{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:40:29Z","timestamp":1776274829883,"version":"3.50.1"},"reference-count":44,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research Grants Council Research Impact Fund of the Hong Kong Special Administrative Region, China","award":["R4040-22"],"award-info":[{"award-number":["R4040-22"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,11]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>With an ageing population, understanding leading causes of hospitalisation in older adults is critical for care strategies. These leading causes may vary across residential settings and by seasonal patterns. This study examines the temporal trends of leading causes of hospitalisation among older adults in community-dwelling and nursing home settings, specifically comparing patterns during winter and summer seasons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants and main outcome measures<\/jats:title>\n                    <jats:p>A retrospective analysis of electronic medical records from Hong Kong public hospitals (2012\u20132018) was conducted for three million adults aged \u226565. Age-standardised and sex-standardised monthly hospitalisation rates and average annual percentage change (AAPC, representing the average yearly percentage change in rates) were examined for leading causes during summer and winter across settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among community-dwelling individuals, the top five causes in 2018 were symptoms, signs and abnormalities not classified elsewhere (NEC), neoplasms, genitourinary, circulatory and respiratory diseases in winter, with digestive diseases replacing respiratory diseases in summer. Symptoms, signs and abnormalities NEC (AAPC: 2.7% (95% CI 1.8% to 3.6%) in winter; 3.4% (2.8% to 4.0%) in summer), neoplasms (2.4% (1.4% to 3.4%) in winter; 2.5% (1.6% to 3.4%) in summer), genitourinary (2.5% (2.1% to 2.9%) in winter; 2.4% (1.8% to 3.0%) in summer) and digestive diseases (2.5% (1.6% to 3.3%) in winter; 2.6% (1.7% to 3.5%) in summer) increased, while circulatory diseases decreased in winter. In nursing home residents, the top five causes in 2018 were respiratory diseases, symptoms, signs and abnormalities NEC, genitourinary, circulatory and digestive diseases in winter and summer. Symptoms, signs and abnormalities NEC increased (2.9% (0.9% to 5.0%) in winter; 2.9% (0.8% to 5.1%) in summer), while circulatory diseases declined across seasons. Genitourinary diseases remained stable across seasons, whereas digestive diseases declined in winter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Hong Kong\u2019s ageing population, seasonal and temporal shifts in hospitalisation causes were observed. Symptoms, signs and abnormalities NEC emerged as the top two causes across settings, highlighting challenges for primary care and hospital management and need for enhanced prevention and care strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110884","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:40:46Z","timestamp":1776271246000},"page":"e110884","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Seasonal and temporal trends in leading causes of hospitalisation among older adults in Hong Kong: a retrospective study across community and institutional care settings"],"prefix":"10.1136","volume":"16","author":[{"given":"Xing Xing","family":"Qian","sequence":"first","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0287-8020","authenticated-orcid":false,"given":"Pui Hing","family":"Chau","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric T C","family":"Lai","sequence":"additional","affiliation":[{"name":"Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China"},{"name":"Medical Data Analytics Center (MDAC), Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace Lai-Hung","family":"Wong","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Center (MDAC), Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7593-3081","authenticated-orcid":false,"given":"Jean","family":"Woo","sequence":"additional","affiliation":[{"name":"Medical Data Analytics Center (MDAC), Department of Medicine and Therapeutics, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong Special Administrative Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"2026041509402517000_16.4.e110884.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61347-7"},{"key":"2026041509402517000_16.4.e110884.2","unstructured":"McDermott KW , Roemer M . Most frequent principal diagnoses for inpatient stays in US hospitals. 2018. Available: https:\/\/europepmc.org\/article\/nbk\/nbk573113 [Accessed 15 Apr 2025]."},{"key":"2026041509402517000_16.4.e110884.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-18006-x","article-title":"Chronic diseases spectrum and multimorbidity in elderly inpatients based on a 12-year epidemiological survey in China","volume":"24","author":"Gao","year":"2024","journal-title":"BMC Public Health"},{"key":"2026041509402517000_16.4.e110884.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-024-04771-2","article-title":"Reasons for hospitalisation and cumulative mortality in people, 75 years or older, at high risk of hospital admission: a prospective study","volume":"24","author":"Lundgren","year":"2024","journal-title":"BMC Geriatr"},{"key":"2026041509402517000_16.4.e110884.5","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3733"},{"key":"2026041509402517000_16.4.e110884.6","unstructured":"World Health Organization . Global health estimates 2021: deaths by cause, age, sex, by country and by region, 2000\u20132021. 2024. Available: https:\/\/www.who.int\/data\/gho\/data\/themes\/mortality-and-global-health-estimates\/ghe-leading-causes-of-death"},{"key":"2026041509402517000_16.4.e110884.7","doi-asserted-by":"crossref","DOI":"10.1093\/ehjopen\/oeab001","article-title":"Causes of hospitalization in the USA between 2005 and 2018","volume":"1","author":"Salah","year":"2021","journal-title":"Eur Heart J Open"},{"key":"2026041509402517000_16.4.e110884.8","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16152769","article-title":"Acute Myocardial Infarction Hospitalizations between Cold and Hot Seasons in an Island across Tropical and Subtropical Climate Zones-A Population-Based Study","volume":"16","author":"Chu","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2026041509402517000_16.4.e110884.9","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kww091"},{"key":"2026041509402517000_16.4.e110884.10","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1513\/AnnalsATS.202405-470OC","article-title":"Impact of Heat on Respiratory Hospitalizations among Older Adults in 120 Large U.S. Urban Areas","volume":"22","author":"O\u2019Lenick","year":"2025","journal-title":"Ann Am Thorac Soc"},{"key":"2026041509402517000_16.4.e110884.11","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/j.jamda.2015.06.025","article-title":"Prevalence of Frailty in Nursing Homes: A Systematic Review and Meta-Analysis","volume":"16","author":"Kojima","year":"2015","journal-title":"J Am Med Dir Assoc"},{"key":"2026041509402517000_16.4.e110884.12","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1038\/s41558-024-02156-2","article-title":"A framework for ageing and health vulnerabilities in a changing climate","volume":"14","author":"Tipaldo","year":"2024","journal-title":"Nat Clim Chang"},{"key":"2026041509402517000_16.4.e110884.13","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-11-1"},{"key":"2026041509402517000_16.4.e110884.14","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.jamda.2012.08.007","article-title":"Challenge to long term care for the elderly: cold weather impacts institutional population more than community-dwelling population","volume":"13","author":"Chau","year":"2012","journal-title":"J Am Med Dir Assoc"},{"key":"2026041509402517000_16.4.e110884.15","unstructured":"Health Bureau, Hong Kong SAR Government . Report of the strategic review on healthcare manpower planning and professional development. 2017. Available: https:\/\/www.healthbureau.gov.hk\/en\/press_and_publications\/otherinfo\/180500_sr\/srreport.html [Accessed 15 Apr 2025]."},{"key":"2026041509402517000_16.4.e110884.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-045868","article-title":"Linking cohort-based data with electronic health records: a proof-of-concept methodological study in Hong Kong","volume":"11","author":"Gao","year":"2021","journal-title":"BMJ Open"},{"key":"2026041509402517000_16.4.e110884.17","doi-asserted-by":"crossref","first-page":"315","DOI":"10.2147\/JAA.S405297","article-title":"Validation of Diagnostic Coding for Asthma in an Electronic Health Record System in Hong Kong","volume":"16","author":"Kwok","year":"2023","journal-title":"J Asthma Allergy"},{"key":"2026041509402517000_16.4.e110884.18","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1007\/s00484-022-02332-z","article-title":"Visits to the accident and emergency department in hot season of a city with subtropical climate: association with heat stress and related meteorological variables","volume":"66","author":"Chau","year":"2022","journal-title":"Int J Biometeorol"},{"key":"2026041509402517000_16.4.e110884.19","doi-asserted-by":"crossref","DOI":"10.1093\/gerona\/glaf002","article-title":"Extreme Hot Weather Events and Risk of Hospitalization for Cardiovascular and Respiratory Diseases in Older People in Hong Kong in 2012-2018","volume":"80","author":"Lai","year":"2025","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2026041509402517000_16.4.e110884.20","unstructured":"World Health Organization . International statistical classification of diseases and related health problems 10th revision. 2019. Available: https:\/\/icd.who.int\/browse10\/2019\/en [Accessed 15 Apr 2025]."},{"key":"2026041509402517000_16.4.e110884.21","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2024.765","article-title":"Physical health challenges faced by elders with severe mental illness: population-based retrospective cohort study","volume":"10","author":"Chang","year":"2024","journal-title":"BJPsych Open"},{"key":"2026041509402517000_16.4.e110884.22","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jcgg.2014.07.001","article-title":"Analysis of emergency department visits by elderly patients in an urban public hospital in Turkey","volume":"5","author":"Keskino\u011flu","year":"2014","journal-title":"Journal of Clinical Gerontology and Geriatrics"},{"key":"2026041509402517000_16.4.e110884.23","doi-asserted-by":"crossref","DOI":"10.1155\/2024\/8506561","article-title":"ICD-10 Classification in the Practice of Emergency Medical Teams: New Insights","volume":"2024","author":"Mitura","year":"2024","journal-title":"Emerg Med Int"},{"key":"2026041509402517000_16.4.e110884.24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2301292"},{"key":"2026041509402517000_16.4.e110884.25","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1038\/s43587-021-00099-3","article-title":"The degree of frailty as a translational measure of health in aging","volume":"1","author":"Howlett","year":"2021","journal-title":"Nat Aging"},{"key":"2026041509402517000_16.4.e110884.26","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-11-1"},{"key":"2026041509402517000_16.4.e110884.27","first-page":"1056","article-title":"Policy implications of population aging in Hong Kong in the UN Decade of Healthy Aging","volume":"4","author":"Woo","year":"2023","journal-title":"Am J Med Public Health"},{"key":"2026041509402517000_16.4.e110884.28","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/j.jamda.2023.07.014","article-title":"Post-Hospital Falls Among the Older Population: The Temporal Pattern in Risk and Healthcare Burden","volume":"24","author":"Qian","year":"2023","journal-title":"J Am Med Dir Assoc"},{"key":"2026041509402517000_16.4.e110884.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-078523","article-title":"Trends in cardiovascular disease incidence among 22 million people in the UK over 20 years: population based study","volume":"385","author":"Conrad","year":"2024","journal-title":"BMJ"},{"key":"2026041509402517000_16.4.e110884.30","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.121.008943","article-title":"Trends in Characteristics and Outcomes in Primary Heart Failure Hospitalizations Among Older Population in the United States, 2004 to 2018","volume":"15","author":"Minhas","year":"2022","journal-title":"Circ Heart Fail"},{"key":"2026041509402517000_16.4.e110884.31","doi-asserted-by":"crossref","first-page":"e919","DOI":"10.1016\/S2468-2667(21)00208-5","article-title":"Understanding longevity in Hong Kong: a comparative study with long-living, high-income countries","volume":"6","author":"Ni","year":"2021","journal-title":"Lancet Public Health"},{"key":"2026041509402517000_16.4.e110884.32","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2015-052496"},{"key":"2026041509402517000_16.4.e110884.33","unstructured":"Legislative Council, Hong Kong SAR Government . Tackling social isolation among the elderly. 2022. Available: https:\/\/www.legco.gov.hk\/research-publications\/english\/essentials-2022ise06-tackling-social-isolation-among-the-elderly.htm [Accessed 15 Apr 2025]."},{"key":"2026041509402517000_16.4.e110884.34","first-page":"906","article-title":"Association of Physical Activity With Urinary Incontinence in Older Women: A Systematic Review","volume":"27","author":"Faleiro","year":"2019","journal-title":"J Aging Phys Act"},{"key":"2026041509402517000_16.4.e110884.35","doi-asserted-by":"crossref","first-page":"2281","DOI":"10.1007\/s11606-020-05814-1","article-title":"A Prospective Study of Physical Activity, Sedentary Behavior, and Incidence and Progression of Lower Urinary Tract Symptoms","volume":"35","author":"Mondul","year":"2020","journal-title":"J Gen Intern Med"},{"key":"2026041509402517000_16.4.e110884.36","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph192315856","article-title":"\u201cWhat If I Die and No One Notices?\u201d A Qualitative Study Exploring How Living Alone and in Poverty Impacts the Health and Well-Being of Older People in Hong Kong","volume":"19","author":"Kwan","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2026041509402517000_16.4.e110884.37","doi-asserted-by":"crossref","DOI":"10.3390\/nu13124337","article-title":"Nutrition and Healthy Aging: Prevention and Treatment of Gastrointestinal Diseases","volume":"13","author":"Cristina","year":"2021","journal-title":"Nutrients"},{"key":"2026041509402517000_16.4.e110884.38","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-019-1148-5","article-title":"Malnutrition risks and their associated factors among home-living older Chinese adults in Hong Kong: hidden problems in an affluent Chinese community","volume":"19","author":"Wong","year":"2019","journal-title":"BMC Geriatr"},{"key":"2026041509402517000_16.4.e110884.39","doi-asserted-by":"publisher","DOI":"10.2174\/1381612824666180510092303"},{"key":"2026041509402517000_16.4.e110884.40","first-page":"10","article-title":"Inadequate health literacy and more hospitalization among frail older adults in Hong Kong","volume":"11","author":"Leung","year":"2016","journal-title":"Asian J Gerontol Geriatr"},{"key":"2026041509402517000_16.4.e110884.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2005.04.004"},{"key":"2026041509402517000_16.4.e110884.42","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.jamda.2023.06.024","article-title":"Rates of Hospital-Based Care among Older Adults in the Community and Residential Care Facilities: A Repeated Cross-Sectional Study","volume":"24","author":"Manis","year":"2023","journal-title":"J Am Med Dir Assoc"},{"key":"2026041509402517000_16.4.e110884.43","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.211883"},{"key":"2026041509402517000_16.4.e110884.44","unstructured":"Hong Kong SAR Government . Climate change. 2024. Available: https:\/\/www.gov.hk\/en\/residents\/environment\/global\/climate.htm [Accessed 15 Apr 2025]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110884","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:40:51Z","timestamp":1776271251000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":44,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,15]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjopen-2025-110884"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110884","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}