Availability of Data and Material
Data are available from the National Health Insurance Research Database (NHIRD) published by the Taiwan National Health Insurance (NHI) Administration. Due to legal restrictions imposed by the government of Taiwan in relation to the “Personal Information Protection Act”, data cannot be made publicly available. Requests for data can be sent as a formal proposal to the NHIRD (https://dep.mohw.gov.tw/dos/np-2497-113.html ).
Conflicts of Interest
The authors have no potential conflicts of interest to disclose.
Author Contributions
Conceptualization: all authors. Data curation: all authors. Formal analysis: Wu-Chien Chien, Chi-Hsian Chung. Funding acquisition: all authors. Investigation: all authors. Methodology: all authors. Project administration: all authors. Resources: Chung-Kan Peng, Wu-Chien Chien, Nian-Sheng Tzeng. Software: Chi-Hsian Chung. Supervision: Chung-Kan Peng, Nian-Sheng Tzeng. Validation: Nian-Sheng Tzeng. Visualization: Chi-Hsian Chung. Writing—original draft: Chun-Han Wu. Writing—review & editing: Chung-Kan Peng, Nian-Sheng Tzeng.
Funding Statement
This work was supported by the Medical Affairs Bureau, the Ministry of Defense of Taiwan (MAB-107-084 and MNDMAB- D-111-075), the TriService General Hospital Research Foundation (TSGH-C108-003, TSGHC108-027, TSGH-C108-151, TSGH-B-109-010, TSGH-B-111-018, and TSGH-D-111-121), and the Taoyuan Armed Forces General Hospital (TYAFGH-A-110-020).
Variables | With intensive care unit | Without intensive care unit | p* |
---|---|---|---|
Total | 7,473 (25.00) | 22,419 (75.00) | |
Sex | 0.999 | ||
Male | 4,735 (63.36) | 14,205 (63.36) | |
Female | 2,738 (36.64) | 8,214 (36.64) | |
Age (yr) | 69.19±8.84 | 69.23±9.13 | 0.741 |
Age group (yr) | 0.999 | ||
50–64 | 2,448 (32.76) | 7,344 (32.76) | |
≥65 | 5,025 (67.24) | 15,075 (67.24) | |
Marital status | 0.789 | ||
Without | 3,638 (48.68) | 10,954 (48.86) | |
With | 3,835 (51.32) | 11,465 (51.14) | |
Education (yr) | 0.385 | ||
<12 | 3,842 (51.41) | 11,656 (51.99) | |
≥12 | 3,631 (48.59) | 10,763 (48.01) | |
Insured premium (NT$) | 0.751 | ||
<18,000 | 6,845 (91.60) | 20,597 (91.87) | |
18,000–34,999 | 531 (7.11) | 1,542 (6.88) | |
≥35,000 | 97 (1.30) | 280 (1.25) | |
Comorbidities | |||
Hypertension | 1,095 (14.65) | 4,413 (19.68) | <0.001 |
Diabetes mellitus | 1,359 (18.19) | 4,566 (20.37) | <0.001 |
Atrial fibrillations | 197 (2.64) | 529 (2.36) | 0.178 |
Stroke | 1,558 (20.85) | 2,368 (10.56) | <0.001 |
Cerebral atherosclerosis | 61 (0.82) | 184 (0.82) | 0.995 |
Other atherosclerosis | 6 (0.08) | 75 (0.33) | <0.001 |
Fracture of lower limbs | 31 (0.41) | 147 (0.66) | 0.021 |
Cancer | 2,749 (36.79) | 885 (3.95) | <0.001 |
Asthma | 61 (0.82) | 184 (0.82) | 0.995 |
Chronic obstructive pulmonary disease | 737 (9.86) | 4,183 (18.66) | <0.001 |
Bronchiectasis | 59 (0.79) | 508 (2.27) | <0.001 |
Idiopathic pulmonary fibrosis | 0 (0.00) | 0 (0.00) | - |
Coronary artery disease | 417 (5.58) | 2,685 (11.98) | <0.001 |
Acute respiratory failure | 1,956 (26.17) | 1,871 (8.35) | <0.001 |
AKI without HD | 41 (0.55) | 96 (0.43) | 0.197 |
CKD without HD | 352 (4.71) | 230 (1.03) | <0.001 |
Obesity | 1 (0.01) | 3 (0.01) | 0.999 |
Liver cirrhosis | 324 (4.34) | 484 (2.16) | <0.001 |
Heart failure | 339 (4.54) | 1,501 (6.70) | <0.001 |
Ventilator dependency | 962 (12.87) | 792 (3.53) | <0.001 |
HD | 3,699 (49.50) | 3,705 (16.53) | <0.001 |
Immunocompromised | 1 (0.01) | 2 (0.01) | 0.739 |
CCI_R | 0.13±0.42 | 0.11±0.38 | <0.001 |
Frequency of pneumonia visits | 0.999 | ||
1–2 | 2,016 (26.98) | 6,048 (26.98) | |
≥3 | 5,457 (73.02) | 16,371 (73.02) | |
Covariates | |||
Season | <0.001 | ||
Spring (Mar-May) | 1,902 (25.45) | 5,961 (26.59) | |
Summer (Jun-Aug) | 1,694 (22.67) | 4,214 (18.80) | |
Autumn (Sep-Nov) | 1,635 (21.88) | 3,909 (17.44) | |
Winter (Dec-Feb) | 2,242 (30.00) | 8,335 (37.18) | |
Location | <0.001 | ||
Northern Taiwan | 2,694 (36.05) | 7,704 (34.36) | |
Middle Taiwan | 2,046 (27.38) | 6,282 (28.02) | |
Southern Taiwan | 2,304 (30.83) | 6,541 (29.18) | |
Eastern Taiwan | 408 (5.46) | 1,769 (7.89) | |
Outlets islands | 21 (0.28) | 123 (0.55) | |
Urbanization level | <0.001 | ||
1 (the highest) | 3,195 (42.75) | 6,465 (28.84) | |
2 | 3,067 (41.04) | 9,214 (41.10) | |
3 | 310 (4.15) | 1,988 (8.87) | |
4 (the lowest) | 901 (12.06) | 4,752 (21.20) | |
Level of care | <0.001 | ||
Medical center | 3,296 (44.11) | 4,647 (20.73) | |
Regional hospital | 2,464 (32.97) | 7,030 (31.36) | |
Local hospital | 1,713 (22.92) | 10,742 (47.91) |
Variables | Crude HR | 95% CI | p* | Adjusted HR | 95% CI | p* |
---|---|---|---|---|---|---|
With ICU stay (reference: without) | 3.371 | 3.093–3.675 | <0.001 | 3.454 | 3.158–3.777 | <0.001 |
Times of ICU stay: 1–3 (reference: without) | ||||||
Times of ICU stay: ≥4 (reference: without) | ||||||
Male (reference: female) | 1.095 | 1.015–1.181 | 0.020 | 1.111 | 1.028–1.201 | 0.008 |
Age ≥65 years (reference: age of 50–64) | 1.762 | 1.680–1.854 | <0.001 | 1.863 | 1.768–1.968 | 0.012 |
Hypertension (reference: without) | 1.847 | 1.776–1.924 | <0.001 | 1.742 | 1.677–1.812 | <0.001 |
Diabetes mellitus (reference: without) | 1.809 | 1.737–1.888 | <0.001 | 1.783 | 1.712–1.861 | <0.001 |
Stroke (reference: without) | 2.631 | 2.418–2.863 | <0.001 | 2.164 | 1.982–2.363 | <0.001 |
Cerebral atherosclerosis (reference: without) | 3.729 | 2.442–4.402 | <0.001 | 2.187 | 1.625–2.944 | <0.001 |
Fracture of lower limbs (reference: without) | 0.777 | 0.609–0.993 | 0.043 | 0.771 | 0.602–1.988 | 0.039 |
Cancer (reference: without) | 1.400 | 1.348–1.469 | <0.001 | 1.373 | 1.319–1.435 | <0.001 |
Bronchiectasis | 0.434 | 0.297–0.634 | <0.001 | 0.496 | 0.336–0.733 | <0.001 |
Coronary artery disease (reference: without) | 1.638 | 1.557–1.731 | <0.001 | 1.649 | 1.566–1.744 | <0.001 |
Acute respiratory failure (reference: without) | 0.570 | 0.511–0.637 | <0.001 | 1.642 | 1.568–1.725 | <0.001 |
AKI without HD (reference: without AKI) | 1.317 | 1.202–1.498 | <0.001 | 1.384 | 1.244–1.605 | <0.001 |
Liver cirrhosis (reference: without) | 1.481 | 1.365–1.632 | <0.001 | 1.587 | 1.445–1.776 | <0.001 |
Heart failure (reference: without) | 1.519 | 1.438–1.614 | <0.001 | 1.601 | 1.506–1.714 | <0.001 |
Ventilator dependency (reference: without) | 1.486 | 1.431–1.549 | <0.001 | 1.531 | 1.464–1.607 | <0.001 |
CCI_R | 1.121 | 1.024–1.227 | 0.013 | 0.926 | 0.846–1.013 | 0.093 |
CCI_R score 1–3 (reference: without) | ||||||
CCI_R score ≥4 (reference: without) | ||||||
Frequency of ICU admission 1–2 (reference: without) | 3.124 | 2.984–3.339 | <0.001 | |||
Frequency of ICU admission ≥3 (reference: without) | 4.650 | 3.375–4.121 | <0.001 | |||
Frequency of pneumonia visits ≥3 (reference: 1–2 visits) | 1.297 | 1.164–1.423 | <0.001 | 1.124 | 1.065–1.279 | 0.011 |
Autumn (reference: spring) | 0.859 | 0.773–0.955 | 0.005 | 0.859 | 0.772–0.955 | <0.001 |
Urbanization level 1 (reference: level 4) | 0.956 | 0.859–1.065 | 0.413 | 1.773 | 1.041–1.320 | 0.009 |
Urbanization level 2 (reference: level 4) | 0.910 | 0.825–1.005 | 0.063 | 1.130 | 1.018–1.255 | 0.022 |
Urbanization level 3 (reference: level 4) | 0.759 | 0.640–0.901 | 0.002 | 0.793 | 0.668–0.942 | 0.008 |
Medical center (reference: local hospital) | 1.490 | 1.354–1.640 | <0.001 | 1.514 | 1.241–1.797 | <0.001 |
Regional hospital (reference: local hospital) | 1.007 | 0.916–1.106 | 0.191 | 1.121 | 1.059–1.788 | <0.001 |
Adjusted for the variables listed in Table 1. ICU, intensive care unit; PYs, person-years; adjusted HR, adjusted Hazard ratio; CI, confidence interval; NT$, New Taiwan Dollars; AKI, acute kidney injury, CKD, chronic kidney disease; HD, hemodialysis; CCI_R, Charlson Comorbidity Index, dementia removed