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Emergency department and hospital utilisation and expenditures in the last year of life: retrospective chronic diseases cohort study
  1. Ana Antunes1,
  2. Barbara Gomes2,3,
  3. Luís Campos4,5,
  4. Miguel Coelho1 and
  5. Sílvia Lopes6,7
  1. 1 NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
  2. 2 Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
  3. 3 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute of Palliative Care and Rehabilitation, London, UK
  4. 4 Serviço de Medicina do Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
  5. 5 NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
  6. 6 NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Lisboa, Portugal
  7. 7 Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
  1. Correspondence to Dr Sílvia Lopes, NOVA National School of Public Health, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal; silvia.lopes{at}


Objectives We aimed to examine the influence of chronic diseases in emergency department (ED) and inpatient utilisation and expenditures in the 12 months before death.

Methods Retrospective cohort study of ED and inpatient database. Adults deceased at a hospital in Portugal in 2013 were included. We tested the influence of chronic diseases on the number of ED visits, hospital admissions and expenditures using generalised linear models.

Results The study included 484 patients (81.8% ≥65 years, median two chronic diseases). Nearly all (91.3%) attended the ED in the 12 months before death. The median number of admissions was 1, median expenditure was €6159. Adjusting for confounders, chronic pulmonary disease increased ED and inpatient utilisation (1.49; 95% CI: 1.22 to 1.83; 95% CI 1.29, 1.09 to 1.51). Increased ED utilisation was observed for patients with renal disease, dementia and metastatic solid tumour (1.40, 95% CI 1.15 to 1.71; 1.39, 95% CI 1.11 to 1.75; 1.31, 95% CI 1.07 to 1.60). Other malignancies showed increased inpatient utilisation (1.24, 95% CI 1.09 to 1.42). The number of chronic conditions had a considerable effect on expenditures (3: 2.08, 95% CI 1.44 to 2.99; ≥4: 4.02, 95% CI 2.51 to 6.45).

Conclusion We found a high use of hospitals at the end of life, particularly EDs. Our findings suggest that people with cancer, renal disease, chronic pulmonary disease and dementia are relevant when developing cost-effective alternatives to hospital care.

  • hospital care
  • chronic conditions

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  • Contributors Study design: AA, BG, LC, SL. Data acquisition: AA, LC. Data analysis and interpretation: AA, BG, MC, SL. Draft manuscript: SL. Critical revision of the manuscript: All authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.