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RESEARCH ARTICLE
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Trajectories of hospital service use in the last 12 months of life by people with chronic kidney disease: a retrospective cohort study

Tolesa Okuba https://orcid.org/0000-0002-9335-0012 A * , Zhisheng Sa A B , Tim Badgery-Parker A , Janet C. Long A , Jeffrey Braithwaite A , Angela Makris C , Annie Hutton D , Jean-Frederic Levesque D E , Diane E. Watson F , Johanna I. Westbrook A and Rebecca Mitchell A
+ Author Affiliations
- Author Affiliations

A Australian Institute of Health Innovation, Macquarie University, NSW, Australia.

B NSW Biostatistics Training Program, NSW Ministry of Health, NSW, Australia.

C South Western Sydney Local Health District, NSW, Australia.

D Agency for Clinical Innovation, St Leonards, NSW, Australia.

E Centre for Primary Health Care and Equity, University of New South Wales, NSW, Australia.

F Bureau of Health Information, NSW, Australia.

* Correspondence to: tolesa.okuba@mq.edu.au

Australian Health Review https://doi.org/10.1071/AH24139
Submitted: 20 May 2024  Accepted: 6 December 2024  Published: 24 December 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Objective

This study aimed to examine group-based trajectories of hospital service use by people with chronic kidney disease (CKD) in the last 12 months of life.

Methods

A retrospective cohort study was conducted using hospital admission and mortality data in New South Wales, Australia. Individuals aged ≥18 years who were hospitalised during 2014–2021 and who died during 2015–2021 were included. A group-based trajectory analysis was conducted including all-cause admissions and unplanned-only admissions. Multinomial logistic regression examined predictors of trajectory group membership.

Results

There were 10,653 adults who had at least one CKD hospital admission 12 months prior to death. Four group-based trajectories of hospital service use were identified for all-cause admissions (i.e. Very-Low, Low, Moderate, High) and three group-based trajectories for unplanned-only admissions (i.e. Low, Moderate, High). The study identified associations between frequent hospitalisations and key patient characteristics and health conditions. Individuals in the High hospitalisation group were more likely to have cancer (OR 4.55; 95% CI: 2.54–8.16). Additionally, the High unplanned hospitalisation group showed increased likelihoods of being adults aged 18–64 years (OR 1.94; 95% CI: 1.32–2.84) and having diagnosis of congestive heart failure (OR 1.80; 95% CI: 1.26–2.55), cancer (OR 2.25; 95% CI: 1.49–3.40), mental disorders (OR 1.88; 95% CI: 1.35–2.62) or smoking (OR 2.01; 95% CI: 1.49–2.70) compared with the Low hospitalisation group.

Conclusions

Group-based trajectory analysis revealed specific patterns in hospital service usage. Understanding these patterns helps in devising targeted strategies to decrease unplanned hospitalisations among these high-risk patients.

Keywords: chronic kidney disease, group-based trajectories, hospital service use, last 12 months of life.

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