Introduction: The Queen Elizabeth Central Hospital (QECH) is the largest hospital in Malawi; approximately 8,000 patients are admitted yearly on the adult medical wards. Infectious disease admissions dominate, however there is an emerging epidemic of non-communicable diseases. QECH has an electronic medical record (EMR) which records information on demographics, HIV status, diagnosis and outcome (discharged alive/died).
Method: Diagnosis, HIV status, length of stay and outcome was extracted from the EMR and analysed according to age for the first 4 months of 2013.
Results: There were 2142 admissions, of which 17% were ≥55 years. The 10 commonest diagnoses and mortality by diagnosis differed across age categories (table). Age was associated with all-cause mortality (p = 0.0212), peaking at 30% in the 50-54 age group. Analysis of the commonest diagnoses showed that pneumonia mortality was higher in those <45 years (15.7%) compared to those >45 years (8.7%), (p = 0.0249) whereas sepsis mortality increased with older age (p = 0.0230). Median length of stay (in live discharges) was 7 and 6 days respectively, among patients <55 years and 55 years (p = 0.05). Younger patients were more likely to know their HIV status (68% vs 42.2%) and if known were more likely to be HIV reactive (74.9% vs 46.4%).
Conclusions: These data reveal important differences in disease pattern, HIV prevalence and outcome between young and older adults. Further research is needed to understand the factors underlying these differences.