title: Does improved survival lead to a more fragile population: time trends in second and third hospital admissions among men and women above the age of 60 in Sweden.
abstract: BACKGROUND
  Life expectancy and time to first hospitalization have been prolonged, indicating that people live longer without needing hospital care. Life expectancy increased partially due to improved survival from severe diseases, which, however, could lead to a more fragile population. If so, time to a subsequent hospitalization could decrease. Alternatively, the overall trend of improved health could continue after the first hospitalization, prolonging also the time to subsequent hospitalizations. This study analyzes trends in subsequent hospitalizations among Swedish men and women above the age of 60, relating them to first hospitalization. It also looks at trends in the proportion of never hospitalized.
  
  
  METHODS
  Individuals were followed in national registers for hospital admissions and deaths between 1972 and 2010. The proportion of never hospitalized individuals at given ages and time points, and the annual change in the risks of first and subsequent hospitalizations, were calculated.
  
  
  RESULTS
  An increase in the proportion of never hospitalized was seen over time. The risks of first as well as subsequent hospitalizations were reduced by almost 10% per decade for both men and women. Improvements were observed mainly for individuals below the ages of 90 and up to the year 2000.
  
  
  CONCLUSIONS
  The reduction in annual risk of both first and subsequent hospitalizations up to 90 years of age speaks in favor of a postponement of the overall morbidity among the elderly and provides no support for the hypothesis that the population becomes more fragile due to increased survival from severe diseases.
authors.affiliation: Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Korinna
authors.initials: K
authors.lastname: Karampampa
authors.affiliation: Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Andersson
authors.affiliation: Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden; Department of Sociology, Demography Unit, Stockholm University, Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Drefahl
authors.affiliation: Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Ahlbom
authors.affiliation: Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Modig
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008017:Life Expectancy; D008297:Male; D012306:Risk; D013548:Sweden