TY - UNPB
T1 - Understanding the differences in in-hospital mortality between Scotland and England
AU - Aragon Aragon, Maria Jose Monserratt
AU - Chalkley, Martin John
PY - 2014/10
Y1 - 2014/10
N2 - Aims: We describe differences in in-hospital mortality between Scotland and England and test
whether these differences are robust to controlling for the case-mix of patients. In spite of
Scotland and England having much in common in regard to their hospital systems and
populations we observe trends in-hospital mortality – the percentage of elective and emergency
Continuous Inpatient Spells (CIS) that ended in death – that are different: England’s in-hospital
mortality rates have decreased faster than Scotland’s for both types of admissions.
Data: Individual patient data from England (HES) and Scotland (SMR01) for the period 2003/04 –
2011/12. Episode data is linked into CIS. Sample: Elective and emergency admissions, including
day cases and excluding maternity.
Methods: Logit regression of in-hospital death on country and financial year dummies, and their
interaction, controlling for age group, gender, deprivation decile, and HRG of the first episode;
separately for elective and emergency admissions.
Results: For elective admissions, England has a lower initial in-hospital mortality rate than
Scotland, and this rate decreases in both countries but the decrease has been faster in England.
For emergency admissions, England starts with a slightly higher in-hospital mortality rate and
both countries in-hospital mortality rates reduce throughout the period but England’s does so
faster.
Conclusions: There are differences in in-hospital mortality between Scotland and England; these
differences increase over time and persist when we account for patient characteristics. It is
important to understand the causes and consequences of these differences and we make a
number of suggestions for future research on this issue.
AB - Aims: We describe differences in in-hospital mortality between Scotland and England and test
whether these differences are robust to controlling for the case-mix of patients. In spite of
Scotland and England having much in common in regard to their hospital systems and
populations we observe trends in-hospital mortality – the percentage of elective and emergency
Continuous Inpatient Spells (CIS) that ended in death – that are different: England’s in-hospital
mortality rates have decreased faster than Scotland’s for both types of admissions.
Data: Individual patient data from England (HES) and Scotland (SMR01) for the period 2003/04 –
2011/12. Episode data is linked into CIS. Sample: Elective and emergency admissions, including
day cases and excluding maternity.
Methods: Logit regression of in-hospital death on country and financial year dummies, and their
interaction, controlling for age group, gender, deprivation decile, and HRG of the first episode;
separately for elective and emergency admissions.
Results: For elective admissions, England has a lower initial in-hospital mortality rate than
Scotland, and this rate decreases in both countries but the decrease has been faster in England.
For emergency admissions, England starts with a slightly higher in-hospital mortality rate and
both countries in-hospital mortality rates reduce throughout the period but England’s does so
faster.
Conclusions: There are differences in in-hospital mortality between Scotland and England; these
differences increase over time and persist when we account for patient characteristics. It is
important to understand the causes and consequences of these differences and we make a
number of suggestions for future research on this issue.
M3 - Discussion paper
T3 - CHE Research Paper
SP - 1
EP - 20
BT - Understanding the differences in in-hospital mortality between Scotland and England
PB - Centre for Health Economics, University of York
CY - York, UK
ER -