraudulent. BMJ 2011; 342: c7452. https://doi.org/10.1136/bmj.c7452 Medline, Google ScholarDepartment of Health and Social Care. Statement on water fluoridation from the UK Chief Medical Officers. 2021. Available at: www.gov.uk/government/publications/water-fluoridation-statement-from-the-uk-chief-medical-officers/statement-on-water-fluoridation-from-the-uk-chief-medical-officers (accessed May 2023). Google Scholar FiguresReferencesRelatedDetails 2 June 2023Volume 50Issue 6ISSN (print): 0305-5000ISSN (online): 2515-589X Metrics History Published online 13 June 2023 Published in print 2 June 2023 Information© MA Dentistry Media LimitedPDF download

Opioid Injection-Associated Bacterial Infections in England, 2002-2021: A Time Series Analysis of Seasonal Variation and the Impact of Coronavirus Disease 2019.

Bacterial infections cause substantial pain and disability among people who inject drugs. We described time trends in hospital admissions for injecting-related infections in England. We analyzed hospital admissions in England between January 2002 and December 2021. We included patients with infections commonly caused by drug injection, including cutaneous abscesses, cellulitis, endocarditis, or osteomyelitis, and a diagnosis of opioid use disorder. We used Poisson regression to estimate seasonal variation and changes associated with coronavirus disease 2019 (COVID-19) response. There were 92 303 hospital admissions for injection-associated infections between 2002 and 2021. Eighty-seven percent were skin, soft-tissue, or vascular infections; 72% of patients were male; and the median age increased from 31 years in 2002 to 42 years in 2021. The rate of admissions reduced from 13.97 per day (95% confidence interval [CI], 13.59-14.36) in 2003 to 8.94 (95% CI, 8.64-9.25) in 2011, then increased to 18.91 (95% CI, 18.46-19.36) in 2019. At the introduction of COVID-19 response in March 2020, the rate of injection-associated infections reduced by 35.3% (95% CI, 32.1-38.4). Injection-associated infections were also seasonal; the rate was 1.21 (95% CI, 1.18-1.24) times higher in July than in February. This incidence of opioid injection-associated infections varies within years and reduced following COVID-19 response measures. This suggests that social and structural factors such as housing and the degree of social mixing may contribute to the risk of infection, supporting investment in improved social conditions for this population as a means to reduce the burden of injecting-related infections.

Rising incidence of Pneumocystis pneumonia: A population-level descriptive ecological study in England

Pneumocystis pneumonia (PCP) is an opportunistic infection that causes significant morbidity and mortality in the immunocompromised population. This population is growing and diversifying, yet contemporary epidemiology is lacking. We investigated the population-level incidence of PCP over the past decade. We conducted a descriptive study of all hospital admissions in England from April 2012 to March 2022. PCP episodes, age, median length of stay, gender and episodes of other respiratory fungal infections were collected. Consumption of Trimethoprim-Sulfamethoxazole was obtained between January 2019 and May 2022. The incidence of PCP increased from 2·2-4·5/100,000 population between 2012/2013 and 2019/2020 (p<0·0001). There was a drop in 2020/2021 to 2·7/100,000 before returning to 3.9/100,000 in 2021/2022. PCP episodes rose as a proportion of all-cause admissions as well as a proportion of episodes due to other fungal infections. The proportion of PCP patients aged 75+increased from 14% to 26%. The median length of stay was 13.5 days. Consumption of intravenous Trimethoprim-Sulfamethoxazole increased from 0.24×100,000 to 0.30 ×100,000 defined daily doses. The incidence of PCP is rising rapidly and represents a significant burden to the healthcare system. Further study into who is at risk of PCP is needed to better determine who should be given prophylaxis.

Musculoskeletal System and Connective Tissue Related Hospital Admission in England and Wales Between 1999 and 2019: An Ecologic Study.

Background There is a lack of data describing inpatient hospitalization trends for musculoskeletal and connective tissue diseases in the United Kingdom. Aim We aim to provide a comprehensive analysis of the trends of musculoskeletal and connective tissue disease related hospitalizations between 1999 and 2019 in England and Wales. Method We conducted an ecologic study. The data were obtained from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales between 1999 and 2019. We used ICD-10 (International Classification of Diseases, 10th Revision) codes M00-M99 to identify hospital admissions. Results The total annual hospital admission rate increased from 1,303.63 (95% CI: 1,300.55-1,306.71) in 1999 to 2,479.09 (95% CI: 2,475.14-2,483.04) in 2019 per 100,000 persons (p<0.01). The ICD-10 categories other joint disorders, osteoarthritis, and other dorsopathies accounted for 19.6%, 19.6%, and 18.6% of hospitalizations, respectively. Advanced age groups experienced a larger increase in hospitalization rates (128.6% in the age group of 75 years and above vs. 45.9% in the age group below 15 years). Females contributed to 57.7% of hospitalizations and experienced a larger increase in hospitalization rate compared to males (103.8% vs. 73.8%). Conclusion Between 1999 and 2009, the hospitalization rate for musculoskeletal and connective tissue diseases has steadily increased in England and Wales. However, the rate has plateaued or declined in many of musculoskeletal and connective tissue diseases between 2010 and 2019. Due to the chronicity of these diseases, their significant morbidity, and significant long-term disability, national interventions are needed to mitigate the effects of the increased cost of treatment.

Hospital Admissions Related to Infections and Disorders of the Skin and Subcutaneous Tissue in England and Wales.

Objectives: To investigate hospital admissions in England and Wales due to infections and diseases of the skin and subcutaneous tissue. Methods: Data from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) database in England for the years between April 1999 and April 2020 were used in this study. Using all the relevant diagnosis codes (L00–L99), hospital admissions related to various skin infections and diseases of the subcutaneous tissue were identified. Results: Hospital admissions for all causes increased overall by 78.8%, from 276,464 in 1999 to 494,433 in 2020, representing an increase in hospital admission rate of 56.1% (from 530.23 (95% CI 528.26–532.20) in 1999 to 827.92 (95% CI 825.62–830.22) per 100,000 people in 2020, p ≤ 0.05). The most prevalent diagnoses were disorders of the skin’s appendages, infections of the skin and subcutaneous tissue, and other disorders of the skin and subcutaneous tissue. Nearly half of all hospital admissions were for males and for patients between the ages of 15 and 59. In 2020, the hospital admission rate for males increased by 60.2%, from 540.16 (95% CI 537.32–543.01) per 100,000 people in 1999 to 865.10 (95% CI 861.76–868.44) in 2020. From 520.75 (95% CI 518.02–523.48) in 1999 to 791.03 (95% CI 787.86–794.19) in 2020, the hospital admission rate for females grew by 51.9%. Conclusion: Hospital admission due to infections and disorders of the skin and subcutaneous tissue increased during the past two decades in England and Wales. Further studies are needed to explore the risk factors associated with infections and disorders of the skin and subcutaneous tissue complications, and its associated admissions.

Temporal association between invasive procedures and infective endocarditis

ObjectiveAntibiotic prophylaxis has been recommended for patients at increased risk of infective endocarditis (IE) undergoing specific invasive procedures (IPs) despite a lack of data supporting its use. Therefore, antibiotic prophylaxis...

Local area public sector spending and nutritional anaemia hospital admissions in England: a longitudinal ecological study

IntroductionReductions in local government spending may have impacts on diets and health which increase the risk of hospital admissions for nutritional anaemias. Mechanisms include potential impacts of changes to local...

Impact of extreme temperatures on emergency hospital admissions by age and socio-economic deprivation in England

Climate change poses an unprecedented challenge to population health and health systems’ resilience, with increasing fluctuations in extreme temperatures through pressures on hospital capacity. While earlier studies have estimated morbidity attributable to hot or cold weather across cities, we provide the first large-scale, population-wide assessment of extreme temperatures on inequalities in excess emergency hospital admissions in England. We used the universe of emergency hospital admissions between 2001 and 2012 combined with meteorological data to exploit daily variation in temperature experienced by hospitals (N = 29,371,084). We used a distributed lag model with multiple fixed-effects, controlling for seasonal factors, to examine hospitalisation effects across temperature-sensitive diseases, and further heterogeneous impacts across age and deprivation. We identified larger hospitalisation impacts associated with extreme cold temperatures than with extreme hot temperatures. The less extreme temperatures produce admission patterns like their extreme counterparts, but at lower magnitudes. Results also showed an increase in admissions with extreme temperatures that were more prominent among older and socioeconomically-deprived populations - particularly across admissions for metabolic diseases and injuries.

Hospital admissions due to vasomotor and allergic rhinitis in England and Wales between 1999 and 2019: an ecological study.

Allergic rhinitis is among the most prevalent chronic disorders in high-income countries. Its estimated cost is €30-€50 billion annually in the European Union and in the UK, it is approximately €1.8 billion per year. To study hospital admissions for vasomotor and allergic rhinitis in England and Wales during the past 20years. This was an ecological study using publicly available data extracted from the Hospital Episode Statistics (HES) database in England and the Patient Episode Database for Wales (PEDW). The trend in hospital admissions was assessed using a Poisson model. Admission rate increased by 2.14-fold [from 2.59 (95% CI 2.46-2.73) in 1999 to 8.16 (95% CI 7.93-8.39) in 2020 per 100,000 persons, trend test, p < 001]. The most prevalent hospital admission reasons were allergic rhinitis due to pollen, other allergic rhinitis, and unspecified allergic rhinitis, which accounted for 56.4%, 22.3%, and 15.7%, respectively. The age group 15-59years accounted for 69.5% of the total number of admissions. Admission rate between males increased by 2.25-fold. Admission rate between females increased by 2.02-fold. Vasomotor and allergic rhinitis are common cause of hospital admissions in England and Wales that showed a clear increase in the rate of their admissions in the past 20years. Allergic rhinitis due to pollen was the most dominant cause of admission, which warrants further investigation to identify its preventable risk factors and decrease the probability of the exacerbation of patients' cases and the need for hospitalization.

Comparative assessment of methods for short-term forecasts of COVID-19 hospital admissions in England at the local level

BackgroundForecasting healthcare demand is essential in epidemic settings, both to inform situational awareness and facilitate resource planning. Ideally, forecasts should be robust across time and locations. During the COVID-19 pandemic in England, it is an ongoing concern that demand for hospital care for COVID-19 patients in England will exceed available resources.MethodsWe made weekly forecasts of daily COVID-19 hospital admissions for National Health Service (NHS) Trusts in England between August 2020 and April 2021 using three disease-agnostic forecasting models: a mean ensemble of autoregressive time series models, a linear regression model with 7-day-lagged local cases as a predictor, and a scaled convolution of local cases and a delay distribution. We compared their point and probabilistic accuracy to a mean-ensemble of them all and to a simple baseline model of no change from the last day of admissions. We measured predictive performance using the weighted interval score (WIS) and considered how this changed in different scenarios (the length of the predictive horizon, the date on which the forecast was made, and by location), as well as how much admissions forecasts improved when future cases were known.ResultsAll models outperformed the baseline in the majority of scenarios. Forecasting accuracy varied by forecast date and location, depending on the trajectory of the outbreak, and all individual models had instances where they were the top- or bottom-ranked model. Forecasts produced by the mean-ensemble were both the most accurate and most consistently accurate forecasts amongst all the models considered. Forecasting accuracy was improved when using future observed, rather than forecast, cases, especially at longer forecast horizons.ConclusionsAssuming no change in current admissions is rarely better than including at least a trend. Using confirmed COVID-19 cases as a predictor can improve admissions forecasts in some scenarios, but this is variable and depends on the ability to make consistently good case forecasts. However, ensemble forecasts can make forecasts that make consistently more accurate forecasts across time and locations. Given minimal requirements on data and computation, our admissions forecasting ensemble could be used to anticipate healthcare needs in future epidemic or pandemic settings.

Trends and characteristics of hospitalisations from the harmful use of opioids in England between 2008 and 2018: Population-based retrospective cohort study.

SummaryObjectiveTo examine the trends and characteristics of opioid-related hospital admissions in England over 10 years, and its burden for the National Health Service and public finances.DesignPatient-level data from the Hospital Episode Statistics database to examine all opioid-related hospitalisations from 2008 to 2018, stratified by type of opioid admission and patient demographics.SettingAll National Health Service hospitals in England.ParticipantsPatients hospitalised from the harmful use of opioids.Main outcome measuresThe number of opioid-related hospitalisations, length of stay, in-hospital mortality, 30-day readmission rate and treatment costs.ResultsOpioid-related hospitalisations increased by 48.9%, from 10,805 admissions in 2008 to 16,091 admissions in 2018, with total treatment costs of £137 million. The growth in opioid-related hospitalisations was 21% above the corresponding rate for all other emergency admissions in England. Relative changes showed that hospitalisations increased most for individuals older than 55 years (160%), those living in the most affluent areas of England (93.8%), and suffering from four co-morbidities (627.6%) or more. Hospitals reduced mean patient length of stay from 2.8 days to 1.1 days over 10 years. Mean in-hospital mortality was 0.4% and mean 30-day readmission risk was 16.6%.ConclusionOpioid use is an increasing public health concern in England, though hospitalisation and mortality rates are less pronounced than in other countries. There are concerns about significant rises in hospitalisations from older, less deprived and sicker population groups. Our findings should prompt policymakers to go beyond monitoring mortality statistics when assessing the impacts of harmful use of opioids.

Current and future burdens of heat-related dementia hospital admissions in England.

The impacts of a changing climate on current and future dementia burdens have not been widely explored. Time-series negative binomial regression analysis was used to assess acute associations between daily ambient temperature and counts of emergency admissions for dementia in each Government region of England, adjusting for season and day-of-week. Using the latest climate and dementia projections data, we then estimate future heat-related dementia burdens under a high emission scenario (Representative Concentration Pathway (RCP8.5), where global greenhouse gas (GHG) emissions continue to rise, and a low emissions scenario (RCP2.6), where GHG emissions are sizeably reduced under a strong global mitigation policy. A raised risk associated with high temperatures was observed in all regions. Nationally, a 4.5% (95% Confidence interval (CI) 2.9%-6.1%) increase in risk of dementia admission was observed for every 1°C increase in temperature above 17°C associated with current climate. Under a high emissions scenario, heat-related admissions are projected to increase by almost 300% by 2040 compared to baseline levels. People living with dementia should be considered a high-risk group during hot weather. Our results support arguments for more stringent climate change mitigation policies.

Impact of antibiotic use on patient-level risk of death in 36 million hospital admissions in England

Objectives: Initiatives to curb hospital antibiotic use might be associated with harm from under-treatment. We examined the extent to which variation in hospital antibiotic prescribing is associated with mortality risk in acute/general medicine inpatients. Methods: This ecological analysis examined Hospital Episode Statistics from 36,124,372 acute/general medicine admissions (≥16y) to 135 acute hospitals in England, 01/April/2010–31/March/2017. Random-effects meta-regression was used to investigate whether heterogeneity in adjusted 30-day mortality was associated with hospital-level antibiotic use, measured in defined-daily-doses (DDD)/1,000 bed-days. Models also considered DDDs/1,000 admissions and DDDs for narrow-spectrum/broad-spectrum antibiotics, parenteral/oral, and local interpretations of World Health Organization Access, Watch, and Reserve antibiotics. Results: Hospital-level antibiotic DDDs/1,000 bed-days varied 15-fold with comparable variation in broad-spectrum, parenteral, and Reserve antibiotic use. After extensive adjusting for hospital case-mix, the probability of 30-day mortality changed -0.010% (95% CI: -0.064,+0.044) for each increase of 500 hospital-level antibiotic DDDs/1,000 bed-days. Analyses of other metrics of antibiotic use showed no consistent association with mortality risk. Conclusions: We found no evidence that wide variation in hospital antibiotic use is associated with adjusted mortality risk in acute/general medicine inpatients. Using low-prescribing hospitals as benchmarks could help drive safe and substantial reductions in antibiotic consumption of up-to one-third in this population.