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Epidemiology of Chronic Critical Illness in Japan: A Nationwide Inpatient Database Study
Hiroyuki Ohbe1, Hiroki Matsui1, Kiyohide Fushimi2
1Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Insights
Chronic critical illness affects 9% of ICU patients in Japan, particularly the elderly. While mortality decreases, costs and patient dependence are rising.
Area of Science:
- Critical Care Medicine
- Public Health
- Health Economics
Background:
- The epidemiology of chronic critical illness (CCI) remains poorly understood.
- Estimating the prevalence, mortality, and economic impact of CCI is crucial for healthcare planning.
Purpose of the Study:
- To estimate the prevalence, mortality, and hospitalization costs of chronic critical illness in Japan.
- To identify demographic trends and outcomes associated with CCI.
Main Methods:
- A nationwide study using inpatient administrative data from 679 acute-care hospitals in Japan (April 2011-March 2018).
- Defined CCI as meeting specific clinical conditions (e.g., prolonged mechanical ventilation, tracheotomy, stroke, sepsis) and requiring ≥8 consecutive ICU days.
- Analyzed 2,395,016 ICU admissions.
Main Results:
- 9.0% (216,434) of ICU admissions met CCI criteria.
- Prolonged mechanical ventilation and sepsis were the most common conditions.
- In-hospital mortality was 28.6%; prevalence was 42.0 per 100,000, increasing with age.
- National estimates indicated ~47,000 CCI cases annually, with costs rising from $2.3 to $2.7 billion (2011-2017).
- In-hospital mortality decreased slightly, but patient dependence and decreased consciousness at discharge increased.
Conclusions:
- Chronic critical illness represents a significant clinical and economic burden in Japan, disproportionately affecting the elderly.
- Despite decreasing mortality, rising costs and increased patient dependence highlight the growing challenge of managing CCI.
- Healthcare systems must adapt to the increasing prevalence and long-term care needs of patients with chronic critical illness.
Objectives:
The epidemiology of chronic critical illness is not well known. We aimed to estimate the prevalence, mortality, and costs associated with chronic critical illness in Japan.
Design:
A nationwide inpatient administrative database study in Japan from April 2011 to March 2018.
Setting:
Six hundred seventy-nine acute-care hospitals with ICU beds in Japan.
Patients:
Adult patients who met our definition for chronic critical illness: one of six eligible clinical conditions (prolonged acute mechanical ventilation, tracheotomy, stroke, traumatic brain injury, sepsis, and severe wound) plus at least 8 consecutive days in an ICU.
Interventions:
None.
Measurements And Main Results:
Among 2,395,016 ICU admissions during the study period, 216,434 (9.0%) met the definition for chronic critical illness. The most common eligible condition was prolonged acute mechanical ventilation (73.9%), followed by sepsis (50.6%), tracheostomy (23.8%), and stroke (22.8%). Overall inhospital mortality was 28.6%. The overall age-specific population prevalence was 42.0 per 100,000. The age-specific population prevalence steadily increased with age, reaching 109.6 per 100,000 in persons aged greater than 85 years. With extrapolation to national estimates in Japan, there were 47,729 chronic critical illness cases in 2011 and the number remained similar at 46,494 cases in 2017. Hospitalization costs increased gradually, rising from U.S.$2.3 billion in 2011 to U.S.$2.7 billion in 2017. Inhospital mortality decreased from 30.6% to 28.2%, whereas the proportion of patients with total/severe dependence increased from 29.6% to 33.2% and the proportion of patients with decreased consciousness at discharge increased from 18.7% to 19.6%.
Conclusions:
Using a nationwide inpatient database in Japan, we found substantial clinical and economic burdens of chronic critical illness in Japan. Chronic critical illness was particularly common in elderly people. Although inhospital mortality of chronic critical illness patients continues to decrease, costs and patients with dependence for activities of daily living or decreased consciousness at discharge are increasing.
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