HEALTHCARE COST & UTILIZATION PROJECT

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HCUP Facts and Figures

TABLE OF CONTENTS

HIGHLIGHTS

INTRODUCTION

HCUP PARTNERS

1. OVERVIEW

2. DIAGNOSES

3. PROCEDURES

4. COSTS

5. MHSA

SOURCES/METHODS

DEFINITIONS

FOR MORE INFO

ACKNOWLEDGMENTS

CITATION

FACTS & FIGURES 2008 PDF
EXHIBIT 5.6 Most Frequent Principal MHSA Diagnoses by Age (PDF)

Number of Discharges, Percent Distribution, and Growth of the Most Frequent Principal MHSA Diagnoses for Inpatient Hospital Stays by Age, 1997 and 2008
AGE GROUP AND PRINCIPAL CCS DIAGNOSIS NUMBER OF MHSA DISCHARGES IN THOUSANDS PERCENT OF AGE-SPECIFIC TOTAL MHSA DISCHARGES CUMULATIVE GROWTH
  1997 2008 1997 2008 1997 - 2008
All ages, total MHSA discharges* 1,602 1,837‡     15%
1-17 years, total discharges 134 135‡ 100.0% 100.0% 1
Mood disorders 64 83‡ 48.0 61.3 29
Depression 54 38‡ 40.3 28.3 -29
Bipolar disorders 10 45 7.7 33.0 333
Attention-deficit/conduct/disruptive behavior disorders 23 16‡ 17.4 12.0 -30
Schizophrenia/other psychotic disorders 7 6‡ 4.9 4.1 -14
Anxiety disorders 5 5‡ 3.7 4.0 9
18-44 years, total discharges 927 920‡ 100.0 100.0 -1
Mood disorders 335 415 36.1 45.1 24
Depression 236 212‡ 25.5 23.1 -10
Bipolar disorders 98 202 10.6 22.0 106
Schizophrenia/other psychotic disorders 197 173‡ 21.2 18.8 -12
Drug-related disorders 156 139‡ 16.8 15.1 -11
Alcohol-related disorders 141 109 15.2 11.9 -22
45-64 years, total discharges 353 612 100.0 100.0 73
Mood disorders 136 251 38.7 41.1 84
Depression 93 145 26.3 23.7 56
Bipolar disorders 44 107 12.4 17.4 145
Schizophrenia/other psychotic disorders 84 136 23.9 22.3 62
Alcohol-related disorders 78 131 22.1 21.4 68
Drug-related disorders 30 65 8.5 10.7 117
65-84 years, total discharges 165 144 100.0 100.0 -13
Mood disorders 92 65 55.5 45.3 -28
Depression 72 44 43.8 30.6 -39
Bipolar disorders 19 21‡ 11.7 14.7 10
Schizophrenia/other psychotic disorders 33 34‡ 19.8 23.5 4
Alcohol-related disorders 18 18‡ 11.0 12.3 -2
Drug-related disorders 8 16 4.9 11.1 96
85+ years, total discharges 23 22‡ 100.0 100.0 -5
Mood disorders 14 9 59.8 41.6 -34
Depression 13 8 54.0 35.3 -38
Bipolar disorders 1 1‡ 5.8 6.4 5
Schizophrenia/other psychotic disorders 5 6 20.2 28.1 33
Drug-related disorders 2 3 7.4 14.6 87
Anxiety disorders 1 1‡ 4.0 4.8 14
* Includes a small number of discharges (2,500 or 0.1 percent) with missing age.
‡ 2008 discharges are not statistically different from 1997 discharges at p‹0.05.
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997 and 2008.
  • Mood disorders was the most frequent principal MHSA diagnosis across all age groups in 1997 and 2008.
    • Mood disorders accounted for the majority (61 percent) of all MHSA hospitalizations among children 1-17 years in 2008 and about four in ten MHSA discharges in other age groups.
    • The number of stays with a principal diagnosis of mood disorders increased among 18-44 year olds (24 percent) and 45-64 year olds (84 percent) from 1997 to 2008.
    • The number of hospitalizations specifically for depression changed little for children 1-17 and adults 18-44, rose for adults 45-64 (by 56 percent), and decreased for older adults (by -39 percent for 65-84 year olds and -38 percent for those 85 years and older).
    • In contrast, stays for bipolar disorders more than doubled over the same period for patient age groups of 64 years and younger. Growth in stays was especially high for children 1-17 years (increasing by 333 percent between 1997 and 2008). While the cause of this increase is unclear and should be interpreted cautiously, it may reflect an increased recognition of bipolar disorder, especially in children—a group that has been historically under-diagnosed.3,4 It may also reflect the difficulty of assigning a diagnosis for a condition, especially in children, that may share presenting symptoms with schizophrenia/other psychotic disorders and attention deficit/conduct/disruptive behavior disorders.
  • Schizophrenia/other psychotic disorders was the second most frequent MHSA condition for all adult age groups (18 years and older), and it was the third most frequent MHSA condition for children 1-17 years in 2008.
    • While the number of stays for schizophrenia for most age groups changed little from 1997 to 2008, it increased 62 percent for 45-64 year olds and 33 percent for patients 85 years and older.
  • Alcohol-related disorders accounted for 12 percent of MHSA hospital stays among 18-44 year olds, 21 percent of MHSA stays among 45-64 year olds, and 12 percent of MHSA stays for 65-84 year olds.
  • Drug-related disorders appeared prominently among the top four principal MHSA conditions for all age groups except children (1-17 years):
    • The number of hospital stays for drug-related conditions rose rapidly among 45-64 year olds (117 percent), 65-84 year olds (96 percent), and adults 85 and older (87 percent) while remaining relatively stable (11-percent decline) among adults 18-44.

 

Number, Growth, and Percent Contribution to Growth of Drug-related Discharges for Selected Age Groups, 1997-2008
PRINCIPAL ICD-9-CM DIAGNOSIS NUMBER OF DRUG-RELATED DISCHARGES IN 2008 CUMULATIVE GROWTH IN DRUG-RELATED DISCHARGES
1997-2008
PERCENT DISTRIBUTION TO GROWTH IN DRUG-RELATED DISCHARGES
1997-2008
45-64 YEARS 65-84 YEARS 85+ YEARS 45-64 YEARS 65-84 YEARS 85+ YEARS 45-64 YEARS 65-84 YEARS 85+ YEARS
All drug-related discharges 65,400 16,000 3,200 117% 96% 87% 100.0% 100.0% 100.0%
Drug withdrawal (ICD-9-CM 292.0) 20,300 2,000 100 270 107 71 41.9 13.5 3.9
Drug-induced delirium (ICD-9-CM 292.81) 4,200 6,400 2,100 143 56 98 7.0 29.0 69.8
Poisonings by codeine [methylmorphine], meperidine [pethidine], morphine (ICD-9-CM 965.09) 8,300 3,300 400 693 381 245 20.6 32.9 19.1
All other drug-related conditions* 32,600 4,300 600 49 80 24 21.5 14.0 0.4
* ICD-9-CM codes 292.1, 292.2, 292.82-292.89, 292.9, 304, 305.2-305.9, 648.3, 655.5, 760.72, 760.73, 760.75, 779.5, 965.00-965.02, and V65.42.
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997 and 2008.
  • Rapid growth in drug-induced delirium and in poisonings by opiate-based pain medications was primarily responsible for the increase in drug-related hospitalizations for patients 85 years and older. Together in 2008, these conditions accounted for 78 percent of the drug-related stays and 89 percent of the increase in drug-related stays for these oldest patients. Drug-induced delirium can result from side-effects of medications and occurs often in elderly hospitalized patients.5,6,7
  • Drug-induced delirium and poisonings by opiate-based pain medications were also responsible for a large number of drug-related discharges in 45-64 year olds (19 percent) and 65-84 year olds (60 percent).

 

(text version)

  • Adults 18-44 years accounted for the majority of stays for bipolar disorders, drug-related disorders, and adjustment disorders.
  • For alcohol-related disorders, 18-44 year olds accounted for 42 percent of stays and 45-64 year olds accounted for 50 percent of stays.
  • For schizophrenia/other psychotic disorders, 18-44 year olds accounted for 49 percent of stays and 45-64 year olds accounted for 38 percent of stays.
  • Children 1-17 years accounted for a substantial proportion (9 to 13 percent) of stays for depression, bipolar disorders, anxiety disorders, and adjustment disorders.
  • Patients 65 and older accounted for 17 percent of anxiety disorders and 12 percent of both depression and schizophrenia/other psychotic disorders.

 

3 Rates of Bipolar Diagnosis in Youth Rapidly Climbing, Treatment Patterns Similar to Adults. National Institutes for Mental Health, Press Release. September 3, 2007. Available at https://www.nih.gov/news-events/news-releases/rates-bipolar-diagnosis-youth-rapidly-climbing-treatment-patterns-similar-adults.
4 Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry. 2007 Sep;64(9): 1032-1039.
5 Alagiakrishnan K, Wiens C. An approach to drug induced delirium in the elderly. Postgrad Med J. 2004 July; 80(945): 388–393.
6 Alagiakrishnan K. Delirium. Available at http://emedicine.medscape.com/article/288890-overview, Exit Disclaimerupdated Apr 2, 2010.
7 Fong TG, Tulebaev SR, and Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009 Apr;5: 210-220.

Internet Citation: Facts and Figures 2008. Healthcare Cost and Utilization Project (HCUP). May 2016. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/factsandfigures/2008/exhibit5_6.jsp.
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Last modified 5/18/16