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Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-.

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Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet].

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Hospitalizations for Women with Circulatory Disease, 2003

Statistical Brief #5

, PhD and , PhD.

Published: .

Introduction

Circulatory diseases—conditions including heart disease and stroke—are the most common reason for admission to the hospital for both men and women, excluding pregnancy and childbirth. These conditions are also the most costly reasons for hospitalization. Although heart disease and stroke are leading causes of death and disability among both women and men, there is continued misunderstanding of the impact of this condition on women.* Campaigns, such as Heart Truth by the National Heart, Lung, and Blood Institute, have been conducted recently to raise awareness of heart disease among women.

This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on hospital stays for women with circulatory disease in 2003. All differences between estimates noted in the text are statistically significant at the 0.05 level or better.

Findings

Highlights

  • Diseases of the circulatory system are the most common reason for hospitalization, accounting for approximately 6.5 million hospital stays with a total hospital bill of $187 billion in 2003. About 48.3 percent of these stays were for women.
  • Six conditions comprised 80 percent of all circulatory disease: myocardial infarction (heart attack), coronary atherosclerosis (hardening of the arteries of the heart), non-specific chest pain, cardiac dysrhythmias (irregular heartbeat), congestive heart failure, and acute cerebrovascular disease (stroke). Women accounted for more than half of all hospital stays for congestive heart failure, non-specific chest pain, and stroke.
  • For myocardial infarction and coronary atherosclerosis, 24–31 percent of hospital stays for 18–44 year olds were for women. This figure increased to more than 60 percent of stays for women 85 years and older.
  • In the case of stroke, men and women accounted for about the same number of hospital stays in the youngest age group, 18–44. Among the oldest age group, however, sex differences emerged: women comprised 69.7 percent of hospitalized stroke patients.
  • For nonspecific chest pain, women were the majority of inpatients in all three older age groups: 45–64, 65–84, and 85+.
  • For most circulatory conditions there were no significant differences in in-hospital mortality between men and women, except for myocardial infarction: 9.3 percent of women died in the hospital compared with 6.2 percent of men.

In 2003, there were about 6.5 million hospital stays in the United States to treat diseases of the circulatory system, with a total hospital bill of $187 billion. About 48.3 percent of hospital stays for circulatory disease were for women, who accounted for 42.8 percent of the national bill for these conditions.

Specific circulatory diseases among women

Six specific conditions were responsible for more than 80 percent of circulatory diseases in U.S. hospitals. As shown in table 1, over the seven-year time period from 1997 to 2003, there were no significant shifts in the percentage of women treated in U.S. hospitals for these conditions. Although only 40 percent of hospital stays for myocardial infarction and coronary atherosclerosis were for women, more than half of stays for nonspecific chest pain, congestive heart failure, and stroke were for women. There was no difference between men and women in hospitalizations for cardiac dysrhythmias.

Table 1. The most common specific reasons for hospitalization for conditions related to the circulatory system, 1997 and 2003.

Table 1

The most common specific reasons for hospitalization for conditions related to the circulatory system, 1997 and 2003.

Age-related differences in hospitalization for specific circulatory disorders

Most hospitalized patients over 65 are women. While the distribution of men and women in the hospital was roughly equal among 45 to 64 year olds (48.9 percent men and 50.9 percent women), this situation changed for older age groups. Specifically, for 65 to 84 year olds, 55 percent of all stays were for women and by age 85 and older, 68.0 percent of all stays were for women.

Table 2 shows that women accounted for less than half of hospital stays for most circulatory conditions in younger age groups, while older women, particularly those 85 years or older, accounted for the majority of hospital stays for each condition. Figure 1 illustrates these findings graphically. The pattern of fewer stays for women in younger age groups and more stays for women among older age groups is most pronounced in two conditions. For myocardial infarction, 28.4 percent of hospital stays for 45 to 64 year olds were for women, but 63.7 percent of stays for those 85 and older were for women. Similarly, for coronary atherosclerosis, 32.7 percent of stays were for women among 45 to 64 year olds; this figure increased to 60.7 percent of stays among those 85 and older.

Table 2. Hospital stays for the most common cardiovascular conditions, by age and sex, number of discharges (percent), 2003.

Table 2

Hospital stays for the most common cardiovascular conditions, by age and sex, number of discharges (percent), 2003.

Figure 1. Hospital stays for the most frequent cardiovascular conditions, by age and sex, 2003.

Figure 1

Hospital stays for the most frequent cardiovascular conditions, by age and sex, 2003. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2003

On the other hand, men and women accounted for roughly the same number of hospital stays for stroke in the 18 to 44 age group. But beyond age 65, women were the majority. For 65 to 84 year olds, 54.5 percent of stroke inpatients were women while among the oldest age group, women constituted 69.7 percent of all stroke patients.

Only for nonspecific chest pain were women more numerous than men among patients younger than 65. About 54.4 percent of hospital stays for nonspecific chest pain were for women age 45 to 64. Women constituted 73.9 percent of nonspecific chest pain stays among patients 85 and older—higher than for any other condition examined.

In-hospital mortality among men and women for specific circulatory disorders

As shown in figure 2, mortality rates for myocardial infarction and stroke were substantially higher than for other circulatory disorders. For most conditions, there were no significant differences between men and women in in-hospital mortality. However, for acute myocardial infarction, one-third more women than men died in the hospital—9.3 percent of women died in the hospital compared with 6.2 percent of men.

Figure 2. In-hospital mortality for the most frequent cardiovascular conditions, by sex, 2003.

Figure 2

In-hospital mortality for the most frequent cardiovascular conditions, by sex, 2003. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2003

Data Source

The estimates in this Statistical Brief are based upon data from the HCUP 2003 Nationwide Inpatient Sample (NIS).

Definitions

Types of hospitals included in HCUP

HCUP is based on data from community hospitals, defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. They exclude long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals, but these types of discharges are included if they are from community hospitals.

Unit of analysis

The unit of analysis is the hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate “discharge” from the hospital.

Region

Northeast: Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania

Midwest: Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas

South: Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas

West: Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, Alaska, and Hawaii

Diagnoses, ICD-9-CM, and Clinical Classifications Software (CCS)

The principal diagnosis is that condition established after study to be chiefly responsible for the patient’s admission to the hospital. ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. There are about 12,000 ICD-9-CM diagnosis codes. CCS categorizes ICD-9-CM diagnoses into 260 clinically meaningful categories. This “clinical grouper” makes it easier to quickly understand patterns of diagnoses and procedures.

References

For a detailed description of HCUP and more information on the design of the NIS and methods to calculate estimates, please refer to the following publications:

Steiner, C., Elixhauser, A., Schnaier, J. The Healthcare Cost and Utilization Project: An Overview. Effective Clinical Practice 5(3):143–51, 2002

Design of the HCUP Nationwide Inpatient Sample, 2003. Online. June 14, 2005. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/db/nation/nis/reports/NIS_2003_Design_Report.jsp

Houchens, R., Elixhauser, A. Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2001. HCUP Methods Series Report #2003-2. Online. June 2005 (revised June 6, 2005). U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/CalculatingNISVariances200106092005.pdf

Footnotes

*

American Heart Association. Women, Heart Disease and Stroke. Retrieved May 5, 2006, from the World Wide Web at http://www​.americanheart​.org/presenter.jhtml?identifier=4786.

National Heart, Lung, and Blood Institute. The Heart Truth, A National Awareness Campaign For Women About Heart Disease. Retrieved May 5, 2006, from the World Wide Web at http://www​.nhlbi.nih​.gov/health/hearttruth/.

About the NIS: The HCUP Nationwide Inpatient Sample (NIS) is a nationwide database of hospital inpatient stays. The NIS is nationally representative of all community hospitals (i.e., short-term, non-Federal, non-rehabilitation hospitals). The NIS is a sample of hospitals and it includes all patients from each hospital, regardless of payer. It is drawn from a sampling frame that contains hospitals comprising 90 percent of all discharges in the United States. The vast size of the NIS allows the study of topics at both the national and regional levels for specific subgroups of patients. In addition, NIS data are standardized across years to facilitate ease of use.

Suggested Citation: Elixhauser, A. and Jiang, H. J. Hospitalizations for Women with Circulatory Disease, 2003. HCUP Statistical Brief #5. May 2006. Agency for Healthcare Research and Quality, Rockville, Md. http://www​.hcup-us.ahrq​.gov/reports/statbriefs/sb5.pdf

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