Poor Self-Rated Health Influences Hospital Service Use in Hospitalized Inpatients With Chronic Conditions in Taiwan

Health Service Utilization and Its Determinants among Senior Citizens in the Semiurban Area of Western Nepal: A Cross-Sectional Study

Background

Senior citizens are usually infected by multiple chronic conditions and other health problems. Health needs and demand for healthcare services increase with age. However, healthcare services and facilities and their utilization are limited, particularly in developing countries.

Aims

To identify the utilization of health services among senior citizens and their contributing factors.

Methods

A cross-sectional analytic study was conducted among 293 senior citizens of the Kushma municipality, Nepal, from June to December 2019. A structured questionnaire was used as a data collection tool using a multistage sampling technique. Face-to-face interviews were conducted to collect data on the interview schedule. Reliability and validity were maintained by applying different strategies and carefully developing tools, pretesting, double entry, and validation. Data entry, management, and analysis were performed using Epi Data and SPSS software. Research ethics were maintained. Descriptive and inferential statistical tests were performed to infer the findings.

Results

Study participants had a mean age (±SD) of 70.08 (±7.6) years and had various preexisting chronic diseases such as hypertension (46%), gastritis (41.9%), arthritis (34.3%), and asthma (28.7%). Only eight out of ten senior citizens had used health services in the past year. Factors such as age, ethnicity, residency, household income, family support, the presence of chronic diseases, and being under medication were found to have statistically significant associations with the utilization of health services among senior citizens with a p value less than 0.05 and 95% confidence interval.

Conclusions

A remarkable proportion of older people reported using health services in the last year. However, a substantial proportion did not utilize health services that require further interventions to enable them. Efforts are required to promote the health and well-being of Nepal's growing elderly population, including potential enhancements to rural healthcare infrastructure by policymakers.

Self-rated health as a predictor of hospitalizations in patients with bipolar disorder or major depressive disorder: A prospective cohort study of the UK Biobank

BACKGROUND

To determine the association between self-rated health (SRH) and subsequent all-cause hospitalizations in patients with bipolar disorder (BD) or major depression (MDD).

METHODS

We conducted a prospective cohort study on people with BD or MDD in the UK from 2006 to 2010 using UK Biobank touchscreen questionnaire data and linked administrative health databases. The association between SRH and 2-year all-cause hospitalizations was assessed using proportional hazard regression after adjustment for sociodemographics, lifestyle behaviors, previous hospitalization use, the Elixhauser comorbidity index, and environmental factors.

RESULTS

A total of 29,966 participants were identified, experiencing 10,279 hospitalization events. Among the cohort, the average age was 55.88 (SD 8.01) years, 64.02 % were female, and 3029 (10.11 %), 15,972 (53.30 %), 8313 (27.74 %), and 2652 (8.85 %) reported excellent, good, fair, and poor SRH, respectively. Among patients reporting poor SRH, 54.19 % had a hospitalization event within 2 years compared with 22.65 % for those having excellent SRH. In the adjusted analysis, patients with good, fair, and poor SRH had 1.31 (95 % CI 1.21-1.42), 1.82 (95 % CI 1.68-1.98), and 2.45 (95 % CI 2.22, 2.70) higher hazards of hospitalization, respectively, than those with excellent SRH.

LIMITATIONS

Selection bias can exist as our cohort cannot fully represent all the BD and MDD cases in the UK. Moreover, the causality is questionable.

CONCLUSION

SRH was independently associated with subsequent all-cause hospitalizations in patients with BD or MDD. This large study underscores the need for proactive SRH screening in this population, which might inform resource allocation in clinical care and enhance high-risk population detection.

Polypharmacy and the Change of Self-Rated Health in Community-Dwelling Older Adults

Polypharmacy is associated with poorer self-rated health (SRH). However, whether polypharmacy has an impact on the SRH progression is unknown. This study investigates the association of polypharmacy with SRH change in 1428 participants of the Berlin Initiative Study aged 70 years and older over four years. Polypharmacy was defined as the intake of ≥5 medications. Descriptive statistics of SRH-change categories stratified by polypharmacy status were reported. The association of polypharmacy with being in SRH change categories was assessed using multinomial regression analysis. At baseline, mean age was 79.1 (6.1) years, 54.0% were females, and prevalence of polypharmacy was 47.1%. Participants with polypharmacy were older and had more comorbidities compared to those without polypharmacy. Over four years, five SRH-change categories were identified. After covariate adjustment, individuals with polypharmacy had higher odds of being in the stable moderate category (OR 3.55; 95% CI [2.43-5.20]), stable low category (OR 3.32; 95% CI [1.65-6.70]), decline category (OR 1.87; 95% CI [1.34-2.62]), and improvement category (OR 2.01; [1.33-3.05]) compared to being in the stable high category independent of the number of comorbidities. Reducing polypharmacy could be an impactful strategy to foster favorable SRH progression in old age.

Associated factors of doctor visits made by urban-dwelling older adults in Sri Lanka: an application of Anderson's model of health service utilization

Background

Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka.

Methods

A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression.

Results

Participants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level.

Conclusions

Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03249-3.

Preventive health behaviors among people with suicide ideation using nationwide cross-sectional data in South Korea

This study aimed to investigate the association between suicide ideation and health-related behaviors and preventive health service use behaviors. We used data from the 2017 Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative survey. The final sample included 4486 participants aged 40 years or older. Preventive health behaviors were assessed for smoking, high-risk drinking, physical activities, regular meal intake, influenza vaccination, general health examination, and cancer screening. Logistic regression was used to examine the association between suicide ideation and preventive health behaviors with a series of adjustments for covariates. In general, suicide ideation was associated with unfavorable outcomes of preventive health behaviors, except for flu vaccination. For example, the crude prevalence of suicide ideation and non-suicide ideation groups were 54.3% vs. 43.7% for flu vaccination, 23.1% vs. 41.6% for physical activity, and 24.8% vs. 18.6% for high-risk alcohol drinking. After adjustment for covariates, the associations of suicide ideation with behaviors remained significant for physical activity (OR 0.52, 95% CI 0.34–0.81) and high-risk alcohol drinking (OR 2.22, 95% CI 1.34–3.69). Suicide ideation leads to the disruption of self-management of health behaviours, especially for physical activity and high-risk alcohol drinking, independently of depressive feelings.

The Health-Seeking Behavior among Malaysian Adults in Urban and Rural Areas Who Reported Sickness: Findings from the National Health and Morbidity Survey (NHMS) 2019

Understanding care-seeking behavior among urban and rural populations can help to support the planning and implementation of appropriate measures to improve health in the community. This study aims to determine the factors associated with the health-seeking behavior among Malaysian adults in urban and rural areas who reported sickness. This study used data of Malaysian adults aged 18 years and over from the National Health and Morbidity Survey 2019; a cross-sectional, national household survey that targeted all non-institutionalized residents in Malaysia. Respondent’s characteristics and health-seeking behavior were described using complex sample descriptive statistics. Multivariable logistic regression analysis was conducted to examine the association between potential factors (sociodemographic characteristics, enabling, and health need) and health-seeking behaviors (seeking treatment from healthcare practitioners and self-medication). A total of 10,484 respondents, estimated to represent 18.9 million Malaysian adults aged 18 years and over, were included in the analysis. Prevalence of seeking treatment from healthcare practitioners and self-medication among Malaysian adults with self-reported sickness were 57.3% and 23.3%, respectively. Self-reported sickness among both the urban and rural populations who rated their health as poor to very poor was more likely to seek treatment than those who rated good to excellent. However, among the urban population, those who rated their health as poor to very poor were less likely to self-medicate. Among the urban population, government employees were more likely to seek treatment, and being without formal education significantly increased the likelihood to self-medicate. Among the rural population, those with at least one long-term condition were more likely to seek treatment than those with none. Understanding the factors which influence health-seeking behavior among the urban and rural population could close the gaps in healthcare utilization among the population in Malaysia.

Sexual Violence as a Key Predictor of Depressive Symptoms in Women: Korean Longitudinal Survey of Women and Families

The purpose of this study was to identify the influence of violence on depressive symptoms in women. We analyzed panel data from the Korean Longitudinal Survey of Women and Families (n  =  6,632). Exposure to sexual violence was a significant predictor of the onset of depressive symptoms. After adjusting for all covariates, other predictors included the perception of a poor or very poor health status than normal and participants in their 40s and 50s versus participants younger than 40 years. Assessing exposure to sexual violence might be beneficial for evaluating depressive symptoms in women who are newly diagnosed with depression.

Associations between degree-of-worry, self-rated health and acute hospitalisation after contacting a medical helpline: a Danish prospective cohort study

OBJECTIVES

Self-rated health (SRH) is a strong predictor for healthcare utilisation among chronically ill patients. However, its association with acute hospitalisation is unclear. Individuals' perception of urgency in acute illness expressed as degree-of-worry (DOW) is however associated with acute hospitalisation. This study examines DOW and SRH, respectively, and their association with acute hospitalisation within 48 hours after calling a medical helpline.

DESIGN

A prospective cohort study.

SETTING

The Medical Helpline 1813 (MH1813) in the Capital Region of Denmark, Copenhagen.

PARTICIPANTS

Adult (≥18 years of age) patients and relatives/close friends calling the MH1813 between 24 January and 9 February 2017. A total of 6812 callers were included.

OUTCOME MEASURES

The primary outcome measure was acute hospitalisation. Callers rated their DOW (1=minimum worry, 5=maximum worry) and SRH (1=excellent, 5=poor). Covariates included age, sex, Charlson Comorbidity Score and reason for calling. Logistic regression was conducted to measure the associations in three models: (1) crude; (2) age-and-sex-adjusted; (3) full fitted model (age, sex, comorbidity, reason for calling, DOW/SRH).

RESULTS

Of 6812 callers, 492 (7.2%) were acutely hospitalised. Most callers rated their health as being excellent to good (65.3%) and 61% rated their worry to be low (DOW 1-3). Both the association between DOW and acute hospitalisation and SRH and acute hospitalisation indicated a dose-response relationship: DOW 1=ref, 3=1.8 (1.1;3.1), 5=3.5 (2.0;5.9) and SRH 1=ref, 3=0.8 (0.6;1.4), 5=1.6 (1.1;2.4). The association between DOW and acute hospitalisation decreased slightly, when further adjusting for SRH, whereas the estimates for SRH weakened markedly when including DOW.

CONCLUSIONS

DOW and poor SRH were associated with acute hospitalisation. However, DOW had a stronger association with hospitalisation than SRH. This suggests that DOW may capture acutely ill patients' perception of urgency better than SRH in relation to acute hospitalisation after calling a medical helpline.

TRIAL REGISTRATION NUMBER

NCT02979457.

Risk factors of readmission after geriatric hospital care: An interRAI-based cohort study in Finland

PURPOSE

To identify risk factors for readmission after geriatric hospital care.

METHODS

A retrospective cohort study of 1,167 community-dwelling patients aged ≥70 years who were hospitalised in two geriatric hospitals and discharged to their homes over a three-year period. We combined the results of the interRAI-post acute care instrument (interRAI-PAC) with hospital discharge records. Factors associated with readmissions within 90 days following discharge were analysed using logistic regression analysis.

RESULTS

The patients' mean age was 84.5 (SD 6.2) years, and 71% (n = 827) were women. The 90-day readmission rate was 29.5%. The risk factors associated with readmission in the univariate analysis were as follows: age, admission from home vs. acute care hospital, Alzheimer's disease, unsteady gait, fatigue, unstable conditions, Activities of Daily Living Hierarchy Scale (ADLH) score, Cognitive Performance Scale (CPS) score, body mass index (BMI), frailty index, bowel incontinence, hearing difficulties, and poor self-rated health. In the multivariable analysis, age of ≥90 years, ADLH ≥1, unsteady gait, BMI <25 or ≥30 kg/m 2 , and frailty remained as risk factors for readmission. Surgical operation during the treatment period was associated with a lower readmission risk.

CONCLUSIONS AND IMPLICATIONS

InterRAI-PAC performed upon admission to geriatric hospitals revealed patient-related risk factors for readmission. Based on the identified risk factors, we recommend that the patient's functional ability, activities of daily living (ADL) needs, and individual factors underlying ADL disability, as well as nutritional and mobility problems should be carefully addressed and managed during hospitalization to diminish the risk for readmission.

Cost-related unmet need for healthcare services in Kenya

Background

The assessment of unmet need is one way to gauge inequities in access to healthcare services. While there are multiple reasons for unmet need, financial barriers are a major reason particularly in low- and middle-income countries where healthcare systems do not offer financial protection. Moreover, accessibility and affordability are paramount in achieving universal health coverage. This study examines the extent of unmet need in Kenya due to financial barriers, the associated determinants, and the influence of regional variations.

Methods

We use data from the 2013 Kenya household health expenditure and utilization (KHHEUS) cross sectional survey. Self-reported unmet need due to lack of money and high costs of care is used to compute the outcome of interest. A multilevel regression model is employed to assess the determinants of cost-related unmet need, confounding for the effect of variations at the regional level.

Results

Cost-related barriers are the main cause of unmet need for outpatient and inpatient services, with wide variations across the counties. A positive association between county poverty rates and cost-related unmet is noted. Results reveal a higher intraclass correlation coefficient (ICC) of 0.359(35.9%) for inpatient services relative to 0.091(9.1%) for outpatient services. Overall, differences between counties accounted for 9.4% (ICC ~ 0.094) of the total variance in cost-related unmet need. Factors that positively influence cost-related unmet need include older household heads, inpatient services, and urban residence. Education of household head, good self-rated health, larger household size, insured households, and higher wealth quintiles are negatively associated with cost-related unmet need.

Conclusion

The findings underscore the important role of cost in enabling access to healthcare services. The county level is seen to have a significant influence on cost-related unmet need. The variations noted in cost-related unmet need across the counties signify the existence of wide disparities within and between counties. Scaling up of health financing mechanisms would fundamentally require a multi-layered approach with a focus on the relatively poor counties to address the variations in access. Further segmentation of the population for better targeting of health financing policies is paramount, to address equity in access for the most vulnerable and marginalized populations.

Association of Self-Perceived Health with Social and Psychological Environment, the Mode of Life and Cardiovascular Risk Markers in Middle-Aged Men – Residents of Moscow

Aim. Estimation of the correlation of self-perceived health (SPH) with social and psychological environment, lifestyle and cardiovascular risk markers in middle-aged men.

Material and methods. A total of 301 men aged 41-44 years were examined. The study included clinical examination and interrogation using a standard form. Physical activity was estimated with the help of the International Physical Activity Questionnaires, the level of psychosocial stress – with the Reeder scale, signs of vital exhaustion with the Maastricht Questionnaire Vital Exhaustion Scale. To evaluate the mode and quality of life the questionnaire developed by I.A. Gundarev was used. All the examined people were divided in three groups according to the distribution of SPH rates by tertiles: the group 1 (from 7 to 60 scores) – bad health, the group 2 (61-79 scores) – satisfactory and the group 3 (80-100 scores) – good health.

Results. Parameters of the social and psychological environment of middle-aged men were the basic determinates of their health self-perception, at that majority of the indices of the quality and mode of life were independent of family material well-being. Bad SPH in middle-aged men was determined by such parameters as: increased blood pressure (BP), abdominal obesity, excessive alcohol consumption, psychosocial stress, vital exhaustion, low physical activity. Material wealth influenced systolic BP level, the waist/hips circumference ratio, a number of cigarettes per day and thus the SPH status. The most significant determinants of SPH were the level of personal happiness, nervous stress at work, support by family, sports activities, working conditions, total cholesterol level, satisfaction with own work.

Conclusion. When working on programs focused on public health improvement the social, psychological and behavioral determinants of health selfperception must be considered.

Spiritual practices and effects of spiritual well-being and depression on elders' self-perceived health

As the population is quickly ageing, strategies for helping elders to maintain and promote good health and well-being are urgently needed. Self-perceived health is a powerful predictor of mortality, physical morbidity, and disability among elderly people. Delivering culturally competent care is necessary for taking care of elders. Self-perceived health is a powerful predictor of mortality, physical morbidity, and disability among elderly people. Spiritual well-being has been found particularly important for older adults' overall health. This descriptive, correlational and predictive study used data that was collected from a convenience sample (N = 150) to examine the effects of spiritual well-being on the relationship between depression and self-perceived health, and to describe spiritual practices commonly used by Taiwanese elders. Findings from this study revealed that spiritual well-being was positively correlated with self-perceived health, negatively associated with depression, and significantly mediated the relationship between depression and self-perceived health. Relaxation and exercise were the most commonly used spiritual practices by Taiwanese elders. Findings from this study support the important role of spiritual well-being in elders' health and add to the body of knowledge about the spiritual practices used by Taiwanese elders. Nurses and health care providers should deliver culturally appropriate spiritual care to enhance spiritual well-being for elders to maintain good health for diverse elder population.

Hypertension Status and Associations with Self-Rated Health and General Practitioner Health Seeking in a Rural Australian Cohort

Hypertension is the most frequently managed condition by Australian general practitioners (GP). Knowledge of hypertension and blood pressure (BP) values may motivate individuals to seek GP management. Our study aims to determine the associations of knowledge of BP values, BP perception, GP health seeking, and self-rated health (SRH) in a rural population. Two-hundred and seventy-eight (278) residents responded to the health survey on socio-demographic profile, medical history, BP knowledge and perception, SRH, and GP visit frequency. Associations were evaluated using Chi-squared test and multivariate logistic regression. Cohort mean age was 63.6 (12.4) years with 63.3% females. Hypertension (37.8%) was the most common condition. GP visits were made at least once every month (19.1%), every 2–6 months (35.6%), >6 months (11.5%), or only when needed (29.5%). Univariate analyses showed age, education, alcohol consumption, comorbidities, hypertension status, and SRH were significantly associated with visit frequency. After adjustments, hypertension status (OR = 3.6, 95% CI [1.7, 7.9]) and poor SRH (OR = 3.1, 95% CI [1.4, 7.0]) were significantly associated with frequent monthly visits. Our cohort demonstrated that having hypertension and poor self-rated health were associated with frequent monthly GP visits. The perception of high blood pressure does not drive seeking additional GP input.

Pain and self-rated health among middle-aged and older Canadians: an analysis of the Canadian community health survey-healthy aging

Background

Pain is an important health problem adversely affecting functionality and quality of life. Though self- rated health (SRH) is a major predictor of mortality, its relationship with pain is not well understood. We explore 1) how pain and age interact to influence SRH, and 2) provincial variations in SRH across Canada.

Methods

We analyzed cross-sectional data from Statistics Canada’s Canadian Community Health Survey-Healthy Aging (n = 30,685), which targeted those 45 years and older and was conducted from 2008 to 12-01 to 2009–11-30. The response rate was 74.4%.The topics covered included socio-demographics, well-being and chronic diseases. We performed both bivariate and multivariate analyses between each predictor and SRH; unadjusted and adjusted odds ratios and 95% confidence intervals are reported. Two-level logistic regression mixed model was used to account for provincial differences. An intraclass correlation coefficient was also computed.

Results

Slightly more than half of respondents (56.40%) were female. In bivariate analyses, those experiencing pain had an odds ratio of 0.20. Which means that the odds of reporting good self-rated health are 4 to 5 times lower for those with pain, compare to the odds of reporting good self-rated health among those without pain (p < 0.001). In multivariate analyses the highly educated, female gender, the never married or single and households with high yearly income were predictors of good health (p < 0.001). Those who reported depressive symptoms, the lonely, the obese, daily smokers and/or the stressed were less likely to rate their health as good (p < 0.001). The influence of pain on SRH was stronger among younger age groups (45–54 years) compared to older age groups (75-84 years, with an odds ratio of 3.53 [p < 0.001] versus 3.14 [p < 0.001]).

Conclusions

Pain, among other determinants, is associated with SRH. Individuals in rating their health may consider a variety of factors, some of which may not be apparent to health providers. We found that those who reported depressive symptoms, were daily smokers, the obese, the lonely, and/or having a stressful life were less likely to rate their health as good. No significant provincial variations in SRH in Canada was observed in this study.

Self-efficacy reduces the impact of social isolation on medical student's rural career intent

BACKGROUND

Social isolation in medical students is a subjective experience that may influence medical career decision making. Rural self-efficacy has been shown to influence rural career intentions following a rural clinical placement, however its impact on social isolation during a rural clinical placement has not been previously modeled. The objective of this study is to explore whether self-perception of social isolation is associated with rural career intent in rural medical students. Secondly, to determine whether self-efficacy influences the association between social isolation and rural career intent.

METHODS

2015 data, from a cross-sectional survey of the National Federation of Rural Australian Medical Educators (FRAME) study. Among 619 medical students attending rural clinical schools (RCS), rural career intent was assessed. This included intended rural location for either postgraduate medical specialist or generalist training or completion of that training. Self-efficacy beliefs in rural medical practice were based on a validated scale consisting of six questions. Social isolation was measured asking students whether they felt socially isolated during their RCS placement.

RESULTS

31.3% of surveyed students self-reported feeling socially isolated during their rural placement. Social isolation was associated with reduced rural career intent after controlling for gender, rural background, RCS preference, RCS support and wellbeing. In step-wise logistic regression the association between social isolation and rural intent disappeared with the inclusion of rural self-efficacy.

CONCLUSIONS

Social isolation during a rural clinical placement is commonly reported and is shown to reduce rural career intent. High levels of rural clinical self-efficacy reduce the effects of social isolation on future rural workforce intentions.

Making meaning around experiences in interventions: identifying meaningfulness in a group-based occupational therapy intervention targeting older people

There is a need to understand the underlying mechanisms at work within health promotion and occupational therapy interventions. The aim of this article was, therefore, to explore and describe how the participants of a group-based occupational therapy intervention with positive health outcomes created meaning of and around their experiences of the intervention. The studied intervention was part of the evaluation of a single-blinded, exploratory randomised controlled trial of three different interventions. A total of 19 participants between 77 and 82 years of age with experiences from the group-based intervention were interviewed, and the transcribed interviews were analysed from a constructivist approach. The results showed five different perspectives of meaning, including enjoyment, usefulness, togetherness, respect for individuality and self-reflection. Based on our findings, we argue that the possibility of getting information, sharing with others and having fun, and the ability to adjust the activities in the intervention so that they met the individual's needs, created meaning for the participants. Moreover, meeting with others supported the participants’ perspectives of themselves. The results are discussed in relation to the pervasive discourse of successful ageing, including how it was present but also challenged within the participants’ accounts of the intervention.

Elevated neutrophil to lymphocyte ratio predicts mortality in medical inpatients with multiple chronic conditions

Neutrophil to lymphocyte ratio (NLR) is an easy measurable laboratory marker used to evaluate systemic inflammation. Elevated NLR is associated with poor survival and increased morbidity in cancer and cardiovascular disease. However, the usefulness of NLR to predict morbidity and mortality in a hospital setting for patients with multiple chronic conditions has not been previously examined. In this study, we investigate the association between NLR and mortality in multimorbid medical inpatients. Two hundred thirty medical in-patients with chronic conditions were selected from a single academic medical center in Taiwan. Retrospective NLRs were calculated from routine full blood counts previously obtained during the initial hospital admission and at the time of discharge. Self-rated health (using a single-item question), medical disorders, depressive symptoms, and medical service utilization over a 1-year period were included in the analyses. Mortality outcomes were ascertained by reviewing electronic medical records and follow-up. The mortality rate at 2-year follow-up was 23%. Depression (odds ratio [OR] 1.9 [95% CI 1.0-3.7]), poor self-rated health (OR 2.1 [95% CI 1.1-3.9]), being hospitalized 2 or more times in the previous year (OR 2.3 [95% CI 1.2-4.6]), metastatic cancer (OR 4.7 [95% CI 2.3-9.7]), and chronic liver disease (OR 4.3 [95% CI 1.5-12.1]) were associated with 2-year mortality. The median (interquartile range) NLR at admission and discharge were 4.47 (2.4-8.7) and 3.65 (2.1-6.5), respectively. Two-year mortality rates were higher in patients with an elevated NLR at admission (NLR <3 = 15.5%, NLR >3 = 27.6%) and discharge (NLR < 3 = 14.7%, NLR >3 = 29.1%). Multivariate logistic regression demonstrated that an elevated NLR >3.0 at admission (OR 2.3 [95% CI 1.0-5.2]) and discharge (OR 2.3 [95% CI 1.1-5.0]) were associated with mortality independent of baseline age, sex, education, metastatic cancer, liver disease, depression, and previous hospitalization. Increased NLR is associated with mortality among medical inpatients with multiple chronic conditions. NLR may provide added value to predict both risk of mortality for the inpatients with chronic conditions, in addition to allowing predictions of likely hospital service needs such as re-admissions that are associated with long-term mortality.