RT Journal Article SR Electronic T1 Emergency department and hospital utilisation and expenditures in the last year of life: retrospective chronic diseases cohort study JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP e466 OP e469 DO 10.1136/bmjspcare-2021-003103 VO 14 IS e1 A1 Antunes, Ana A1 Gomes, Barbara A1 Campos, Luís A1 Coelho, Miguel A1 Lopes, Sílvia YR 2024 UL http://spcare.bmj.com/content/14/e1/e466.abstract AB 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.