Elderly ICU patients had the highest mortality, but their mortality decreased significantly from 19.5% in 2014 to 8.8% in 2021 (OR 0.86 per year, p<0.001) without a rise in real costs.
Cohort (n=31,535)
Elderly ICU mortality in China significantly declined from 2014 to 2021 without an increase in inflation-adjusted costs, though surgical interventions substantially increased expenses in this demographic.
Odds Ratio: 0.86
Absolute Event Rate: 8.8% vs 19.5%
p-value: p=<0.001
Background/Objectives: Elderly patients represent a growing proportion of ICU admissions, raising concerns about outcomes and healthcare costs. Evidence from China remains limited, yet understanding cost and mortality patterns is critical for optimizing care in aging populations. Methods: We retrospectively analyzed 31,535 ICU patients admitted from 2014 to 2021. After 1:1:1 matching on severity, comorbidities, sex, and admission type, three groups were formed: elderly (≥80 years), older (65–79 years), and younger (16–64 years), with 3398 patients each. Costs were inflation-adjusted, and outcomes compared across groups with appropriate statistical models. Results: Elderly patients accounted for 11.5% of admissions, had the longest ICU stay (4.5 vs. 3.8 vs. 3.1 days, p < 0.001), and the highest ICU (11.5%) and hospital (13.5%) mortality. Among non-surgical patients, elderly incurred the lowest costs; however, surgery reversed this pattern, producing a 124% increase. Expenditures were mainly driven by drugs and consumables. From 2014 to 2021, consumables rose from 32.0% to 42.0% of total costs, whereas drug costs declined. Inflation-adjusted hospital costs remained stable over time, while mortality among elderly patients decreased significantly (19.5% in 2014 vs. 8.8% in 2021; OR 0.86 per year, p < 0.001). Conclusions: Elderly ICU patients demonstrate unique cost and outcome profiles. While non-surgical elderly patients are less costly, surgery substantially increases expenses. Mortality declined over time without a rise in real costs, suggesting improved efficiency of critical care. These findings support tailored resource allocation and policy planning for aging ICU populations.
Zhu et al. (2026) conducted a cohort in ICU admission (n=31,535). Elderly age (≥80 years) vs. Older (65-79 years) and younger (16-64 years) age was evaluated on Mortality among elderly ICU patients (2021 vs 2014) (OR 0.86 per year, p=<0.001). Elderly ICU patients had the highest mortality, but their mortality decreased significantly from 19.5% in 2014 to 8.8% in 2021 (OR 0.86 per year, p<0.001) without a rise in real costs.