Burden and temporal trends of cardiovascular disease among medical inpatients and age-specific and sex-specific risk of CVD-related hospitalisation at a national referral hospital in Uganda: a retrospective cohort study

Objectives Cardiovascular disease (CVD) is a growing cause of morbidity and mortality in sub-Saharan Africa, yet data on hospitalisation trends and in-hospital mortality (IHM) remain limited. This study assessed the trends in CVD risk of hospitalisation among medical inpatients and age-specific and sex-specific patterns and examined the association between CVD and IHM. Design We conducted a retrospective cohort study using 10-years of inpatient data (2014–2024) from Mulago National Specialized Referral Hospital, Kampala. Methods Adult medical admissions (aged ≥18 years) with CVD, defined by International Classification of Diseases, Tenth Revision, codes, were included. The primary outcomes were CVD diagnosis and IHM. Univariable and multivariable modified Poisson regression with robust error variance estimated risk ratios (RR) for CVD and IHM, including age-specific and sex-specific CVD prevalence. Temporal trends were assessed by modelling admission year as a continuous variable. Results Overall, 86 304 medical inpatients were included (mean age, 45.83±20.05 years; 52.2% female; mean hospital stay, 6.10±6.35 days). CVD accounted for 17.8% of admissions, increasing steadily with admission year. CVD was independently associated with IHM (RR 1.89; 95% CI 1.80 to 1.98; p<0.001), while females had a higher risk of CVD hospitalisation than males (RR 1.23; 95% CI 1.18 to 1.28; p<0.001). Compared with age <30 years, CVD admission risk was higher at 30–50 years (RR 5.81; 95% CI 5.25 to 6.40; p<0.001) and ≥50 years (RR 7.69; 95% CI 7.15 to 8.22; p<0.001), with significant age-sex interaction. Compared with females aged <30 years, females aged 30–50 years had no increased risk (RR 1.05; 95% CI 0.95 to 1.15; p=0.137), whereas those ≥50 years had higher risk (RR 1.33; 95% CI 1.24 to 1.42; p<0.001). Males aged <30 years (RR 0.71; 95% CI 0.63 to 0.77; p<0.001) and 30–50 years(RR 0.67; 95% CI 0.61 to 0.73; p<0.001) had lower risk, while those ≥50 years did not differ significantly (RR 1.00; 95% CI 0.90 to 1.14; p=0.375). Conclusion In this decade-long inpatient investigation, CVD accounted for a substantial proportion of medical inpatients and was associated with a higher risk of IHM. The prevalence of CVD diagnosis increased steadily over time, with higher risk among older patients and females. These findings support targeted CVD prevention.