Global number of patient harms rose significantly over last 3 decades

Key takeaways:

• The rise in cases of patient harms was highest among adults aged 65 to 69 years.
• PCPs should look to enhance their skills and awareness in preventing harms in older age groups, the study author said.

The global number of patient harms increased from 11.3 million to 18 million from 1990 to 2019, with cases substantially rising in developed countries like the United States, a study showed.

The data align with prior literature on increasingly occurring patient harms. For example, a study published last year in The New England Journal of Medicine reported that more than one in four patients admitted to hospitals in the U.S. were likely to experience a harmful event. These harms could be contributed to several factors, like low-value care and diagnostic errors.

In the current analysis published in BMJ Quality and Safety, Liangquan Lin, from the School of Marxism in China, used 1990 to 2019 Global Burden of Disease data to quantify incidence rates of adverse effects of medical treatment (AEMT) — defined as harm resulting from treatment, a procedure or other contact in a health care system — across 204 countries.

Lin told Healio that past research on trends of AEMT over time have used traditional methods, “which have limitations such as underreporting and data scarcity, especially in low-income and developing countries.”

Lin stratified data by sociodemographic index (SDI) quintiles, age groups and sex.

He found that the global number of patient harms increased by 59.3% during the study period, which greatly outpaced the global population growth during that time (44.6%).

The overall AEMT incidence rate in 2019 was 232.5 per 100,000 people, which equaled a 10.1% increase since 1990.

Additionally, the age standardized AEMT incidence rate was 233.3 per 100,000 in 2019, an increase of 4.4% from 1990.

High SDI countries like France and Germany saw overall incident rates jump from 515 to 822.7 per 100,000, for an increase of nearly 60%. In the U.S. specifically, cases increased by 1.31%.

In contrast, countries with lower SDI had an overall incident rate decline of 13.8%, from 154.6 to 140.6 per 100,000.

However, “the period effect showed a continuously rising incidence risk globally after 2002, with a significant upward trend in low SDI regions starting from 2012,” Lin noted.

Middle and older aged adults were most effected by rising AEMT trends, as the proportion of cases in those aged 50 to 74 years and 75 to 94 years increased. Those aged 65 to 69 years had the steepest increase in cases at 2% per year.

In comparison, cases among those aged younger than 1 year, 1 to 4 years, 5 to 9 years and 10 to 24 years dropped.

“As primary care coverage and medical service volume increase, the number of AEMT also increases,” Lin explained. “One potential reason for the occurrence of AEMT is the lack of standardized treatment protocols and insufficient oversight in primary care clinics, rural hospitals, and community health centers, leading to loopholes in medical practice.”

He added that primary care providers should enhance their skills and awareness in preventing AEMT, especially for older populations that might be at an increased risk.

“PCPs should also optimize the medical management of the elderly, such as rational drug use and prevention of complications, to reduce the incidence of AEMT among the elderly,” he said.

There were some study limitations, according to Lin. For example, lower SDI countries may lack reliable data on AEMT, which could possibly lead to underestimation of trends and bias.

“Expanding the research scope, not only analyzing the overall AEMT incidence but also further classifying different types of adverse reactions and investigating their specific trends, would allow for more targeted prevention measures,” he concluded.

References:

• Bates D, et al. N Engl J Med. 2024;doi:10.1056/NEJMsa2206117.
• Lin L. BMJ Qual Saf. 2024;doi:10.1136/bmjqs-2023-016971.
• Rise in global number of patient harms from 11 million to 18 million (59%) in 30 years. https://www.eurekalert.org/news-releases/1047519. Published June 11, 2024. Accessed June 18, 2024.