The Effect of Hospital Admission Day on Mortality from Myocardial Infarction in England: A National Record Linkage Study
Nagrebetskyi, Igor (2021)
2021
Kansanterveystieteen maisteriohjelma - Master's Programme in Public Health
Yhteiskuntatieteiden tiedekunta - Faculty of Social Sciences
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Hyväksymispäivämäärä
2021-06-29
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:tuni-202106105820
https://urn.fi/URN:NBN:fi:tuni-202106105820
Tiivistelmä
Background: There are concerns that quality of medical care and availability of medical procedures may vary between weekdays and weekends. Acute myocardial infarction (AMI) is a life-threatening condition, which requires urgent specialized care and, potentially, invasive procedures. The specialized care and invasive procedures may not be equivalently available on weekends and weekdays, which may affect mortality from AMI. We tested the hypothesis that case fatality rates (CFRs) within 30 days from hospital admission for AMI did not differ between weekend and weekday admissions.
Methods: The National Health Service (NHS) provides health-care for all residents of England. We used datasets of English National Hospital Episode Statistics (HES) and mortality records supplied by, respectively, the NHS Information Centre and the Office for National Statistics. Linkage between the datasets was done using encrypted values of the unique HES identifier and of the unique NHS number supplemented with encrypted values of the patients’ date of birth and postcode. We used the hospital admission and mortality data for England from 1999 to 2011 to calculate 30-day CFRs. We used chi-squared statistics to compare categorical variables and to test for statistical significance. We set the level of statistical significance at 0.01. Logistic regression analysis was used to quantify the effects of age, year of admission and day of the week of admission on the CFR. Statistical tests were carried out in SPSS Statistics version 20 for Windows.
Results: The study comprised 541,165 people. In patients admitted with AMI, CFRs for weekday and weekend admissions did not differ significantly: they were 11.5% (45,629/397,173) on weekdays and 11.5% (16,566/143,992) on weekends, P-value=0.602. The 30-day CFR for all patients admitted to hospitals was 11.5%.
Conclusion: Overall, there was no evidence of a “weekend effect” on CFRs in patients hospitalized with AMI in England in 1999-2011. This indicates that the delivery of NHS care, at least in respect of CFRs for AMI in the period studied, was as effective for weekend as for weekday admissions.
Methods: The National Health Service (NHS) provides health-care for all residents of England. We used datasets of English National Hospital Episode Statistics (HES) and mortality records supplied by, respectively, the NHS Information Centre and the Office for National Statistics. Linkage between the datasets was done using encrypted values of the unique HES identifier and of the unique NHS number supplemented with encrypted values of the patients’ date of birth and postcode. We used the hospital admission and mortality data for England from 1999 to 2011 to calculate 30-day CFRs. We used chi-squared statistics to compare categorical variables and to test for statistical significance. We set the level of statistical significance at 0.01. Logistic regression analysis was used to quantify the effects of age, year of admission and day of the week of admission on the CFR. Statistical tests were carried out in SPSS Statistics version 20 for Windows.
Results: The study comprised 541,165 people. In patients admitted with AMI, CFRs for weekday and weekend admissions did not differ significantly: they were 11.5% (45,629/397,173) on weekdays and 11.5% (16,566/143,992) on weekends, P-value=0.602. The 30-day CFR for all patients admitted to hospitals was 11.5%.
Conclusion: Overall, there was no evidence of a “weekend effect” on CFRs in patients hospitalized with AMI in England in 1999-2011. This indicates that the delivery of NHS care, at least in respect of CFRs for AMI in the period studied, was as effective for weekend as for weekday admissions.