Send to

Choose Destination
BMJ Open. 2019 May 1;9(4):e026443. doi: 10.1136/bmjopen-2018-026443.

Determinants of inappropriate admission of elderly people in county-level hospitals: a cross-sectional study in rural China.

Hu X#1,2, Gao H#1,2, Zhang Y1,2, Li H1,2, Su D1,2, Chang J1,2, Jiang D1,2, Lei S1,2, Chen Y1,2.

Author information

School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Province, Wuhan, Hubei, China.
Contributed equally



The purpose of this paper is to investigate the characteristics and determinants of inappropriate admission to hospital of elderly people in rural China.


A cross-sectional study of a comparison between the elderly and non-elderly groups of people.


The survey was conducted on the largest county-level general hospitals in four counties in central and western China.


A total of 652 rural patients admitted in hospitals were surveyed, who were divided into two groups according to age: elderly group (n=230, age ≥60 years) and non-elderly group (n=422, age <60 years).


The Chinese version of the appropriateness evaluation protocol was used to evaluate the inappropriate admission rates. The interactive regression models based on the relationship of age (elderly and non-elderly) with other factors and binary logistic regression models were used in the analysis of the specific factors and determinants of the inappropriate admission of elderly people.


The inappropriate admission rate for the rural elderly was 30%, which was lower than that of the non-elderly people (40.8%). Compared with the non-elderly group, women in the elderly group (OR=0.33, 95% CI 0.15 to 0.73) had a lower incidence of inappropriate admission, and elderly people with chronic diseases (OR=3.33, 95% CI 1.23 to 9.04) were more prone to being inappropriately admitted than non-elderly people with chronic diseases. The binary logistic regression analysis shows that county, age (OR=0.94. 95% CI 0.90 to 0.99), gender (OR=0.49, 95% CI 0.25 to 2.98), department and response to doctor's admission request were the determinants of the inappropriate admission of elderly patients.


The inappropriate admission rate of elderly people in rural China was high. We found that gender and chronic disease are the specific factors that were specific to non-elderly people. County, age, gender, department and response to a doctor's admission request had substantial influence on the inappropriate admission of the elderly in rural China.


elderly; health policy; inappropriate admission; quality in health care; rural china

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center