Understanding poor health behaviours as predictors of different types of hospital admission in older people: findings from the Hertfordshire Cohort Study.
BACKGROUND
Rates of hospital admission are increasing, particularly among older people. Poor health behaviours cluster but their combined impact on risk of hospital admission among older people in the UK is unknown.


METHODS
2997 community-dwelling men and women (aged 59-73) participated in the Hertfordshire Cohort Study (HCS). We scored (from 0 to 4) number of poor health behaviours engaged in at baseline (1998-2004) out of: current smoking, high weekly alcohol, low customary physical activity and poor diet. We linked HCS with Hospital Episode Statistics and mortality data to 31/03/2010 and analysed associations between the score and risk of different types of hospital admission: any; elective; emergency; long stay (>7 days); 30-day readmission (any, or emergency).


RESULTS
32%, 40%, 20% and 7% of men engaged in 0, 1, 2 and 3/4 poor health behaviours; corresponding percentages for women 51%, 38%, 9%, 2%. 75% of men (69% women) experienced at least one hospital admission. Among men and women, increased number of poor health behaviours was strongly associated (p<0.01) with greater risk of long stay and emergency admissions, and 30-day emergency readmissions. Hazard ratios (HRs) for emergency admission for 3/4 poor health behaviours in comparison with none were: men, 1.37 (95% CI 1.11 to 1.69); women, 1.84 (95% CI 1.22 to 2.77). Associations were unaltered by adjustment for age, body mass index and comorbidity.


CONCLUSIONS
Clustered poor health behaviours are associated with increased risk of hospital admission among older people in the UK. Lifecourse interventions to reduce number of poor health behaviours could have substantial beneficial impact on health and use of healthcare in later life.
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Holly E
HE
Syddall
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Leo D
LD
Westbury
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Shirley J
SJ
Simmonds
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Sian
S
Robinson
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
Cyrus
C
Cooper
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK NIHR Collaboration for Leadership in Applied Health Research and Care: Wessex, University of Southampton,Southampton, UK Institute for Ageing and Institute of Health & Society, Newcastle University, Newcastle, UK.
Avan Aihie
AA
Sayer
D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D015331:Cohort Studies; D004032:Diet; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
Cohort studies; Epidemiology of ageing; HEALTH BEHAVIOUR; Life course epidemiology; NHS