Death by stroke single largest cause of inpatient mortality at RGGGH: Study

CHENNAI: Stroke has emerged as the leading cause of inpatient deaths at Rajiv Gandhi Government General Hospital (RGGGH), followed by cancer and ischaemic heart disease, according to a landmark study that offers the first comprehensive analysis of mortality patterns at a government tertiary care hospital in Tamil Nadu and highlights the growing dominance of non-communicable diseases over infectious illnesses.

The retrospective study published in the inaugural issue of the Journal of Madras Medical College-Medicine analysed inpatient deaths recorded at RGGGH, attached to Madras Medical College, between May 2023 and April 2024. The researchers said the findings reflect India's ongoing epidemiological transition, with chronic diseases accounting for a substantial proportion of hospital deaths, while also underscoring the need for stronger preventive healthcare, timely referrals and improved surveillance of mortality trends.

During the one-year study, the hospital registered 1,40,793 admissions and 7,954 deaths, translating into an overall in-hospital mortality rate of 5.6%. Of these, 7,752 deaths were included in the analysis after excluding brought-dead cases and records with incomplete clinical information.

The study identified stroke as the single largest cause of death, accounting for 1,096 fatalities, or 14.1% of all inpatient deaths. Of these, 556 patients died due to ischaemic stroke while haemorrhagic stroke claimed 540.

Cancer was the second leading cause, with 698 deaths (9%), followed by ischaemic heart disease with 630 deaths (8.1%), decompensated chronic liver disease with 610 deaths (7.9%) and road traffic accidents with 598 deaths (7.7%). Collectively, these five conditions accounted for 46.8% of all inpatient deaths analysed.

"The mortality pattern in this study shows a predominance of stroke, cancer and cardiovascular disease as the causes. This observation highlights the rising burden of non-communicable diseases and their impact on mortality, " the authors said.

When classified according to the International Classification of Diseases (ICD-11), ailments of the nervous system emerged as the largest category, contributing 19.9% of all deaths. Diseases of the circulatory system accounted for 14.4%, followed by external causes of morbidity and mortality, including accidents and injuries, at 13.2%. Digestive diseases contributed 10.4%, infectious and parasitic diseases 9.9%, cancers 9%, genitourinary diseases 8.2%, respiratory diseases 7.9% and endocrine, nutritional and metabolic disorders 4.3%.

The analysis also revealed a clear demographic pattern. Men accounted for 5,169 deaths, or 66.7% of all fatalities, while women accounted for 2,583 deaths. The highest mortality was recorded among patients aged 51 to 60 years, who constituted 24.3% of all deaths, followed by those aged 61 to 70 years. Overall, nearly 70% of the deceased were 45 years and above.

One of the study's most striking findings relates to the timing of deaths after admission. More than half of the patients, 54.4%, died within the first 72 hours of admission, including 13.7% who died on the day they reached the hospital. Nearly 75.7% of all deaths occurred within the first week of hospitalisation.

The researchers said the trend warrants a closer evaluation of whether delayed referrals, late presentation of critically ill patients or suboptimal management before transfer contributed to the high proportion of early deaths. As RGGGH serves as the principal referral centre for northern Tamil Nadu, it receives critically ill patients from more than 500 government and private hospitals across the State.

Beyond the five leading causes, the study identified chronic kidney disease as another significant contributor, accounting for 471 deaths, while sepsis claimed 349 lives. Among infectious diseases, tuberculosis caused 144 deaths, infectious meningitis 73, HIV-related illnesses 60 and leptospirosis 10.

The cancer profile reflected the increasing burden of malignancies, with haematological cancers accounting for the highest number of deaths, followed by lung cancer, metastatic cancers of unknown primary origin, brain and central nervous system tumours and stomach cancer.

Among respiratory illnesses, pneumonitis caused 264 deaths, chronic obstructive pulmonary disease accounted for 134 deaths and respiratory failure for 101. In endocrine and metabolic disorders, diabetic ketoacidosis alone resulted in 214 deaths, while uncontrolled diabetes mellitus accounted for another 70. Diabetic foot syndrome was responsible for 174 deaths under circulatory diseases, highlighting the impact of poorly controlled diabetes.

The study also pointed to the growing burden of alcohol-related liver disease, as it emerged as the dominant contributor to deaths from decompensated chronic liver disease. The researchers linked this to changing lifestyle patterns, increasing alcohol consumption and the rising prevalence of liver disorders in the country.

Road traffic accidents remained the leading external cause of death, particularly among young men. The researchers also flagged poisoning as an emerging concern, noting that paraquat poisoning accounted for the largest share of poisoning-related deaths. Given its extremely high fatality rate and increasing use in suicide attempts, the study said the trend warrants urgent public health attention.

The authors noted that the findings broadly mirror national and global estimates showing non-communicable diseases replacing infectious diseases as the leading causes of mortality. At the same time, they observed that conditions such as alcohol-related liver disease and paraquat poisoning require focused interventions in Tamil Nadu.

Conducted at one of Asia's oldest hospitals, RGGGH houses about 3,300 beds, 49 speciality departments and 21 intensive care units, besides handling nearly 10,000 outpatient visits every day.

The researchers described the study as the first detailed assessment of inpatient mortality in a government tertiary care hospital in southern India.

Calling for stronger public health interventions, the authors stressed the need to intensify prevention and early detection of stroke, cardiovascular diseases, cancers and diabetes through improved control of hypertension, dyslipidaemia and other risk factors. They also recommended strengthening road safety measures, establishing robust hospital-based mortality surveillance systems and integrating institutional data with national health databases to support evidence-based health planning.

The study acknowledged that it did not include paediatric and most obstetric cases because those patients are treated in separate institutions attached to Madras Medical College. It also noted that disease-specific case-fatality rates could not be calculated since only records of deceased patients were analysed.

"Improved surveillance for hospital-based mortality and integrating it with national health database systems may be helpful to improve evidence-based planning. Multicentre population-based studies should be conducted to verify these results, " the authors concluded.

Highlights

* First comprehensive mortality study from a government tertiary care hospital in Tamil Nadu and southern India

* Hospital: Rajiv Gandhi Government General Hospital

Period of the study - May 2023-April 2024

1,40,793 admissions

7,954 total deaths

7,752 records analysed

5.6% overall in-hospital mortality rate

66.7% deaths were of men

51-60 age group recorded highest mortality

70% of deaths were of people above 45

54.4% patients died within 72 hours of admission

75.7% died within the first week of hospitalisation