Hospitalization burden among chronic disease patients was high in South Ethiopia
Hospitalization remained common among patients with chronic diseases attending a tertiary follow-up clinic in Wolaita Zone, South Ethiopia, and the pattern points toward gaps in day-to-day disease control rather than isolated acute events. In this facility-based cross-sectional study, 321 patients were enrolled from the chronic follow-up clinic at Wolaita Sodo University Comprehensive Specialized Hospital between November and December 2022. Two-thirds of participants, 66%, reported at least one hospitalization while on treatment, and the mean number of hospitalizations per patient was 1.70 ± 1.81. For a chronic disease program, those figures suggest repeated destabilization of long-term illness, repeated use of scarce inpatient resources, and an ongoing strain on outpatient follow-up systems.
The burden was not evenly distributed across causes. Drug discontinuation was the most frequently documented reason for hospitalization, accounting for 39.5% of admissions, followed by disease complications at 22.3% and infections at 11.7%. In a setting where chronic care depends heavily on continuous treatment, medication interruption is not a minor detail; it is often the first step in a cascade that ends in decompensation, emergency care, or admission. When therapy stops, blood pressure can rebound, glycemic control can deteriorate, inflammatory disease can flare, and latent complications can surface before they are clinically obvious in the clinic.
Medication interruption dominated the admission story
The central signal from the hospitalization profile is blunt. Patients were not predominantly entering hospital because of rare catastrophic events; many were arriving after treatment had already broken down. That pattern is clinically important because it points to potentially preventable admissions, especially when the most common trigger is nonadherence or discontinuation rather than unpredictable disease biology. In chronic disease care, continuity of medication acts as a protective buffer against escalation, and once that buffer is removed, even stable patients can quickly shift into higher-acuity care.
Multimorbidity was also common. Most participants, 59.8%, lived with 2–3 chronic conditions, and the mean number of chronic diseases per patient was 2.40 ± 1.02. Multiple diagnoses increase regimen complexity, raise the chance of drug burden, and make adherence harder to sustain across months and years. Patients managing several conditions often face overlapping prescriptions, competing follow-up demands, and more opportunities for confusion, especially when symptoms are intermittent and the immediate benefit of preventive treatment is not visible.
Male sex and exercise separated lower- from higher-risk patients
Two factors stood out in the regression analysis. Male sex was associated with a higher hospitalization rate, while regular physical exercise was associated with fewer hospitalizations. The study used negative binomial regression and reported incidence rate ratios with 95% confidence intervals, which is an appropriate approach when count outcomes such as hospitalization frequency are overdispersed. The direction of the associations is clinically plausible. Men may face different patterns of health-seeking behavior, treatment continuity, occupational exposure, or late presentation, all of which can push chronic disease into more advanced stages before intervention occurs.
Regular physical exercise, by contrast, fits the expected biology of chronic disease prevention. Consistent activity improves cardiometabolic control, supports functional capacity, and may reduce the physiologic stress that accelerates complications. Exercise also tends to reinforce self-management behavior more broadly: patients who maintain routine physical activity often stay more engaged with diet, medication schedules, and clinic follow-up. In chronic disease management, movement is not an accessory. It is part of the maintenance architecture that can reduce the need for inpatient rescue.
A single behavior change can alter the trajectory of repeat admissions.
What the admission pattern means for chronic care delivery
The data point toward a practical clinical priority: adherence support needs to sit at the center of chronic disease programs, not at the margins. When nearly four in ten hospitalizations are linked to drug discontinuation, every missed refill, side effect concern, financial barrier, or counseling gap becomes a potential admission pathway. Structured adherence support could include repeated medication education, simplified dosing where possible, routine review of barriers to access, and closer follow-up for patients with multiple chronic conditions.
The findings also support exercise counseling as a routine component of chronic disease follow-up, rather than an optional lifestyle suggestion. Regular physical activity deserves the same seriousness as pharmacologic treatment because both influence downstream hospitalization risk. For clinics serving patients with multimorbidity, exercise advice should be tailored to functional status and disease burden, then reinforced consistently at each visit. Gender-sensitive interventions may also be warranted if men are more likely to reach hospital after avoidable deterioration.
Because the study was cross-sectional and drawn from a single tertiary hospital, it cannot establish causality or fully capture community-level patterns of hospitalization. It also relies on self-report and medical record review, which leaves room for recall limitations and incomplete documentation of admission reasons. Even so, the clinical message is direct: hospitalization among chronic disease patients in this setting was frequent, medication discontinuation was the leading documented reason, and better adherence support plus structured exercise promotion may help reduce repeat admissions. The next step is to test whether those interventions can lower hospitalization rates in routine care, especially among patients carrying more than one chronic diagnosis.