Age and sex patterns of mortality in a tertiary care teaching hospital in Bagalkot, North Karnataka, India

INTRODUCTION

Mortality is an inevitable component of hospital practice and patient outcomes. The age and sex mortality pattern and the audit give a myriad of information. This helps to identify the trend of mortality. Audit of mortality data is needed for further improvement of the hospital services and to allocate resources where needed. The spectrum of patients admitted to a tertiary care teaching hospital is different from the peripheral hospital.¹

Non communicable diseases are the leading cause of death and primarily affect those of working age. Studies indicate that deaths in those less than 60 years of age adversely affect economic growth and development. In 2004, the estimated loss to gross domestic product in India due to cardio vascular disease alone was about 1 trillion rupees.²

Hence, this study was done to identify age and sex patterns of mortality of the patients admitted to Hangal Sri Kumareshwar Hospital and Research Centre, Navanagar, Bagalkot, Karnataka, India in the year 2018.

METHODS

A retrospective study of all deaths that occurred in the year 2018 in Hangal Sri Kumareshwar Hospital and Research Centre, Navanagar, Bagalkot, Karnataka was done by analyzing the available records from medical records department after institutional review board clearance.

Data regarding age, sex, area of residence, ward of admission and cause of death was noted. The deaths have been classified according to International classification of diseases - 10^th revision.

Statistical analysis

The data was analyzed using percentages and chi square test.

RESULTS

Out of 411 deaths during 2018 in HSK hospital, 64.96% were males and 35.04% were females. Majority (71.53%) were from rural areas (Table 1) Majority were from Bagalkot district (75.91%).

DF=1, X²=1.49, p=0.11.

DF=7, X²=14.31, p=0.045.

DF=11, X²=36.25, p=0.0001.

Maximum number of deaths (27.98%) were observed in those more than 61 years of age followed by those between 41 to 60 years of age (Table 2). Overall, 72.02% of deaths were below 60 years of age.

Majority of the deaths (45.98%) had occurred in General Medicine ward followed by 20.92% in Neonatal intensive care unit (Table 3).

Overall, maximum number of deaths (69.35%) was due to a non-communicable disease (Table 4).

DF=1, X²=8.308, p=0.003.

Infectious and parasitic disease contributed to 10.46% of deaths. Cardio vascular disease contributed to 16.30% deaths.

Regarding deaths in males between 21 to 40 years of age, organo phosphorous poisoning and chronic liver disease contributed each to 18.42% deaths followed by 13.16% deaths due to a road traffic accident. Acquired immuno deficiency syndrome and pulmonary tuberculosis was responsible for 7.89% deaths each. In females of the same age group, sepsis and burn injury contributed each to 12.5% deaths.

In males between 41 to 60 years of age, the most common cause for death was chronic liver disease (24.05%) followed by Ischemic heart disease (13.92%) and diabetes mellitus (12.66%) Hypertension contributed to 7.59% deaths. In females between similar age group, diabetes mellitus contributed to 16.66% of deaths followed by chronic obstructive pulmonary disease and ischemic heart disease responsible for 13.33% deaths each. Necrotizing fasciitis and hypertension contributed each to 10% of deaths.

DISCUSSION

In the present study, maximum number of male deaths (64.96%) than female deaths were noted and this finding is similar to other studies.^2,3 It was observed that 71.53% of deaths were in those residing in rural areas. This fact can be explained that this is a tertiary care teaching and referral hospital.

In this study, premature mortality (age less than 60 years of age) was seen in 72.02% of deaths. Elderly contributed to 27.98% of deaths. In 2008, premature mortality by age 60 accounted for one third of total deaths in low- and middle-income countries.² The higher level of premature mortality in this study is mainly due to demographic and epidemiological changes that have altered mortality levels and disease patterns across age groups and this finding is similar to other studies.^4-6

Non communicable diseases contributed to almost 70% of deaths in this study and this finding is similar to other studies.^7,8

Almost 20% of the deaths were observed in the neonatal period. Emphasis on newborn care is needed in today’s perspective. Study tertiary care hospital is a major referral hospital in Bagalkot and caters to high risk neonates referred from its wide catchment area. This could be the reason for witnessing higher mortality in a well-equipped neonatal intensive care unit. Similar findings have been observed in another study.⁹

Estimating deaths in less than 60 years of age and understanding the factors responsible is essential to reduce preventable deaths and to improve population health.

Organo phosphorous poisoning, chronic liver disease, road traffic accidents and acquired immuno deficiency syndrome contributed to majority of deaths in 21 to 40 years age group males. Behavior change communication and mental health interventions needs to be provided by primary health care.

Regarding deaths in females between 21 to 40 years of age, sepsis and burn injury was the major cause. Women need to be educated to take care of their health both physically and mentally and approach the nearest health service provider.

In males between 41 to 60 years of age, again chronic liver disease was the major cause of death followed by Ischemic heart disease, diabetes mellitus and hypertension. Life style and fitness is the need of the hour.

About females between 41 to 60 years of age, non-communicable diseases like diabetes mellitus, chronic obstructive pulmonary disease, hypertension and ischemic heart disease were leading causes of death. Primary prevention has to be stressed at grass root level to avoid premature mortality. Dietary habits, exercise and stress factors need to be looked at and addressed.

From this study, it is obvious that the level of mortality in age less than 60 years of age is higher than in many developed and developing countries. It is high because of both higher neonatal mortality and higher adult mortality.² Intensive neonatal care is the need of the hour. Awareness needs to be created regarding a healthy lifestyle to reduce risk factors for non-communicable diseases and avoidable mortality in the primary health care system in both urban and rural areas of the region.

CONCLUSION

Primary prevention of non-communicable diseases by creating awareness in the community and secondary prevention by early identification is needed to prevent premature mortality before the age of 60 years. Almost 20% of the deaths were observed in the neonatal period. Emphasis on new-born care is needed in today’s perspective. Skilled birth attendant training is the need of the hour in remote facilities to decrease neonatal mortality.

ACKNOWLEDGEMENTS

The authors acknowledge the Dean of S. N. Medical College and HSK Research Centre, Bagalkot for permission to conduct the study and the staff of medical records department for their co-operation in providing the data required for the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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