Determinants of death in the hospital among older adults

Objectives: To investigate patient-level determinants of in-hospital death, adjusting for patient and regional characteristics.

Design: Using multivariable regression, the relationship between in-hospital death and participants' social, functional, and health characteristics was investigated, controlling for regional Hospital Care Intensity Index (HCI) from the Dartmouth Atlas of Health Care.

Setting: The Health and Retirement Study, a longitudinal nationally representative cohort of older adults.

Participants: People aged 67 and older who died between 2,000 and 2,006 (N = 3,539) were sampled.

Measurements: In-hospital death.

Results: Thirty-nine percent (n = 1,380) of participants died in the hospital (range 34% in Midwest to 45% in Northeast). Nursing home residence, functional dependence, and cancer or dementia diagnosis, among other characteristics, were associated with lower adjusted odds of in-hospital death. Being black or Hispanic, living alone, and having more medical comorbidities were associated with greater adjusted odds, as was higher HCI. Sex, education, net worth, and completion of an advance directive did not correlate with in-hospital death.

Conclusion: Black race, Hispanic ethnicity, and other functional and social characteristics are correlates of in-hospital death, even after controlling for the role of HCI. Further work must be done to determine whether preferences, provider characteristics and practice patterns, or differential access to medical and community services drive this difference.