Abstract
Background: Mortality analysis is important for health planning and resource allocation. These data are essential for low and middle-income countries like India. Globally, the adult mortality rate was 175.45 deaths per 1000 males and 121.19 deaths per 1000 females in 2018 whereas in India it was 204 death per 1000 for males and 147 deaths per 1000 for females. Tuberculosis, respiratory infections and diarrhoea form a large proportion of in-hospital deaths. Causes of death analysed through hospital mortality data can provide an idea about the epidemiological trends as they are complete and accurate.
Methods: We retrospectively analysed the records of all admitted patients who died in the Department of Medicine at All India Institute of Medical Sciences, New Delhi, between the periods of December 2017 to November 2018. Patients with age less than 14 years of age and those with incomplete records were excluded. Cause of death was classified into infectious, cardiovascular system, respiratory system, gastrointestinal system, neurological system and others.
Results: Out of 205 deaths, 132 (64.4%) were males with a mean age of 49.3 ± 16.2 years, and 73(35.6%) were females with a mean age of 48.2 ± 16.9 years. The interval between admission and deaths ranged from 2 hours to 74 days, with a median duration of 4 days. The leading causes of death were infectious and parasitic diseases (57.6%), cardiovascular (17.6%), gastrointestinal diseases (10.7%) and neurological diseases (4.9%).
Conclusion: In our study, infections were the most common cause of death (57.6%), followed by cardiovascular causes (17.6%). In-hospital complications like hospital/ventilator-associated pneumonia, catheter-associated urinary tract infections and acute coronary syndromes together cause 29.26% of deaths in the medical ward. Hospital derived mortality data are an important component of health statistics and regular auditing helps in policy making.
Keywords: Infectious disease, epidemiology, public health.
References
- English M, Mwaniki P, Julius T, Chepkirui M, Gathara D, Ouma PO, et al. Hospital Mortality – a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries. BMC Med. 2018 Dec;16(1):32.
- Rampatige R, Mikkelsen L, Hernandez B, Riley I, Lopez AD. Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers. Bull World Health Organ. 2014 Nov 1;92(11):807–16.
- World Health Organization, editor. International statistical classification of diseases and related health problems. 10th revision, 2nd edition. Geneva: World Health Organization; 2004. 3 p.
- World Health Organization. World Population Prospects 2019: Highlights [Internet]. Geneva; 2019 Jul. Available from: https://population.un.org/wpp/
- Beaglehole R, Irwin A. The world health report 2003: shaping the future. Geneva: World Health Organization; 2003.
- Joshi R, Lodhe R, Jain A, Agrawal S. Hospital based infectious disease related proportional mortality study. J Glob Infect Dis. 2014;6(1):10.
- Godale L, Mulaje S. Mortality trend and pattern in tertiary care hospital of Solapur in Maharashtra. Indian J Community Med. 2013;38(1):49.
- Holambe VM, Thakur NA. Mortality Pattern in Hospitalized Patients in a Tertiary Care Centre of Latur. Holambe VM Thakur NA 2014 Mortal Pattern Hosp PatJournal Krishna Inst Med Sci Univ. 2014;3(2):111–5.
- Barford A, Dorling D, Smith GD, Shaw M. Life expectancy: women now on top everywhere. BMJ. 2006 Apr 8;332(7545):808.
- Hadiza S. Mortality patterns in the Medical Wards of Murtala Muhammad Specialist Hospital, Kano, Nigeria. Niger J Basic Clin Sci. 2018;15(1):73.
- Khare N, Gupta G, Gupta SK, Khare S. Mortality Trend in a Ter-tiary Care Hospital of Bhopal, Madhya Pradesh. Vol. 7, National Journal of Community Medicine│Volume. 2016.
- Hari Kumar KVS, Ajai Chandra NS. Mortality audit of medical patients at armed forces hospitals. Med J Armed Forces India. 2017 Jul;73(3):299–303.
- Prakash G, Bakhshi S, Raina V, Bhatnagar S, Kumar L, Shukla N, et al. Characteristics and Pattern of Mortality in Cancer Patients at a Tertiary Care Oncology Center: Report of 259 Cases. :5.
- Troeger C, Forouzanfar M, Rao PC, Khalil I, Brown A, Swartz S, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017 Nov;17(11):1133–61.
- World Health Organization. Global Report on the Epidemiology and Burden of Sepsis: Current evidence, identifying gaps and future directions [Internet]. Geneva: World Health Organization; 2020. Available from: https://apps.who.int/iris/bitstream/handle/10665/334216/9789240010789-eng.pdf
- Office Of The Registrar General, Report on Medical Certification of Cause of Death 2018 [Internet]. New Delhi; 2020 Jul [cited 2020 Oct 11]. Available from: https://censusindia.gov.in/2011-Documents/mccd_Report1/MCCD_Report-2018.pdf
- Sopena N, Sabrià M. Multicenter Study of Hospital-Acquired Pneumonia in Non-ICU Patients. Chest. 2005 Jan;127(1):213–9.
- Werarak P, Kiratisin P, Thamlikitkul V. Hospital-acquired pneumonia and ventilator-associated pneumonia in adults at Siriraj Hospital: etiology, clinical outcomes, and impact of antimicrobial resistance. J Med Assoc Thail Chotmaihet Thangphaet. 2010 Jan;93 Suppl 1:S126-138.
- Chant C, Smith OM, Marshall JC, Friedrich JO. Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: A systematic review and meta-analysis of observational studies: Crit Care Med. 2011 May;39(5):1167–73.
- Clec’h C, Schwebel C, Français A, Toledano D, Fosse J-P, Garrouste-Orgeas M, et al. Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients? Infect Control Hosp Epidemiol. 2007 Dec;28(12):1367–73.
- Ayaz T, Sahin SB, Sahin OZ, Bilir O, Rakıcı H. Factors Affecting Mortality in Elderly Patients Hospitalized for Nonmalignant Reasons. J Aging Res. 2014;2014:1–7.
Corresponding Author
Prof. Ashutosh Biswas
Department of Medicine, All India Institute of Medical Sciences, New Delhi, India- 110029
DOI: https://dx.doi.org/10.18535/jmscr/v8i12.33
